Dr. Pamela D. Toler

The dramatic PBS series Mercy Street tells the story of the Civil War medicine and nursing through the professional and personal lives of the staff at the Mansion House Hospital in the Union-occupied Southern city, Alexandria, Virginia, in 1862. The series focuses on two women: Mary Phinney, Baroness von Olnhausen, a Union Army nurse and abolitionist, and Emma Green, a Southern belle and daughter of the owner of Mansion House, a former luxury hotel. The series also captures the frenetic world of occupied Alexandria, a melting pot behind the lines, where Confederate sympathizers mingled with Union troops in a city populated by longtime residents, civilian refugees, freed African Americans, escaped slaves, wounded men from both sides, corrupt officials, prostitutes, women volunteers, and others.

Historian Pamela D. Toler provides historical context for the PBS series in her new book Heroines of Mercy Street: The Real Nurses of the Civil War (Little Brown and Company). In addition to providing background for Mercy Street viewers, the book can also be read as a stand-alone reference on the state of medicine and nursing in mid-nineteenth century America.

In her book, Dr. Toler delves into the medical consequences of the Civil War, the bloodiest conflict in U.S. history that left 750,000 troops dead--more than twice the number of American troops killed in World War II and two percent of the population in the 1860s. If a similar number of Americans died in a war today, the toll would reach about 7.5 million.

Hundreds of thousands more troops were wounded or seriously ill. As Dr. Toler writes, women stepped into the fray and at least twenty thousand volunteered to serve in capacities related to medicine from nurses to laundresses to hospital staff, including about six thousand Union Army nurses, many under the command of renowned reformer Dorothea Dix, the Superintendent of Army Nurses.

The U.S. was considered a medical backwater at the dawn of the war, as Dr. Toler vividly recounts. Virtually anyone who had the desire to be a doctor could practice whether or not they had a medical degree, and even trained physicians were unprepared for the devastating carnage of the war, the hordes of traumatized men. The nursing profession was also in its infancy, and most of the women volunteers came with a desire to help others but no medical training. They learned to care for severely wounded and seriously ill men, advocate for their patients, cut red tape and persist as they battled blatant sexism, squalid working conditions, and gross inefficiency as a flood of sick or injured men crowded medical facilities.

Dr. Toler’s Heroines of Mercy Street is based on extensive historical research including the letters, books, and diaries of nursing pioneers, such as the memoirs of the real Mary Phinney von Olnhausen and the stories of Louisa May Alcott who also served as a volunteer nurse. Dr. Toler has won praise for her vivid storytelling, wide-ranging research, and engaging writing for academics and lay readers alike.

Dr. Pamela D. Toler earned a PhD in South Asian history at the University of Chicago, a program of study that was sparked by her love for Rudyard Kipling’s novel Kim. She now writes for a wide range of readers. Her other books include The Everything Guide to Socialism, Mankind: The Story of All of Us, and The War of 1812. She has also written many articles and essays for popular publications. She has had a special interest in the Civil War since her childhood in Missouri. She lives in Chicago.

Dr. Toler has devoted her career to writing about history for a broad audience, as she explains on her website www.pameladtoler.com: “These days I write about a wide range of historical topics for history buffs, nerdy kids and–you get the idea.  On any given day I could be working on World War I recruiting posters, the mud mosques of West Africa, the first European translation of the Arabian Nights, Napoleon’s invasion of Egypt, or the history of absinth.  At least half the time I’m writing outside of “my field,” exploring odd corners of the past with field-tested research skills, a red-hot library card, and a large bump of curiosity.”

Dr. Toler graciously responded by email to an exhaustive series of questions on her work and her new book on Civil War nursing.

Robin Lindley: You’re a wide-ranging historian and writer. Have you been interested in history since you were a little girl?

Dr. Pamela Toler: Absolutely! One of my favorite things to do when I was small was curl up next to my grandmother and ask her "What did you do when you were a little girl?" From there it was a short step to reading biographies about historical women who ignored social boundaries and accomplished thing—the kind that are written with the intention of inspiring young girls. My grade school's revolving library owned a whole series of them. Every week a new one arrived and I snatched it before anyone else could get it, eager to read about Clara Barton, Madame Curie or Julia Ward Howe.

