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For an aspiring writer, it was a grueling, at times unbearable life—baking, washing, mending, ironing, jobs that at the time could last for days. In 1858 she wrote to her married sister, “If I think of my woes, I fall into a vortex of debt, dishpans and despondency awful to see…so I say, every path has its puddle and I trust to play gaily as I can… in my puddle… while I wait for the lord to give me a lift.”

For “economic salvation” she considered marriage. She considered it all of one day, coming to the same conclusion that Susan B. Anthony reached on behalf of an undecided niece: “Marriage. It is an all absorbing profession.” Instead, she worked as a seamstress, a paid companion. She took teaching jobs at her father’s school and argued with him about his plans to leave her the school (she didn’t want it). As her mother aged, more of the housework fell to Louisa and her less-than-enthusiastic youngest sister. She had to get out. The Civil War was on, and she wrote in her diary: “November—30 years old. Decided I must go to Washington as a nurse, if I would find a place. Help is needed and I love nursing and MUST LET OUT MY PENT UP ENERGY in some way. I want new experiences…. So I’ve sent my name in if they will have me.”

In Washington she worked diligently as a nurse-in-training at the Union Hotel Hospital, where she treated thousands of injuries, witnessed terrifying operations and many deaths. For a woman who’d spent most of her life indoors, it was an astonishing experience and she afterward reworked her letters home into a book called Hospital Sketches (1868).

She never really went “home” after the war. Living but not slaving in Concord, she became the editor of a children’s magazine, Merry’s Museum, and worked continuously for the suffrage movement. (She was the first woman to register to vote in Concord after Massachusetts passed its state suffrage law.) She wrote ten novels and two volumes of nonfiction. When her youngest sister died, she adopted her niece, Lulu, who’d been named for her, and took her to Boston, where she established a new family compound.

Louisa May Alcott never married because she could not envision the latter half of her life, like the first part, trapped in a house that needed cleaning. As she put it: “The loss of liberty… and self-respect is poorly repaid by the barren honor of being Mrs. instead of Miss.”

Like Louisa May Alcott, Clara Barton, the youngest of five children, longed to escape from Massachusetts, once writing in her diary, “Have ye work, my brave countrymen, real work for me there?… Is there anything useful I can do?” She’d been working since age fifteen when, after tutoring her at home, the family sent her out as a teacher. For years she reported feeling nervous in these jobs, insecure, and always tired. She later worked to organize free schools in towns throughout New England—apparently still feeling very shy but not always quite so nervous. She was most proud of an experimental free school she had planned and opened in New Jersey. But when she learned that her male coworkers, even those beneath her in the hierarchy, were earning more than she was, she quit, “full of familiar uncertainty and queer sickness.”

Through an acquaintance, Clara took a “real” job in the U.S. Patents Office in Washington—at just about the time wounded Civil War soldiers started appearing in the city. Although her only nursing experience had been the two years she spent tending a sick brother, she immediately began to organize relief efforts. Her quick, critical observation was that nurses were plentiful; supplies were short. She collected and advertised for food, blankets, and medicine and soon after founded an organization that would distribute goods to battle sites. The scheme was so efficiently executed that the U.S. Surgeon General granted her a pass to travel with army ambulances “for the purpose of distributing comforts for the sick and wounded, and nursing them.”

She was one of the only women on the front lines of the Civil War, appearing as if on schedule at every major battle and making sure there was enough of everything to go around. After the war she spent years working to find soldiers still missing in action. She also took her first trip to Europe and while there met with members of the International Red Cross. Immediately she envisioned an American branch, an organization that would function like a Clara Barton during the Civil War: getting supplies and other assistance to disaster sites. Despite complex political opposition, she opened the first chapter of the American Red Cross in 1881 and began training recruits in emergency procedures and a new concept she had devised called “first-aid skills.” Barton invented the first-aid kit. She wrote a book called The Women Who Went to the Field, a Civil War study that included Louisa May Alcott. She was present at many Red Cross interventions—fires, floods, tornados. As an older woman, she became one of the first female diplomats in U.S. history and spent six months as a substitute prison warden. She was the first woman ever to hold such a resolutely male post. It was often said—and this was a real first—that she was “very popular among the prisoners.”

* * *

Florence Nightingale’s story had a far stranger and more ambiguous ending. When the Crimean War ended, something in Florence, arguably the most famous woman in England, seemed to snap.

Whether it was battle fatigue, psychosomatic or genuine illness—she’d been exposed to hundreds of viruses—she retreated to bed, alone, refusing all requests to appear or speak. The quarantine lasted months, until she was named to a royal commission investigating health issues in the British army. She was also commissioned to write a monograph on the health of the British military in India. In 1860 she published Notes on Nursing, a guide that is still in print, and used the rest of her Crimean funds to open her own training hospital. But most of this activity, including her involvement in the Nightingale clinic, took place from her room. She communicated through letters and rarely spoke.

By age forty she had done it all—reached her professional peak and permanently won the war with her mother. It is hard to believe, but during the remaining fifty years of her life, Florence rarely left her flat. Now and then she heard or gave lectures, attended openings for hospitals, and had graduating students of the institute over for tea. But the majority of her time she spent in bed with a malady even she could not cure.

I’ve always thought that Charlotte Perkins Gilman had Florence in mind when she wrote her short story “The Yellow Wallpaper” (1892), the tale of a woman confined to bedrest. (The diagnosis: nerves, neuritis, neuralgia—the vague ailments ascribed to uppity women—a version of which appeared on aspirin labels into the 1960s.) All day the woman stares at the wallpaper, until one day its shapes and patterns—yellow flowers, loops, and vines—start to undulate. Then one day a vine turns into a tiny struggling woman. Every day thereafter, she wakes to see tiny women crawling everywhere, trapped inside the yellow wallpaper, until the entire room is overtaken by a howling morass of fairy-size women.

Florence Nightingale is pictured in most history texts as a female crusader wearing a halo. Fair enough. She was a brilliant exemplar of what single women could accomplish despite intense opposition. But she is also a strange and bitter reminder of the high personal price such women paid.

AND NOW THE POOR DEAR THING