Table of contents for On the field of mercy : women medical volunteers from the Civil War to the First World War / by Mercedes Graf.

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PREFACE										iii	
INTRODUCTION 									1	 	
 AMERICAN WAR							202
VIII. ANNA COLEMAN LADD and the Red Cross 		328
 STUDIO of Portrait Masks in WWI
Epilogue									350
To be inserted later.
This book is about a select group of women healthcare givers (doctors, nurses, and nuns) who volunteered in early wars--the Civil War, Spanish-American War, and World War I. All of them shared one thing in common--a desire to provide good medical care in time of war. All of them also demonstrated that whenever war breaks out, American women have hastened to the battlefield to take care of the dying and the wounded. As early as the Revolutionary War, fragmentary accounts document their struggles; and by the time of the Civil War, a larger body of narratives demonstrates how thousands of well-meaning but untrained females rushed to government facilities and make-shift hospitals to offer their services.1 Looking backwards we recognize that their efforts were made at great personal risk as they assumed new roles which imposed various tensions on them while they defied nineteenth-century norms. Inevitably they were forced to challenge tradition and confront male authority as they sought to establish themselves as nurses--and perhaps never again would the notion of "refined womanhood" be the same for these volunteers. 
A few Civil War women with medical degrees could also be found in the hospitals and even on the battlefield, although the majority of them had to serve as nurses rather than assistant surgeons like their male colleagues given the constraints of the times.2 Because the topic of the Civil War has and continues to generate much interest among historians and writers, new research continues to emerge about the experiences of women in this conflict, especially women nurses and soldiers. I have chosen to focus instead on the work of female doctors, as it has not been generally known that such a group was present in this war. 
By the start of the Spanish-American War in 1898, women nurses were graduates of the many nursing schools that had sprung up across the country since 1865. The criticism that they were unskilled and untrained workers who knew little or nothing about medical and surgical procedures could no longer be leveled against them. Realizing that this first group would set the standard for military nursing for years to come, Dr. Anita Newcomb McGee, Acting-Assistant Surgeon and the first superintendent of what would become the Army Nurse Corps, upheld only the highest standards of moral behavior and conduct for these women who should be "useful to our sex."3 In even stronger terms, she would say later: 
The fate of women as Army nurses in U. S. hung then on the character of the women appointed and that nothing but that won over the old army surgeons and made possible the permanent Corps. Their training was of great importance but after all, it was secondary to their character. The doctors don't care a bit what the training school may have been; what they want is a competent, honorable woman...Mind, I am not intending in the least to undervalue fine training; I am only saying that to win the permanent esteem of the powers that then were, other things were more important than that.4 
It is evident that McGee's words were a reflection of societal attitudes at the time as well as a carry-over of the concerns from the Civil War regarding females working in an all-male army. And the newly formed Nurse Corps intended to be rigorous in its application of the rating system that went into place once a woman had signed a contract. The original Personal Data cards that contain these efficiency reports are housed at the National Archives in Washington D. C., and the chapters on female Spanish-American nurses, physicians, and nuns detail how this rating system affected the service of these women. 
In World War I, several thousand women served as Army and Navy nurses with no rank or benefits, although they were given full veteran's status after the war.5 By 1919, they had demonstrated that their services were indispensable in time of war. I have chosen not to discuss the service of such a large group of women in this book as their efforts have been well documented elsewhere. On the other hand, I did not wish to totally ignore these women either so I refer the reader to Chapter Six, which describes the unheralded efforts of a small group of women nurses who served successively in two wars. Included in this group is a sister nurse who led a band of religious women who were the only nuns from America sent to Europe during WWI. 
Women physicians were not as fortunate as nurses in finding any kind of recognition with the army. The government refused to modify its position regarding the nature of their services, and in all three wars discussed in this book, women could not be commissioned as medical officers like their male counterparts. Thus, by the start of the Spanish-American War, they still had to volunteer as nurses if they wanted to work in government hospitals.6 As late as 1918, only fifty-five women were appointed as contract surgeons by the government--and even then they were denied the rights and privileges of male medical officers. Hundreds of enterprising American women physicians, however, who would not be denied their right to serve during wartime, made their way abroad where they served with the French Army and various other social service organizations and independent overseas groups. 
