What Louisa May Alcott's 'Hospital Sketches' reminds us about military hospitals

“I WANT something to do.”

That’s the opening sentence of “Hospital Sketches,” Louisa May Alcott’s 1863 chronicle of her time as a US Civil War nurse. 

In period detail and prose, Alcott tells of her motivations and trepidations. Once past her wardrobe issues, her packing decisions, goodbyes, and halting travels south to Washington, DC, we get to her sketches of the wounded and how they fare.

Alcott was no Clara Barton and so it was easy for me to decide not to assign "Hospital Sketches" to the health science students in the “medical moments” literature-and-film courses I teach at Quinnipiac University. But I would definitely urge it on Veteran Administration hospital officials and politicians dealing with wounded warriors and their healthcare.

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. 

The "Sketches" are historical in that they do convey a sense of how the patients and their wounds were dealt with at facilities that were understaffed, under-supplied, and unprepared for the toll of war.

I can't help wondering if Alcott’s accounts of the management of the hospital (which she dubbed “Hurly-burly House”) might not ring true at 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 of course the pain of seeing others suffer remains completely contemporary, despite the advances medicine has made since Alcott's time.  Viewing the rough surgeries of those who were rarely salvageable, 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 advised, “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.”  

Unfortunately, to today's reader, the "Sketches" seem all too prepared, fussed over, occluded with descriptions and ruminations that are flowery and poetical. The book is not likely to engage the 21st-century students whom I attempt 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. 

Alcott can be annoying when, as the book's narrator, she switches back and forth from first person to third person, referring to herself as young nurse Tribulation Periwinkle.  And while her accounts of hospital conditions – disarray and lack of preparation – 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.”). In other words: Louisa May knows best. 

And yet, there remains much in this book that touches, with words as unsettling today as the day they were written. Ruing the death of a soldier due to the disastrous Battle of Fredericksburg (also know as 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.”

Reading such observations and condemnations, I can only conclude that Louisa May Alcott was no little woman.

Joseph H. Cooper teaches “medical moments” literature-and-film courses at Quinnipiac University.  His “Pauses and Moments” columns appear at PsychologyToday.com.