Dorothea Dix had built a global reputation as a reformer for mental health institutions in the 1840s and 1850s. She had already changed medicine by insisting that the most vulnerable in society were treated with dignity. When the Civil War started, her influence would spread even further as she moved to change the nursing profession.

Dix, a Massachusetts native, was already 59 years old when the Civil War erupted. She had spoken out against slavery in the past, and though she could not serve in the military, she was determined to serve in some capacity.

In June 1861, Dix was appointed superintendent of army nurses, though she was a civilian. Her position, based in Washington, DC, made her the highest-ranking woman in the history of the federal government to that point. There was very little formal training for nurses at that point, but Dix was in charge of training the volunteers who stepped forward as nursing shortages increased. As casualties mounted, she was also in charge of setting up field hospitals to treat the wounded.

One of the nurses she helped train was noted novelist and poet Louisa May Alcott. Alcott later remembered Dix as immensely respected but also a stern disciplinarian, which intimidated many of the other nurses. What also impressed many nurses was Dix’s insistence that all patients be given the best care and treated as equals in the hospital, regardless of whether they were Union or Confederate soldiers.

Dix insisted that women be allowed to serve as nurses, but it was a struggle for Dix to get women trained as nurses. At the time, many people consider it unseemly for women to see the ravages of war or even to see men in various stages of undress, which is often required of nurses in surgical and hospital settings.

Often, she feared for the well-being of nurses, decades before sexual harassment became a legal issue in the American workplace. Unable to offer them legal protections, however, she instead insisted on strict dress codes and strict codes of conduct, hoping to deflect attention from unwanted advances.

She found it difficult to work in a bureaucracy – for her whole career, she had either run her own school or been a one-woman crusader and reformer. The stresses and demands of so many different groups were overwhelming for her, and she often commented that she was disappointed in her results. She stepped down from her position in August 1865, a few months after the war ended.

As a result of the work of Dix, Red Cross founder Clara Barton, and others, Americans began changing the way they saw nurses, steadily allowing it to become a viable career for women outside the home in a time when many medical schools and universities would not admit women at all.

After the Civil War, Dix continued to work to reform prisons and hospitals, taking her work across the South. She spoke extensively across the nation and in Europe and also helped raise funds for memorials to the fallen soldiers of the Civil War. Her pace slowed considerably after she fell ill with malaria in 1870.

Dix never married or had children. By 1881, when her advancing age and fragile health prevented her from travelling the country, she settled into retirement at the New Jersey State Hospital. Administrators had set aside a comfortable private room for her years earlier in honor of her work for patients over the years. She spent the next six years there, not as a patient, but as an honored guest, corresponding with activists, physicians, politicians, and well-wishers. She died quietly in 1887 at age 85.

In 1956, the psychiatric hospital she helped found in North Carolina in 1856 was renamed for Dix. The post office later issued a stamp in her memory as well. Astronomers named a crater on the planet Venus after her. In 2006, a hospital in Maine was renamed for her. Her most lasting legacy, however, was reminding the world of the value of the patient, no matter who it may be.