By the time I was in high school, I was that nerdy kid who hung out at the local historical society and Wilson Creek National Battlefield on the weekends.

Robin Lindley: I read that you decided to write for people who love history and general readers when you were in graduate school. You’ve written several non-academic books of history. What prompted your work in this direction?

Dr. Pamela Toler: I'm a storyteller at heart and a bit of an evangelist as far as history is concerned. I feel strongly that as a society we need to hear the stories that don't get told in high school history classes: the history of other parts of the world as well as history from the other side of the battlefield, the gender line, or the color bar. Much as I admire--and depend on--academic scholarship, most academic books don't reach a popular audience.

Robin Lindley: Do you also teach history?

Dr. Pamela Toler: It's been a long time since I taught. I write full-time. Which isn't to say that I don't occasionally stand up in front of a class or an audience to talk about history, writing, or writing about history.

Robin Lindley: How did you come to write the companion book to the PBS dramatic series on nursing and medicine of the Civil War, Mercy Street?

Dr. Pamela Toler: The project started with an email. PBS was looking for a writer to produce a work of historical non-fiction as a companion to a new historical drama about Civil War nurses, Mercy Street. The time frame was insane and I probably wouldn't have taken the assignment if it hadn't aligned so closely to a topic that has fascinated me for years: the roles women play in warfare and how those roles are rooted in and occasionally help change a society's fundamental beliefs about women.

Robin Lindley: Did you work on the production of the Mercy Street series?

Dr. Pamela Toler: No. It seems to be a rule that companion books are assigned very late in the development process. The producers of Mercy Street worked with an impressive array of period specialists as advisors, many of whose works served as my starting point for Heroines of Mercy Street.

Robin Lindley: You note in your book that the United States was a medical backwater when the Civil War began and that the military was unprepared for the massive casualties the war produced. How would you describe the state of American medicine then and preparedness at the time?

Dr. Pamela Toler: After decades of stretching a slender operating budget to care for a small professional army, the Medical Bureau was not surprisingly unprepared to deal with the needs of the 75,000 volunteers who joined the army in a matter of weeks or the carnage that followed.

When the Civil War started in 1861, the Union Army's Medical Bureau totaled 30 surgeons and 86 assistant surgeons under the leadership of a Surgeon General who was a veteran of the War of 1812 and took office under the administration of Andrew Jackson. They had a few small hospitals on army posts in the frontier states, but none in the East. The Army's Quartermaster Corps refused to build any in anticipation of the coming war on the grounds that "men need guns not beds."

At least the Medical Bureau doctors were required to pass tests proving that they had mastered the basic skills of battlefield medicine. Civilian doctors were not required to obtain either a license or a medical degree to practice medicine. And in fact, a medical degree was no guarantee that a doctor was well trained. The quality of American education had declined in the early nineteenth century, when proprietary medical schools sprang up across the country in response to a rising population with a growing need for doctors. Many of these schools were diploma mills that were more concerned with generating "graduation fees" than training doctors.

At some level, their qualifications didn't matter. Even the best of the civilian doctors who volunteered had little or no experience with even simple gunshot wounds, let alone dealing with the effects of cannon shot or minnie balls.

Robin Lindley: What was the state of the nursing profession during the Civil War?

Dr. Pamela Toler: The nursing profession as we know it did not exist. Florence Nightingale opened her first nursing schools in England in 1860, but no such schools existed in the United States.

Things were beginning to change, but nursingfor pay, especially nursing in a hospital, was not considered a job for respectable women. And the act of nursing was less a matter of providing medical care than of providing comfort. Nursing meant keeping patients clean, feeding them, and making sure they took what few medications were available.

A few women worked as private nurses for well-to-do families—they were basically temporary domestic servants who provided the same type of care a family member might provide in less wealthy homes. Women who did this kind of work were from the same class as other household servants.

