The next challenge for health care workers in the fight against coronavirus

In the past year, more than half a million Americans have died of COVID-19. Nurses, doctors and health-care workers nationwide have borne the brunt of the vortex of death swirling over the country. That burden is heavy, unfair and lasting.

During the Civil War, nurses faced similar trauma as they cared for soldiers in a mostly losing battle with disease. Instead of the coronavirus, though, those nurses treated soldiers sick with measles, mumps, influenza, gangrene, smallpox and other ailments. They also treated combat wounds. Despite the differences, their experience illuminates the ways that treating patients in any health disaster, from the Civil War to COVID-19, are similar. It also hints at the psychic trauma that may await health-care professionals treating patients during the coronavirus pandemic.

Before the Civil War, the medical profession was composed mainly of male doctors who made house calls to farms and plantations or practiced medicine at city hospitals on the urban poor. The wartime emergency demanded more caretaking volunteers, however, and women answered the call. Many had never set foot in a hospital and were shocked at the suffering and death they witnessed. In 1862, volunteer nurse Kate Cumming left the relative safety of her home in Mobile, Ala., and traveled by train to a hospital in Corinth. Like all antebellum women, Cumming had nursed members of her family in the grip of fever or consoled friends and neighbors after death made its unwanted harvest. But according to her diary, "Nothing that I had ever heard or read had given me the faintest idea of the horrors" she would witness in the wards of Corinth.

After major battles, Civil War nurses were almost overwhelmed washing the grimy bodies of innumerable soldiers from both sides, splinting broken arms and legs, and trying desperately to plug arterial bleeds. Opportunities to eat or rest were rare. "I have been busy all day, and can scarcely tell what I have been doing," Cumming wrote in her diary while nursing the wounded from the Battle of Shiloh. "I have not taken time even to eat, and certainly not to sit down." In the weeks and months between battles, nurses mostly fought a losing fight against disease. Country boys fell victim to measles and mumps. Others experienced waves of diarrhea and dysentery, influenza and pneumonia.

Losing soldiers to illness and disease was heartbreaking for nurses such as Cumming. After an attending surgeon told her that two of her patients "would [not] live to see another day," all Cumming could do was console them as they neared death, holding their hands and promising to notify their families of their passing.

The hospital was a place where death was common, as every day it seemed another soldier gasped his last ragged breath. Some hospital workers were deeply shaken by the experience. "Dr. Allen was conversing about the horrors with which we are surrounded," Cumming wrote in her diary. "He remarked that it was hard to think that God was just in permitting them."

More commonly, though, many nurses noticed they increasingly grew desensitized to the shock and pain of constant death. Amanda Stearns, who had left her Quaker family in Upstate New York to become a nurse at Amory Square Hospital in D.C., admitted that she had "forgotten how to feel" and that she felt "entirely separated from the world I left behind. I am not myself at all."

During the war, an estimated 10,000 women served as nurses for the Union, while an unknown but probably similar number served as nurses for the Confederacy. They took care of thousands of patients, with ultimately an estimated 750,000 men — from both North and South — dying from combat wounds or sickness. Soldiers were twice as likely to die of a microbial infection than from Minie balls.

The ingenuity of doctors and nurses helped save lives as the war progressed. For example, they learned to isolate patients with fever, gangrene or erysipelas to prevent the infections from spreading. "The rule is to remove bad fever patients out from the main wards to a tent by themselves," Walt Whitman wrote from Armory Square Hospital. That same ingenuity has manifested amid COVID-19, as health-care workers have found more effective treatments, such as dexamethasone and turning patients on their stomachs.

Even so, following the Confederate surrender, the trauma of their work stayed with these medical professionals. Cumming joined a ragtag company for a long and arduous return trip to Mobile. Along the way, she was occasionally plagued by visions of her time in the hospital. "Oh I felt so sad!" she wrote, "Visions of the terrible past would rise in review before me — the days, weeks and months of suffering I had witnessed — and all for naught. Many a boyish and manly face, in the full heyday of life and hope, now lying in the silent tomb."

These flashbacks or hallucinations struck Cumming randomly with a force and vividness that shocked her. Such symptoms are emblematic of traumatic disorders, such as post-traumatic stress disorder, the signature symptom of which is reexperiencing a trauma through invasive nightmares and/or flashbacks.

Cumming was not alone. Whitman suggested that he, too, was haunted by visions of his time in the hospitals of Washington, where he had worked as a nurse of sorts. After the war ended, he published a poem titled "Old War Dreams," in which he described being chased in dreams by visions of his experiences in the hospital. He referenced moments that were seared in his memory: pale faces in anguish, the desperation in the eyes of mortally wounded men, and cold, clammy bodies splayed on their backs awaiting interment.

This evidence, while not conclusive, suggests that Civil War healers could have endured invisible wounds from the war. Many coped with the experience of the war and went on to live healthy, well-adjusted lives. For both Cumming and Whitman, writing may have been a balm, a healthy way to cope with their hospital dreams. Cumming also found solace in the evangelical Protestantism of the South.

It is only reasonable to assume that health-care workers today may suffer from the same psychic trauma. We have passed half a million deaths as a result of the coronavirus pandemic. That alone could be traumatic — especially given how many of those deaths might have been prevented by better adherence to practices such as mask-wearing. Health-care professionals have also witnessed colleagues falling sick and dying. One New York City doctor has died by suicide. The past calls out to us and warns us that we will need to take care of the health-care workers who have so bravely taken care of all of us.

Dillon Carroll is a historian and freelance writer in Sacramento, and is currently writing a book on Civil War veterans and mental illness. This piece was written for The Washington Post.