Although this book recounts the experiences of female caregivers, no effort has been made to treat the efforts of all groups equally in war. Instead, the accounts focus on the contributions of those lesser-known individuals who have not been discussed previously or else have not been widely recognized by writers and historians. Although there is an increasing body of literature on the contributions of females in the Civil War, for example, the subject of medical women in the Spanish-American War has not been treated to any great extent, so that little is known about the women nurses who labored or died in the typhoid camps in the South or went to Cuba or Puerto Rico.7 Likewise, little has been documented previously about the women physicians who served as nurses in this same war.8
While there are many books available on the history of nursing, these do not deal in depth with the efforts of nurses in war.9 Recently, however, there has been a growing interest in the history of women including the experiences of those in the military.10 When we delve into the subject of female military physicians, however, we find that writers on both history and medicine have even more sorely neglected the subject. This is probably due to the invisibility of this group as most of these early pioneer women made contributions as nurses during wartime. Thus, it would appear that historians have not so much deliberately ignored women doctors as overlooked them, not just because of their lack of numbers, but because their accounts have been mixed with nursing records or submerged in other archives and depositories--making them all the harder to find.11 
Obviously, there are other groups of civilian women who made contributions to war effort throughout the period discussed. Two other groups that have been ignored are women journalists and artists who were active in wartime.12 Since the focus of this book is on medical women in war, only one artist, Anna Coleman Ladd, will be discussed 
here--and she has been selected because of her efforts with the Red Cross in France.13 A renowned woman sculptor who recognized the psychological effects of facial wounds, she made a contribution to military medicine by designing masks that disguised the hideous facial deformities French soldiers (mutiles) received as a result of injuries associated with trench warfare in WWI. Given her unique work, however, Ladd seems to have avoided the difficulties inherent in working within a military bureaucracy. She did know how to solicit male advice, however, and in her early efforts she presented her designs to male surgeons and courted their opinions on her work. This strategy was also successful for many pioneer nurses and physicians who aligned themselves with male sponsors at one time or another. 
In studying the contributions of female medical volunteers in wartime, it is clear that they had a hard course to steer laboring in a military bureaucracy where the attitude towards them was even more exaggerated than in a polite society that also frowned on women in the workplace. Thus, they had to deal with military surgeons who represented two camps, medicine and the all-male army-- both equally entrenched in the stereotypical views of the day. Clearly, these women had to develop unique coping strategies as a way of dealing with male authority in male-defined surroundings. It is not the aim of this book to discuss hierarchical developments in nursing or medicine as others have already done so; however, the work of female medical workers during wartime sheds light on the changing role of professional women in America.14 
There is also a strong link between early female military nurses and doctors because they shared many things in common. As women they entered a medical world polarized along gender lines at the time of the Civil War and well into WWI, and at all times they were caught in a matrix formed by gender and medical professionalism. Prevailing nineteenth-century views with their doctrine of separate spheres meant that these women were expected to operate in the private realm of home and family while their male relatives were free to operate within the public sphere. Whether practicing medicine or nursing, the ethos of "true womanhood" demanded that they cherish the concept of domesticity in their private and public lives. It was well and good for them to tend the sick at home, and if they chose to conduct this work in the public arena at least it could be rationalized as an extension of woman's noble work-- but they could not expect the same status as their male counterparts in doing do. While the climate for women was changing by the start of WWI, women were still not able to vote, and they continued to have secondary status within the larger male dominated medical profession.15 
Despite these similarities, the two groups were separated by the fact that women physicians had a medical degree and were, therefore, viewed more suspiciously by the public at large. By the time of the Spanish-American War, female nurses were more readily accepted in civil and government hospitals, as they were more visible since their numbers had greatly increased and they were graduates of the numerous nursing schools that had been established throughout the country. At the same time, it was also the case that male surgeons viewed them as performing a subservient role that did not challenge their authority.16 On the other hand, women doctors posed a definite threat by virtue of having the MD after their name. But the male dominated medical establishment was quick to point out that their colleagues were generally graduates of women's medical schools--a situation that existed since orthodox medical schools remained slow to admit females until the turn of the twentieth century.17 As a result, early women physicians labored under the stigma of inferiority related to their graduation from sectarian institutions where problems frequently existed with limited facilities and experienced teachers.16 While it was also acceptable at the time for students to study under preceptors, women had the added problem of trying to find a qualified physician who was willing to supervise them. 