Hospital nurses were an enormous step down the social scale. Florence Nightingale described them as women "who were too old, too weak, too drunken, too dirty, too stolid or too bad to do anything else." It was a job for women who had few options left. At Bellevue Hospital in New York, for instance, the nurses were for the most part "ten-day women". These were women who were arrested for public drunkenness or disorderly conduct. They were sentenced to ten days in the workhouse. Once they sobered up, they would be paroled if they agreed to work as nurses in the Bellevue wards for a month. Obviously these were not women for whom nursing was a vocation.

Robin Lindley: Didn’t most of the women who became nurses during the Civil War lack medical or nursing clinical skills but shared a desire to help others?

Dr. Pamela Toler: True. Most women of the period had some experience nursing a relative or neighbor, but taking care of someone with measles or a broken leg was no preparation for working in military hospital. When you read the letters and memoirs written by women who served as nurses, their first experiences of hospital work often made them ill and sometimes caused them to faint.

Robin Lindley: In this Victorian period, wasn’t nursing seen by many as a lowly and undesirable occupation for respectable young women? What sorts of women volunteered for this work?

Dr. Pamela Toler: The women who volunteered to nurse in the Civil War came from all levels of society, all ages and all ethnicities: from teenaged girls to widowed grandmothers, Mayflower descendants to recent immigrants. My two favorite nurses were a New York socialite and a cobbler's daughter from Maine.

Robin Lindley: Did the Civil War period represent the beginnings of the institution of the hospital as we know it today? (You describe hospitals at the time as less than sanitary and often very corrupt.)

Dr. Pamela Toler: The Civil War was certainly the first time that large numbers of Americans—patients and doctors alike--had any experience with a hospital. General hospitals were charity institutions and they existed only in the largest cities. Even in large cities, female family members attended the ill at home if at all possible. Only the poor and desperate went to a hospital when they were ill.

Hospitals underwent a certain amount of reform as a result of the Civil War, but I think the real transformation of hospitals came later as a result of the First and Second World Wars.

Robin Lindley: Mercy Street takes place in Alexandria, Virginia, a Southern city occupied by Union forces during the Civil War. Was the city as open as portrayed in the television series? It seems that Southerners and Confederate sympathizers lived and worked side by side with Union occupiers.

Dr. Pamela Toler: Confederate sympathizers remained in Alexandria throughout the war and enjoyed considerable freedom of movement as long as they did not take aggressive action against the Union Army's soldiers or installations. There was always the fear that Confederate sympathizers in occupied areas would support a resistance movement. For instance, in May, 1863, when rumors flew that Confederate troops were poised to invade and liberate the city, Mary Phinney von Olnhausen wrote to a friend, "The town is full of Secesh [sic] just waiting for a raid in order to come out openly."

Robin Lindley: What was the historical context of the series in terms of the battles in northern Virginia that were producing the wounded and dying casualties for the Mercy Street nurses in 1862?

Dr. Pamela Toler: Occupied Alexandria was a major operations and medical center for the Union Army. The city was the site of the first general hospital that the army's Medical Bureau opened after the First Battle of Bull Run. By the end of the war, Alexandria had 33 military hospitals of different sizes and designed for different purposes, including the Mansion House Hospital that served as the setting for Mercy Street.

Because of its strategic location as a transportation hub, Alexandria was the first stop for sick and wounded soldiers after most of the major battles that took place in northern Virginia, including Second Bull Run, the Peninsular Campaign, Cedar Mountain, and Fredericksburg.

Robin Lindley: How would you describe the condition of the wounded and sick soldiers that the nurses faced on arrival at the Mansion House Hospital?

Dr. Pamela Toler: I read as many nursing memoirs as I could get my hands on. Nurses who served near the battlefields all said much the same thing as Hannah Ropes, who described the fifty soldiers who arrived her first day on duty at the Union Hotel Hospital in Washington as "grim, dirty, muddy, and wounded."

