Civil War Nursing and Literary Realism in Hospital Sketches

Narrative Origins and Publication History Thinly disguised as a novel, this account of Louisa May Alcott’s venture to the Union Hotel Hospital in Washington, D.C., during the early stages of the American Civil War details the young, untrained woman’s new challenges. These duties included wiping the brows, cleaning the bodies, and writing the mail for soldiers—both Union and Confederate. Printed first in serialized form in the Commonwealth during May and June 1863 (within the year of Alcott’s experience), it was published in book form two months later. Influenced by Charles Dickens’s Bleak House, Alcott blends the tragedy of those who fill the messy hospital beds in the middle of Washington with satiric thrusts at many of the characters, particularly the central figure Tribulation Periwinkle, whose adventures mirror those of Alcott.

The Heroine's Journey to Hurly-Burly Hospital "I want something to do," declares Trib in the book’s opening. Indeed, she finally has a great deal to do, but first and for many pages she takes us swiftly through a burlesqued version of the Alcott family and the tribulations of Trib in actually reaching Hurly-Burly Hospital. The Periwinkles, she says, "are a hopeful race. . . . They all wear rose-colored spectacles and are lineal descendants of the inventor of aerial architecture" (4). So much for Bronson Alcott’s lofty pronouncements. Periwinkle/Alcott is also humorous about herself; the minute she signed up—not an easy task—"I turned military at once, called my dinner my rations, saluted all comers, and ordered a dress parade that very afternoon" (6).

Historical Realities and Racial Perspectives The trip itself she compares to Christian’s pilgrimage in Pilgrim’s Progress, especially his crossing of the "Slough of Despond," but finally she reaches Baltimore—"a big, dirty, shippy, shiftless place, full of goats, geese, colored people, and coal" (16). The reference to "colored people" is one of many in the book; her father may have braved an angry mob to help a slave, but Alcott’s racial attitudes bear some scrutiny:

"But more interesting than officers, ladies, mules, or pigs, were my colored brothers and sisters, because so unlike the respectable members of society I had known. Here was the genuine article . . . the sort of creatures generations of slavery have made them: obsequious, trickish, lazy and ignorant, yet kind-hearted, merry-tempered, quick to feel and accept the least token of . . . brotherly love." (57–58)

Alcott’s attitudes toward race, toward the city of Washington, toward wounded men she found (mostly) so sweet, and toward her own development as a woman at work in a critical job make Hospital Sketches one of Alcott’s most interesting books.

Clinical Realities and Medical Trauma For her first two days Trib, who knew nothing of medicine or, for that matter, of men, ran from bed to bed in a 40-bed ward nursing pneumonia, diphtheria, and typhoid victims. On the third day, 40 ambulances arrived from Fredericksburg to overflow the 80 available beds. They were announced by "a little wooly head," Joey: "Miss Blank is jes' wild fer ye, and says fly around right away. They's comin' in, I tell yer, heaps on 'em—one was took out ded, and I see him—Ky! warn't he a goner!" (21).

Tragic Realism and Personal Cost The book moves from high adventure and satire to serious reflection. Alcott praises the stoicism and silence of the suffering men, their reluctance to let her witness the worst of their suffering or to labor over them. Half an hour after the death of a man she had attempted to help, the bed had been emptied. "It seemed," she said, "a poor requital for all he had sacrificed and suffered . . . no familiar face for him to look his last upon . . . no hand to lead him gently down into the Valley of the Shadow" (28). Tribulation Periwinkle says of the letters she writes to mothers, sisters, and wives from their gravely wounded relatives that they are "an excellent chapter for some future history of the war" (30). Hospital Sketches is, itself, "an excellent chapter" on the Civil War—and on the development of Alcott. Her work at "Hurly-Burly" (Union Hotel) Hospital was cut short by her own serious illness, typhoid pneumonia. She recovered from the disease but never from the treatment—the poisonous calomel (mercurous chloride, Hg₂Cl₂) with which she was dosed—or from the jarring images of hell she witnessed.

For Discussion or Writing
1st question: What do you make of the blend of satire and raw remarks Tribulation directs at herself and others and the sudden shifts to genuine sadness and tragedy?

2nd question: What are Tribulation’s strengths and weaknesses? Does she seem interested in others in her new little world? Which character would you nominate for second in importance to Tribulation herself?

3rd question: Research Civil War hospitals. How many of the wounded arrived alive at such hospitals? How many of those who did were saved to live full lives? What was the role of such "nurses" as Tribulation/Louisa?