Many accounts reveal that even though women doctors were likely to be given positions of authority such as matron in the Civil War or chief nurse in latter wars (which might be construed as a recognition of their medical degree), they were rarely allowed to engage in the practice of medicine that included surgery. This was due largely to the fact that the majority of women physicians' professional opponents were "neither scientific nor consistent", and while they praised women's abilities to nurse, they rejected their competence in medicine.18 When Dr. Mary E. Walker applied to be an army surgeon in the Civil War, for instance, male physicians who interviewed her found her so inadequate "as to render it doubtful whether she has pursued the study of medicine." The Board was "of the further opinion that her practical acquaintance with diseases and the use of remedies is not greater than most housewives possess. The Board would except [sic] obstetrics, with which she seems to be more familiar. As a nurse, in a general hospital the Board believes her services may be of value and respectfully recommend her for that position."19 Years later Walker would condemn this examination as a farce aimed at keeping her out of the army because of her "sex", especially since she had graduated from Syracuse Medical College, an eclectic coeducational institution where the curriculum was considered average for the period. Eventually she would be the only woman to be awarded a contract as an acting assistant surgeon until the Spanish-American War.20 
Although the number of women doctors identified thus far in the Civil War and the Spanish-American war is small, these women were relegated to positions of inferior status as nurses because it denied them their authority as physicians.21 It seems surprising to us today that they were able to assume these positions with such grace and courage, but we have to remember that nineteenth century and early twentieth century women doctors never moved too far away from the ideological mainstream in which they perceived the public would not accept them unless change was gradual. Hence, many female doctors limited themselves to gynecology, obstetrics, pediatrics, public health, and teaching; in some cases, they abandoned medicine and took up other causes. In the beginning of the twentieth century, this was still the case although the more venturesome women gravitated to other areas of medicine. Women contract surgeons in WWI, however, were generally assigned to stateside locations rather than in war zones abroad, and there were limited opportunities for them to engage in surgery or work beside their male colleagues under battlefield conditions (see Chapter Seven). 
As a result of the differences in their level of training, female nurses and physicians assumed complementary but different roles in postwar years.22 On the whole, women physicians were likely to marry and have a family while practicing medicine (usually private practice) and still be successful in their roles. By the end of the nineteenth century, another option available to them was institutional work so it will be seen in later chapters that an occasional women opted for a position in a college infirmary, sanitarium, or lunatic asylum. Nurses, however, "were less likely to marry and to continue their work."23 This was in strong contrast to medical women who seemed exceptionally committed to their profession. Nuns (more correctly referred to as sister nurses) generally remained in the convent where they resumed their teaching or nursing although a few of them died in service and others were left weak and ill at war's end.24
Having proved their worth in war, however, women medical workers still had a major hurdle to overcome in postwar years. Nurses who had faithfully served their country in the Civil War had grown old and destitute, and many were sick and disabled as a result of their efforts in caring for the sick and wounded. In 1892, Congress passed legislation on the behalf of nurses as part of the Army Nurses' Pensions Act. The Department of the Interior began to make monthly payments of twelve dollars to nurses who could prove that they had served at least six months and who were not already drawing widows' pensions. Often the women who needed the most help were rejected because they could not produce the required proof.
It became increasingly clear that the application process was a hardship for countless nurses who had to gather such proof. Juliet G. Robbins Howe, for example, went to great ends to have her affidavit signed by nearly one hundred Civil War soldiers who knew her as a nurse during the war.25 There were also numerous times when Dr. Anita Newcomb McGee had to intervene for "her" nurses who served in the Spanish-American War. Producing the required proof was just as difficult for female doctors from the Civil War since they had to apply under their service as nurses. It was also true that had they been male medical officers, they would have been entitled to a higher pension. As shall be seen, Dr. Sarah Chadwick Clapp (who had volunteered directly with an Illinois regiment) and Dr. Mary E. Walker (the only woman to be awarded the Medal of Honor) had to battle the government for years over pension benefits (see Chapter Two). 
