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For generations of Americans, Louisa May Alcott has been revered as the author of Little Women (1868), the semi-autobiographical novel about four sisters living in Concord, Massachusetts, while their father served in the Civil War. In Little Women and its equally popular sequels, Alcott was clearly the model for her heroine, Jo March, the rebellious tomboy who grows up to be a writer. It’s no surprise, therefore, that she is chiefly remembered today as the author of children’s books. The real Louisa May Alcott was a much more complex and interesting figure. To earn a living she penned—under a pseudonym—lurid and even racy stories with titles like “Pauline’s Peril and Punishment” for popular magazines. In addition, she wrote serious novels for adults. But she was also a lifelong advocate for social reform, championing abolitionism as well as women’s rights. Perhaps the least well-known aspect of her surprising career is that she volunteered to serve as a nurse in the Civil War. She nearly died from a disease she contracted during that period, and she later wrote one of the first memoirs to draw the public’s attention to conditions in the military hospitals and chronicle the suffering endured by wounded soldiers.

When the war broke out, the Alcotts, like many other New England families, regarded the sectional conflict as a glorious crusade to end slavery. Unlike the fictional Mr. March of Little Women, Louisa’s father Bronson Alcott, a philosopher, educational reformer and Trans­cendentalist who had long battled financial woes, was over 60 and too old to serve. But his second daughter—who was by then approaching 30 and already accustomed to thinking of herself as a spinster, destined to become the breadwinner of their family—burned with desire to help the Union cause. Given what we know about Louisa’s tomboy leanings, it seems only natural that she refused to be satisfied with knitting socks and sewing bandages, choosing instead to volunteer for the Union’s fledgling corps of female nurses.

At the war’s outbreak there were no female nurses, and the medical departments of both the Union and Confederate armies were woefully unprepared for the torrent of casualties from wounds and disease that soon overwhelmed them. The only nursing care was provided by convalescent soldiers. Women began traveling to the battlefields and hospitals to try to aid their loved ones. Many of the conflict’s most famous nurses began this way, including “Mother” Mary Ann Bicker­­dyke, who was so revered by Union troops that she was invited by William T. Sherman to ride in the Grand Review in Washington at the war’s end. Inspired by the example of England’s Florence Nightingale during the Crimean War, women also pressed to serve formally. Despite resistance from the military medical establishment, by August 1861 women could be officially mustered as nurses, “to receive forty cents a day and one ration.”

Still, it was not until the summer of 1862 that women began to serve in numbers, and Surgeon General William Hammond issued Circular No. 7, setting forth the conditions under which women would be accepted. That order became the template for Dorothea Dix, the first super­visor of Nurses. Only “matronly” women between 35 (quickly lowered to 30) and 50 who could furnish character references would be accepted, and they must agree to dress plainly in “brown, gray, or black…without ornaments of any sort.” No formal training was required since none was available, only “a capacity to care for the sick.”

Dix had once worked as an assistant in Bronson Al­cott’s Temple School in Boston, so it was not difficult for Louisa to secure an appointment. In early December 1862, just after the disastrous defeat of Union forces at Fredericksburg, she reported for duty at the ramshackle Union Hotel in Washington, which had been hastily converted into a hospital. Her plunge into the reality of war was swift, since casualties from the battle—which she referred to as “the Burnside blunder”—were streaming in. As she relates in her memoir, Hospi­tal Sketches:

There they were! “our brave boys,” as the papers justly call them, for cowards could hardly have been so riddled with shot and shell, so torn and shattered, nor have borne suffering for which we have no name, with an uncomplaining fortitude….In they came, some on stretchers, some in men’s arms, some feebly staggering along propped on rude crutches, and one lay stark and still with covered face, as a comrade gave his name to be recorded before they carried him away to the dead house.

One can only imagine how shocking this introduction to the brutal aftermath of combat was for Alcott. But she quickly settled into hospital routines—washing and feeding the wounded, and following the surgeons on their rounds to change dressings and administer what few medicines were available. Much of the nurses’ time, of course, was devoted to providing whatever comfort they could to the soldiers, reading to them, writing letters, talking and listening to them, and holding their hands while the doctors probed their wounds—without benefit of anesthetics.

In hospitals as well as in the field, the greatest danger to soldiers and caregivers alike was disease. Less than one month after she took up her duties in Washington, in early January 1863 Alcott came down with typhoid pneumonia. At first she stubbornly tried to keep up with her duties, despite a high fever and racking cough, but she soon was confined to bed. Even then she continued to write letters and sew for the soldiers until she became dangerously ill. Her supervisor, Hannah Ropes (whose own Civil War letters and diary were finally published in 1980), wrote asking her family to come and take her home. Ropes herself subsequently fell ill and died on January 20. The next day Louisa agreed to let her father take her home.

Often delusional (and perhaps poisoned by the mercury-laced calomel she’d been dosed with), Alcott was not well enough to leave the house until spring. But as soon as she could work, at the urging of friends and family she set about revising for publication the letters she had sent and the journal she had kept. Hospital Sketches first appeared in the Boston Commonwealth, a weekly newspaper, in four installments in May and June 1863.

To Alcott’s surprise, the sketches proved to be extraordinarily popular, and were quickly reprinted in newspapers across the North. Two publishers vied to produce an expanded version in book form, which appeared in hardcover that August. It too turned out to be a success with a public hungry for news about its “boys.” The volume was reprinted again in 1869 with additional material, as Hospital Sketches and Camp and Fireside Stories, and again did well, selling another 3,000 copies.

In retrospect, Alcott’s illness could be viewed as a fortunate outcome of her brief service, for it meant she was invalided out of nursing relatively early in the conflict (Sketches was in print before the Battle of Gettysburg) and enabled her to be first in the field with a firsthand account of how wounded troops were treated. Many nurses served longer and under more trying conditions than Alcott, and after the war some of them produced more substantial memoirs. But the war’s scale and the extent of its casualties were still sinking in with the public when Alcott’s Hospital Sketches first appeared.

Then too, Alcott was a skilled writer who knew how to make her sketches vivid and entertaining as well as realistic. She cast herself as a kind of Dickensian character—Nurse Tribulation Periwinkle—and alternated grim ac­counts of suffering soldiers with descriptions of her own travels, sketches of wartime Washington and self-deprecating accounts of her encounters with staff and patients.

Still, one suspects that it was Alcott’s empathy for the wounded that made Hospital Sketches so popular. The centerpiece of her memoir is a passage describing the sufferings of John Suhre, a Virginia blacksmith with an iron constitution and a bullet wound through his lungs. After examining him, the surgeon left it to Alcott to tell him that his wounds were fatal. Though Suhre’s sufferings were protracted, he bore them in silence and good spirits. When the end finally came days later, Alcott relates, “he held my hand close, so close that when he was asleep at last, I could not draw it away….but though my hand was strangely cold and stiff, and four white marks remained across its back…. I could not but be glad that, through its touch the presence of human sympathy, perhaps, had lightened that hard hour.”

Her Hospital Sketches gave a human face to the staggering casualty statistics that were beginning to appear, and it remains a pioneering account of military nursing in its infancy. Tellingly, one of the surgeons with whom Alcott had worked at the Union Hotel wrote to thank her for revealing to him the nobility of the soldiers’ character. “It is humiliating to me,” he wrote, “to think that I have been so long among them with such mental or moral obtuseness that I never discovered it for myself.”