12/03/2013 10:28 am ET Updated Feb 02, 2014

A Gettysburg Address Call to Arms -- Health Care Arms

No Clara Barton -- yet Louisa May Alcott did address patients' needs and indignities.

I wouldn't assign Alcott's 1863 book to my health-science students, but I would urge it on VA hospital administrators and politicians who claim to be concerned about wounded warriors and their health care.

.... some of Alcott's accounts of the management of the Civil War hospital (which she dubbed "Hurly-burly House") might describe the administration of some of our 21st century VA hospitals.


Seven Score and Ten Years Ago, Louisa May Alcott brought forth a collection of letters conceived in her relatively brief service as a volunteer nurse, and dedicated to the proposition that not all military hospitals were created equal.

Now our nation is engaged in a great civil conflict over health care, testing whether compassion, resource allocation, and fiscal sanity may (or may not) long endure.

The 21st century world has paid little note and the reading public has not long remembered Alcott's 1863 military medical observations. Sadly, most regrettably -- tragically -- there is, as to wounded warriors, much unfinished work -- much to be advanced medically in recompense for their full measure of devotion. Perhaps Alcott's observations and complaints will inspire an addressing, a high resolve -- so that the wounded (in body and mind) shall not have been maimed in vain.

"I want something to do."

That's the opening sentence of Hospital Sketches, Louisa May Alcott's 1863 chronicle of how she became a war-time nurse.

In period detail and prose, she told of her motivations and trepidations. Once past her wardrobe issues, her packing decisions, good-byes, and halting travels south to Washington, D.C., we get to her sketches of how the wounded fared.

We learn what she saw, heard, and felt as a nurse attending to Civil War casualties for about four weeks at a ramshackle Georgetown hotel that served as a makeshift hospital for those who made it back from the Union disaster at Fredericksburg ("Burnside's Blunder").

Before succumbing to typhoid fever and returning to Boston, Alcott washed the wounded and dressed their wounds, served rations, and provided whatever comforts and assurances were appropriate to a patient's condition and prospects.

While her military-hospital nursing tenure lasted just shy of a month, her letters home detailed her significant patient-care involvements and interactions. The letters described the long and exhausting hours of nurses, and physicians.

At home, recovered, Alcott elaborated and expanded on the letters, which, at their new length, appeared serially in an anti-slavery journal published in Boston. Soon thereafter, again in 1863, the articles -- "revised and enlarged" -- were published in book form.

A hundred fifty years later, that embellished manuscript might undergo editorial triage -- a melodrama-ectomy: literary liposuction.

The Sketches are historical in that they do convey a sense of how the wounded and their wounds were dealt with at facilities that were understaffed, undersupplied -- and unprepared for the toll of war. Yet the Sketches seem all too prepared, fussed over: occluded with descriptions and ruminations that are flowery and poetical.

Such potions are not likely to engage the 21st century students who I have to lure to literature: students who spend their mornings and afternoons rushing to physiology lectures, enduring bio-chem labs, cramming for anatomy exams, working in hospitals and ambulances -- and who, still in their clinical uniforms, somehow make their way into my evening classrooms.

A Louisa May Alcott biographer noted that "from the innocence of ignorance Alcott -- an ardent abolitionist -- had welcomed the War between the States." So it is understandable that in paying tribute to "our brave boys," Alcott celebrated their "honorable scars" even while acknowledging "the horrors that succeed the glories of a battle."

After a day of attending to the "marred and maimed," Alcott's labor of love was rewarded with "the silent eloquence of those long lines of faces, showing pale and peaceful in the shaded rooms as we quitted them, followed by grateful glances that lighted us to bed, where rest, the sweetest, made our pillows soft, while Night and Nature took our places, filling that great house of pain with the healing miracles of Sleep, and his diviner brother, Death."

Alcott owned up to feeling "a glow of moral rectitude" by being near enough to experience the "solace in listening to recitals of last words, breathed into nurse's ears."

Of a "dead" soldier, she wrote, "though the heavy breaths still tore their way up for a little longer, they were but the waves of an ebbing tide that beat unfelt against the wreck, which an immortal voyager had deserted with a smile." To her, "half an hour's acquaintance with Death" had made the noble patient and Death "friends."

"Romantically," Alcott revealed that she "felt a tender sort of pride in my lost patient; for he looked a most heroic figure, lying there stately and still as the statue of some young knight asleep upon his tomb... serenely waiting for the dawn of that long day which knows no night."

Here and there, amid such beatitudes, there are telling admissions. Viewing the rough surgeries of those who were rarely salvage-able, obliged Alcott, while on duty, to "cork up" her feelings. She learned "the wisdom of bottling up one's tears for leisure moments." Good lesson, good advice.

Further, she observed, "A hospital is a rough school, its lessons are both stern and salutary." She imparted, "One of the best methods of fitting oneself to be a nurse in a hospital, is to be a patient there; for then only can one wholly realize what the men suffer and sigh for; how acts of kindness touch and win."

Annoyingly, though, she switches back and forth from first person to third person -- referring to herself as young nurse Tribulation Periwinkle.

And while Alcott's accounts of hospital conditions -- disarray and unpreparedness -- deliver doses of war's "gories," some of those injections strike me as officious, self-righteous and self-congratulatory: ("I finally command... I make my demand."). Her appraisals read, Louisa May knows best.

And yet, I wonder if some of Alcott's accounts of the management of the hospital (which she dubbed "Hurly-burly House") might describe the administration of some of our 21st century VA hospitals: "the circumlocution fashion prevailed, forms and fusses tormented our souls, and unnecessary strictness in one place was counterbalanced by unpardonable laxity in another."

And to her credit, she did record her feelings about attending to the boys who had fought for, and been torn apart for, the glory of the Confederacy. Those passages might put some hospital personnel to think about how they would respond to the wounds of those rightly-identified as terrorists or enemy combatants; the wounds rightly inflicted to still the Fort Hood shooter and the Boston Marathon bomber.

And to her further credit, Alcott noted her thought process in deciding how to speak to -- and what to say to -- those who had been torn open and de-limbed; those who were gasping to "bring blessed air to parched lips in a fuller flow" -- with every breath becoming "a stab" and "finding neither forgetfulness nor ease."

Her soothings, and her readiness to take down dictations for last letters home, seemed to bring about a kind of psychological "cease fire" to those who had diagnosed themselves to be "goners."

Rueing the Fredericksburg disaster (the Burnside Blunder), Alcott mourned a particular "excellent nature robbed of its fulfillment, and blundered into eternity by the rashness or stupidity of those at whose hands so many lives may be required."

With those observations and condemnations concerning her "little household" -- rarely indulging in "moist luxury" and insisting that the patient and his wounds are not "separate institutions" -- I concluded that Louisa May Alcott was not a little woman.