While the sketches that emerge here form a kaleidoscope of images as varied as the women themselves, they are joined by a common thread: early medical women were not content to remain on the home front in times of war. What they did and how they did it shaped the attitudes and values of nation. Thus, it is important to explore the varied views of the implications gender difference and professionalism meant for these pioneers who chose to embrace their work in an age of reform. At the same time, one has to be aware of the problem of oversimplification, a problem that plagues all fields of scholarship, and one must also concede the difficulty of addressing different audiences with varying views and concerns. Finally, there is no question that all of these early medical women were uncommon individuals for their day, a special breed of women if you will, as they chose to do the unthinkable for a woman--march off to war leaving family and friends behind--most decidedly, a male prerogative. When they were done with their work they earned the gratitude of the soldiers they nursed and even won the respect of many of the officers and surgeons under whom they worked. It is not an exaggeration to say that these women also earned the thanks of a grateful nation no matter in what war they served. 
Still many of the stories of these pioneer medical women have not been told before although women's history has been the most dynamic field of historical scholarship during the past two or three decades. In addition, social historians have done much to shift the focus of war to ordinary people, including women and minorities. In this book, all eight essays focus on the work of women medical volunteers. The first chapter treats the historical antecedents and background issues that relate to the role women have played in war from ancient times through World War I. Chapter Two discusses the work of eight Civil War female physicians, a subject on which almost nothing has been written about although this war has been a popular subject for historians as well as novelists and screen writers. Three essays from chapters three through five relate the experiences of nurses, nuns, and women physicians in the Spanish-American War. Perhaps nothing illustrates the devotion and patriotism of women in war so much as chapter six since it surveys the efforts of a handful of women who served in two wars. By World War I, women physicians were finally awarded official jobs as contract surgeons and this is discussed in chapter seven. Finally, the last chapter details the work of a renowned woman sculptor, Anna Coleman Ladd, who worked under the auspices of the American Red Cross in designing portrait masks for disfigured French soldiers in World War I.26 
It is the author's hope that these essays on early healthcare givers will contribute to an understanding of the impact of women's work in war. The opportunities to nurse sick and wounded soldiers were limited until the Civil War, and even more limited when it came to the services of female physicians. But the idea of military nursing had left a great impact on American women as thousands of them trained as civilian nurses after 1865, and they were ready when the Spanish-American War broke out in 1898, and again at the time of the First World War. 
Military nursing lent validity to female interests and concerns outside the home, so much so, that women physicians were willing to serve as nurses in both the Civil and Spanish-American Wars. Although women's acceptance as military nurses and physicians was a long and painful process, it reflected changes in their position in the wider society; at the same time, it helped women accelerate changes themselves as they assumed new roles. Tracing the history of these early medical workers gives us some insight into how these women moved from the private sphere to the public realm as well as their transition from the home front to the decidedly masculine army world. How these women transformed nursing and medicine in military settings from a predominantly male occupation to one that included female nurses and doctors is the subject of this book. 
Nuns were the exception as they had experience working in their own hospitals and facilities. Classic works on Civil War women and nurses include Mary Gardner Holland, Our Army Nurses (Boston: Press of Lounsbery, Nichols & Worth), 1897; Mary Elizabeth Massey, Women in the Civil War (Lincoln: University of Nebraska Press, 1994), originally published as Bonnet Brigades (New York: Alfred A. Knopf, 1966); Frank Moore, Women of the War: Their Heroism and Self-Sacrifice (Hartford, CT: S. S. Scranton & Co.), 1866; L. P. Brockett and Mary C. Vaughan, Women's Work in the War (Boston: Zeigler, McCurdy & Co.), 1867. 
Mercedes Graf, "Women Physicians in the Civil War," Prologue (Quarterly of the National Archives and Records Administration), summer 2000.