Robin Lindley: The series begins in 1862. Mary Phinney von Olnhausen, the main character in Mercy Street, was assigned to the Alexandria hospital by Dorothea Dix, the director of Army nurses. Both were real women. What would you like people to know about the real Dix, a renowned social reformer, and the real Mary Phinney?

Dr. Pamela Toler: Both of them were amazing women in their own way.

Dorothea Dix. Courtesy of Dr. Pamela Toler.

Dorothea Dix was driven by her need to do socially useful work. She set up a school for younger children when she was only fourteen and spent the rest of her life working for others, first in education and later pursuing reform of the treatment of the mentally ill and the handicapped. She saw her work in the Civil War as an exhausting and thankless interlude to her real life's work.

Dix had a difficult time during the war because her skills as a reformer and visionary were not those needed to manage the army's nursing corps. She had always worked alone. She knew how to inspire action in others. But she didn't know how to run an organization and she didn't know how to defend herself against bureaucratic attacks on her authority, which began almost immediately after her appointment. Instead she treated the nursing corps as a web of personal relationships with herself at the center. George Templeton Strong, who was the treasurer of the United States Sanitary Commission and definitely not a Dix fan, gave what is perhaps the most definitive description of Dix when he wrote {Dorothea Dix] "is energetic, benevolent, unselfish and a mild case of monomania; working on her own hook, she does good, but no one can cooperate with her for [she] belongs to the class of comets, and can be subdued into relations with no system whatever."

Despite her limitations, Dix appointed more than three thousand nurses, roughly 15 percent of the total who served with the Union army, and more than any other person or organization involved with nursing in the Civil War.

Mary Phinney von Olnhausen. Courtesy of Dr. Pamela Toler.

Unlikely as it seems, Mary Phinney von Olnhausen, really was a baroness when she arrived at Mansion House Hospital, but she was by no means wealthy.

Mary Phinney lived and worked on her family's farm, near Lexington, Massachusetts, until her father died. She was 31 and suddenly needed to find a way to support herself. Mary didn't take the usual paths available to an unmarried woman at the time. Instead she enrolled in the newly founded School for Design for Women in Boston--one of several such schools founded in industrial cities in the mid-nineteenth century—where she trained as a textile designer. After graduation, she found steady employment as a textile designer.

She was working in a textile mill in Manchester, New Hampshire, when she met Gustav, Baron von Olnhausen, a trained chemist and German political radical who, like many others, had fled to the United States after the political revolutions that shook Europe in 1848. Gustav was employed as a dye chemist in the same mill where Phinney was employed as a designer. They married in 1858, when Mary was 40 and enjoyed a brief happy marriage before Gustav became seriously ill and died. Mary had been a widow less than a year when the Civil War began.

Robin Lindley: What prompted Mary Phinney von Olnhausen to volunteer as a nurse?

Dr. Pamela Toler: Like many women who served as nurses, von Olnhausen was inspired to volunteer by what she called "the terrible affair at Bull Run." If you read the memoir that her nephew put together from her letters and other writings, it is clear that she was driven by the same desire for patriotic action that led men to enlist during the first rush of enthusiasm for the war. Reading between the lines, I suspect that she was still grieving for her husband and looking for hard work to absorb that grief.

Robin Lindley: Emma Green, daughter of the prominent Green family in Alexandria, was also a real historical character. In the series, she volunteers to nurse at the hospital, and chooses to help Confederate wounded. Did the real Emma serve as a nurse and treat Confederate troops?

Dr. Pamela Toler: There's no evidence to suggest that the real Emma Green volunteered as a nurse. However, the fictional Emma makes choices that were very typical for Southern women during the war. With the war right on their doorsteps, Confederate women often volunteered on a casual basis. Many of them, like Mercy Street's Emma Green, were "lady visitors" rather than nurses: women from the community who brought comfort to soldiers in the form of food and entertainment. They read to patients, helped them write letters and perhaps washed their faces but did not mop up bloody floors, empty bedpans or bathe patients. At Mansion House Hospital, Southern women who tried to bring luxuries for the sole benefit of Confederate soldiers were greeted with hostility by their Union counterparts.

