For someone who was not educated as a nurse, Dorothea Lynde Dix made quite an impact on the profession in the United States. A social reformer, educator and nursing pioneer, Dix was instrumental in improving care for prisoners, the disabled and mentally ill during the 19th century.

Born in 1802 in Hampden, Maine, Dix spent most of her childhood in Worcester, Mass. The daughter of an alcoholic father and a mentally unstable mother, Dix was forced to grow up fast and take care of her two younger brothers. When she was 12, the Dix children were sent to Boston to live with their grandmother.

Dix’ maturity and experience caring for her brothers led to an interest in teaching. In 1816, when she was only 15, Dix began teaching at a small private school, which she ran for three years.

She wrote children’s books and taught until 1836, when she began taking care of her sick grandmother. Later that year, her own health problems took their toll and she moved to England to recuperate. After five years in England, Dix’ health had improved and she returned to the United States.

With her grandmother and mother now dead, Dix was ready to embark on a new mission at age 39. She volunteered to teach Sunday school to female inmates at a jail in Cambridge. Appalled by the horrible conditions at the jail, she was inspired to become a crusader for inmates and the mentally ill.

Dix did extensive research, visiting jails and almshouses around Massachusetts, carefully documenting conditions and interviewing people in the system. Her work led to a report entitled, “Memorial,” which she delivered to the state legislature.

“I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience,” she wrote.

Her efforts and her influence with the governor resulted in an expansion of the state’s mental hospital in Worchester. Dix didn’t stop there, traveling to every state east of the Mississippi and helping to start 32 mental hospitals, 15 schools for mentally challenged students, a school for the blind and a number of nurse training programs. She also established libraries at correctional institutions and mental hospitals.

After 13 years of fighting to help inmates, disabled and mentally ill, Dix went for broke. She proposed that the federal government set aside millions of acres to take care of the mentally ill. Although the bill passed both houses of Congress, President Franklin Pierce vetoed it in 1854.

The defeat inspired Dix to take her crusade cross the Atlantic to Europe. She traveled to France, England, Germany, Belgium, Scotland, Russia, Italy, Greece, Turkey, Sweden, Austria, Denmark and Holland to spread her gospel of improving conditions in jails and almshouses.

She returned to the United States in 1856 and continued her work in the states she hadn’t investigated previously.

When the Civil War broke out in 1861, she was appointed Superintendent of Army Nurses for the Union. She recruited, trained and oversaw more than 3,000 nurses to work in military hospitals and fought to convince doctors and military officials that female nurses were fit and qualified to serve. Dix was an early crusader for patient advocacy, working to improve care for the wounded and making sure injured Confederate soldiers were treated on par with their Union counterparts. Clashes with doctors and military officials led Dix to resign her post in 1865.

After the war, Dix returned to her work improving care in prisons and mental institutions. One of her first tasks was to travel to the devastated post-war South to examine the conditions there.

By 1881, her health was failing and Dix moved into an apartment at Trenton New Jersey State Hospital, which she founded in 1848. She died on July 17, 1887, at the age of 85.