"Dr. Anita Newcomb McGee's Address Before the Pennsylvania State Conference of Chapter Regents, Congress Hall, Philadelphia, June 8, 1898," Anita Newcomb McGee's Office Files, Entry 230, box 3, National Archives and Records Administration (NARA), Washington, DC; hereafter referred to as McGee's Office Files. WWI records are housed in College Park, Maryland, hereafter referred to NARA/CP.
Emphasis mine. From "Untitled Text of ANM," (probably part of an intended history of the Army Nurse Corps), McGee's Office Files. 
The National Defense Act as amended June 4, 1920, conferred relative rank on members of the Army Nurse Corps, and authorized wearing the insignia of their rank from Major to Second Lieutenant. It accorded them the rights and privileges of officers with a few exceptions, i.e., pay. Julia C. Stimson, head of the Army Nurse Corps at the time, received the rank of Major. 
It should be recalled that Florence Nightingale campaigned for the establishment of an army nursing service in Great Britain as early as 1856 when she returned from the Crimea.
Early historical records refer to Puerto Rico as Porto Rico but the spelling has been changed throughout. At the present time, no book has been written about medical women in the Spanish-American War although a few articles have appeared over the years. See Philip A. Kalisch, "Heroines of '98: Female Army Nurses in the Spanish-American War," Nursing Research, November-December 1975, Vol. 24, No. 6, 411-429; Barbra Mann Wall, "Courage to Care: The Sisters of the Holy Cross in the Spanish-American War," Nursing History Review 3, 1995, 55-77. 
See Mercedes Graf, "Women Physicians in the Spanish-American War," Army History, fall 2002, No. 56.
The best known of these books is that by M. A. Nutting and L. L. Dock, A History of Nursing (New York: Putnam, 1907), in four volumes. Also see Ellen Condliffe Lagemann, Ed., Nursing History: New Perspectives, New Possibilities (New York: Teachers College Press, 1983), 5. 
See Mary T. Sarnecky, A History of the U. S. Army Nurse Corps (Philadelphia: University of Pennsylvania Press, 1999); Lettie Gavin, American Women in World War I (Niwot. Colorado: University of Colorado Press), 1997. Interest in women soldiers has also been spurred on by: De Anne Blanton and Lauren Cook Burgess, They Fought Like Demons (Baton Rouge: Louisiana State University Press, 2002); Elizabeth D. Leonard, All the Daring of the Soldier: Women of the Civil War Armies (New York: W. W. Norton & Co., 1999); Lauren M. Cook, An Uncommon Soldier: The Civil War Letters of Sarah Rosetta Wakeman, Alias Pvt. Lyons Wakeman (New York: Oxford University Press, 1995). For information on British nurses, see Anne Summers, Angels and Citizens: British Women as Military Nurses 1854-1914 (London: Routledge & Kegan Paul, 1998). Her book is important because it points out that British nurses encountered the same difficulties that nurses experienced in American wars. Before Florence Nightingale's expedition to the Crimea in 1854, military nursing was a predominantly male occupation. British soldiers were nursed by male orderlies. "In 1898, a year before the Anglo-Boer War, there were still only seventy-two [female nurses]. It was only after that war that they began to be enrolled in their hundreds; and on the eve of the First World War thousands were in readiness for service." See Introduction in Angels and Citizens, 2. 
Two exceptions are books on Esther Hill Hawks, M.D. and Mary Edwards Walker, M.D. See Gerald Schwartz, Ed., A Woman Doctor's Civil War; Esther Hill Hawks' Diary (Columbia, South Carolina: University of South Carolina Press, 1984); Charles McCool Snyder, Dr. Mary Walker, the Little Lady in Pants (New York: Vantage Press, 1974); Mercedes Graf, A Woman of Honor: The Civil War Years of Dr. Mary E. Walker (Gettysburg: Thomas Publications, 2000). 
See Margaret R. Higonnet, Lines of Fire: Women Writers of World War I (New York: Penguin Group, 1999). She discusses women writers around the world and includes a few American women. 
The Red Cross Nursing Service supplied about 20,000 nurses before the war ended and most of these served in base hospitals. As part of the base hospital plan, a civilian medical center provided a fully staffed and equipped field hospital that was transferred to military authority when needed. 