Robin Lindley: Another prominent character is the alcoholic, conniving and snooty English nurse Anne Hastings who worked with Florence Nightingale during the Crimean War. She is based on a real nurse, Anne Reading. Was the real Anne Reading like the character in Mercy Street?

Dr. Pamela Toler: There's a reason why they changed Anne Reading's name in the show!

Anne Reading was a professional nurse, to the limited extent that such a thing existed in the United States at the beginning of the Civil War. She appears to have worked as a nurse in several British hospitals prior to March 1855, when she sailed for Turkey as part of the third contingent to join Florence Nightingale's nursing corps in the Crimean War. Even though nursing was still considered a lower-class job in England at the time, there is no reason to believe Reading was anything less than respectable since Nightingale held high moral standards for her nursing corps.

Reading's status as one of Nightingale's nurses proved invaluable over the course of her nursing career, but in fact she served less than three months in the Crimea because she contracted what was then called "Crimea fever," now believe to have been brucellosis, a highly infectious bacterial disease carried by animals. In 1860, after five years of working as a surgical nurse in London, Reading came to the United State in search of greater opportunity. She found that opportunity in the Civil War.

If you read Reading's collected letters you'll find that while she was inclined to look down on American medical practices and liked an occasional drink, she had little in common with the delightfully awful Nurse Hastings. On the other hand, Mary Phinney von Olnhausen describes one occasion on which Reading was escorted into the hospital dead drunk and swearing like a trooper. Von Olnhausen did not like Reading and had a talent for holding a grudge so we'll never know whether she exaggerated.

Robin Lindley: I’ve learned that Frank Stringfellow was also a real character. In the series, he is a despicable Confederate spy and murderer—as well as the lover of Emma Green. What have you learned about the real Stringfellow and Emma?

Dr. Pamela Toler: The real life Benjamin Franklin Stringfellow was a Confederate spy who was known for disguises and narrow escapes. On one occasion, he disguised himself as a woman and used a travel pass that had been issued in the name of a young woman of his acquaintance to attend a ball given by Union officers, where he danced, flirted, and gained useful information about troop movements. Later in the war, he posed as a traveling dental student. By the end of the war, some Union leaders considered him to be "the most dangerous man in the Confederacy". There was a $10,000 dollar reward for his capture.

But he wasn't a cold-blooded murderer. In fact, after the Battle of Cold Harbor, Stringfellow was close enough to General Grant to shoot him in the back, but couldn't bring himself to pull the trigger. After the war, he wrote to then President Grant about the incident, evidently providing enough detail to make the president believe it was true. Grant wrote back, saying that he or any future president would grant Stringfellow a request.

Stringfellow called in that favor several decades later.

After the war, Stringfellow fled to Canada, where he underwent a religious conversion. In 1867, he returned to Virginia, entered an Episcopalian seminary, was ordained as a priest and married his long-time love, Emma Green.

In 1898, at the age of 58, Stringfellow attempted to enlist as an army chaplain in the Spanish-American War. When the army rejected him as too old, he called on President William McKinley to honor Grant's promise. Under McKinley's orders, Stringfellow was allowed to serve as an army chaplain. He returned safely from the war and continued working as a minister until his death in 1913. If he'd lasted a bit longer, I suspect he'd have found a way to sign up in the First World War, too.

Robin Lindley: Treating severe wounds during the Civil War had to be a gruesome task at best in the days before reliable anesthesia and before germ theory. And more men were lost to disease than to combat wounds. Although the series depicts the human face of some of the suffering, wouldn’t the actual hospital have been even more chaotic and terrible that portrayed in the series? Can you comment on the conditions such as hygiene and sanitation at the time?

Dr. Pamela Toler: Despite the best efforts of those involved, conditions at the actual hospitals were horrific: crowded, chaotic, and dirty.

Nurses, supported by convalescent attendants and an army of laundresses, fought to keep hospitals clean in the face of a seemingly endless flood of blood, mud, and human filth. (Diarrhea was a major problem: on average 78% of the Union army suffered from what they called the "Tennessee trot" at some point in the year.) It was a monumental task even by standards of cleanliness that required patients' undergarments to be changed once a week and saw nothing wrong with reusing lightly soiled bandages.

Hospitals were breeding grounds for contagious diseases, including smallpox, measles, pneumonia, influenza, tuberculosis, typhoid and yellow fever. The most progressive American doctors recognized the relationship between badly maintained latrines, human waste and diseases like dysentery, but the mechanism of contagion was unclear. The prevailing medical theory of the period assumed that disease was transmitted by contaminated air rather than contaminated water. Efforts to keep hospital wards "sanitary"--a word that didn't mean quite the same thing in the mid-nineteenth century as it does today--focused on eradicating bad smells.

Sanitary arrangements in Civil War hospitals 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 needed 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.

Louisa May Alcott, writing about Union Hotel Hospital in Washington, which was ultimately closed due to the poor conditions there, described it as a "perfect pestilence-box ...cold, damp, dirty, full of vile odors from wounds, kitchens, wash-rooms and stables."

Robin Lindley: In the series, several of the doctors absolutely want no women treating wounded men and some even sabotage the work of female nurses. What struck you in your research about sexism and the hostility of male doctors toward women who worked with them?

Dr. Pamela Toler: Meeting a hostile doctor was almost a rite of passage for nurses as they arrived at a new hospital. But over time most of the women who volunteered as nurses in the army's hospitals wore down individual doctors' objections to their presence. The longer a nurse was on the job, the more likely she was to conquer the prejudice of the doctors she worked with.

Robin Lindley: Did you find that many African American women served as nurses? Although the series features African American characters including a prominent free black man with surgical skills and a contraband laundress, it seems that no black nurses worked at Mansion House.

Dr. Pamela Toler: This is a complicated question. As the Union army moved south, hospitals hired increasing numbers of escaped slaves to work. Most of them seem to have worked as laundresses, but there is some evidence that suggests that African-American women were often categorized as laundresses even when they performed the same jobs as white nurses.

In contrast, the largest number of women who performed front-line nursing and other hospital work in Confederate general hospitals were African-American slaves, who were either impressed into service or hired out by their owners.

Robin Lindley: What happened to Mary Phinney, Anne Reading, and Dorothea Dix after the war?

Dr. Pamela Toler: Mary Phinney volunteered as a nurse in the France-Prussian War in 1870 and received the Iron Cross, the Prussian equivalent of the Medal of Honor, for her courage in shepherding wounded Prussian soldiers through hostile territory.

Anne Reading married one of her patients in October 1862--an unforgiveable sin from Dorothea Dix's point of view. In the face of Dix's strong disapproval, Reading resigned. It was hard for a married woman to find work as a nurse. Instead she got a job in a factory in Yonkers, where she stayed through the end of the war. Her nursing career was over.

Dorothea Dix was eager to abandon what had become a thankless task and return to her life's work helping the helpless, but she recognized there was little point in resuming her role as an advocate for asylum and prison reform as long as state legislatures focused their time and resources on rebuilding after four years of war. Instead she stayed in Washington, where she appointed herself a one-woman relief agency for disabled soldiers and nurses, poor veterans and their families, and war orphans.

Robin Lindley: Is there anything you’d like to add about your book or other things you’d like readers to know about the medicine and the real nurses of the Civil War?

Dr. Pamela Toler: The performance of volunteer nurses in the Civil War convinced Americans that nursing was not only a job for respectable women, but a profession. Three years after the war ended, the American Medical Association recommended that general hospitals open schools to train nurses. It was a two-edged response to the success of women like Mary Phinney von Olnhausen. The AMA both acknowledged the value of skilled nursing in hospitals and hoped to avoid another flood of untrained and uncontrollable volunteer nurses in future wars.

By 1880, there were a total of 15 nursing schools in the United States. By 1900, there were 432.

Robin Lindley: Thank you for your comments and insights Dr. Toler. Readers are sure to be fascinated by your remarks. You’re a brilliant researcher and storyteller.