D'Antonio, for example, notes that the legacy of early 19th century nursing reform can be found in "today's disciplinary tensions between nurses and physicians." It continues to reflect a "groping toward new ways to care for the sick when older ways lose their validity and power." See Patricia O'Brien D'Antonio, "The Legacy of Domesticity: Nursing in Early Nineteenth-Century America," Nursing History Review l, 1991, 242.
This is not true today as women dominate the nursing field in terms of numbers. 
Doctors usually welcomed sister nurses since they had taken vows of obedience and understood subservience to authority figures. See Chapter Three. 
Regina Markell Morantz-Sanchez, Sympathy and Science: Women Physicians in American Medicine (New York: Oxford University Press, 1985), 71. Although women were divided themselves on the issue of coeducational colleges, by the 1880s students at the regular women's medical colleges were receiving an education comparable to men at the best schools. See her discussion on the problems of medical education for women physicians, 64-90. Proprietary medical schools were soon caught up with problems regarding standards in the mid to late 1880s as they were founded to turn a profit in the competition for students. Also see Richard Harrison Shryock, "Women in American Medicine," Journal of the American Women's Medical Association, September 1950. 
Morantz-Sanchez, Sympathy and Science, 54. For another source on women doctors, see Gloria Moldow, Women Doctors in Gilded-Age Washington: Race, Gender, and Professionalization (Urbana and Chicago: University of Illinois Press, 1987. 
"Copy of Letter to Brig. Genl. W. D. Whipple Forwarded from Surgeon G. Perin, dated March 8, 1864," representing the opinion of the Examining Board, Walker's Pension File, SC 142 715, NARA. 
Anita Newcomb McGee would be appointed acting assistant surgeon of the United States Army on August 29, 1898.
Parallels to the professional difficulties of women physicians can also be found in law. When women lawyers began to practice in the mid eighteenth century, they learned that females were not going to be easily accepted in the male workplace, but they were more likely to be accepted when they assumed secondary roles in their chosen profession. Although Myra Bradwell passed the Illinois bar examination, she was barred from practicing law because she was a woman. She chose to establish and write for the Chicago Legal News. See Jane M. Friedman, America's First Woman Lawyer: The Biography of Myra Bradwell (Buffalo, New York: Prometheus Books, 1993). 
Some wartime nurses went on to study medicine in peacetime. 
Morantz-Sanchez concluded this from analyzing women's marriage rate in selected occupations from 1900 to 1950. See Sympathy and Science, 157.
While the term nun is generally used to refer to those religious women who never left the convent walls, it is used interchangeably with the word sister. The Native American sisters discussed in Chapter Four were the exception as some married in postwar years; but they had broken with the Catholic Church in Rome before they entered the war. 
See Howe's account: 49th Congress, 2d Session, February 8, 1887. In another instance, Mary Wood was shot in her shoulder while traveling on board a steamer with the wounded of her husband's regiment. When she applied for a pension, twenty-four of the officers and enlisted men of the Seventh Missouri Cavalry Volunteers came forward to testify that she had served as an Army nurse not just for the six months required by the government, but for more than three years. See Wood's account: 49th Congress, 2d Session, Senate Report No. 1816, February 10, 1887. Margaret Durand of Illinois called on two nuns who had served with her in the Mound City Hospital near Cairo, Illinois, to write affidavits regarding her service. (This seemed tantamount to calling on God as a witness). See 50th Congress, 2d Session, H. R. No. 3569, December 12, 1888.
After the reorganization of the Red Cross Society in 1905, enrollment of nurses for war or disaster became an outstanding program although their efforts had been heralded starting with the work of Clara Barton. For a comprehensive account of this group, see Portia B. Kernodle, The Red Cross Nurse in Action 1882-1948 (New York: Harper & Brothers, 1949).

Library of Congress Subject Headings for this publication:

Women in medicine -- United States -- History.
Women physicians -- United States -- History.
Nurses -- United States -- History.
Nuns -- United States -- History.
War -- Relief of sick and wounded.
United States -- History, Military.
Military Medicine -- history -- United States.
Physicians, Women -- history -- United States.
Military Nursing -- history -- United States.
American Civil War.
Spanish-American War, 1898.
World War I.
History, 19th Century.
History, 20th Century.