chimborazo
hospital
the
largest in the world
Medicine during the
Civil War on the Union side has been well described. What about military medicine
in the South? A note on the South’s largest Civil War hospital can serve as a
starter.
When Fort Sumter was fired upon the
Union Army already had medical services in place, complete with a Surgeon
General, career medical officers, and hospitals. Conversely, the South had to put
together a new government, an army, and an army medical service from scratch.
The Confederate Congress created the Medical Department in February 1861 and
President Jefferson Davis appointed Dr. Samuel Preston Moore as Surgeon General
(replacing an earlier, brief appointee), a wise choice. After attending the
South Carolina Medical College Moore had joined the U.S. Army Medical Dept, working
in various western posts. He served in the Mexican-American War, where he met
Jefferson Davis who was impressed with his organizational skills. When S.
Carolina seceded Moore resigned his Army commission and was later appointed by
Davis to run the Army Medical Department. He was a stern but efficient
administrator.
 |
| Samuel Preston Moore (from National Library of Medicine) |
Moore centered the Medical
Dept in Richmond, as it was the Confederate capital, the largest city in the
area, a hub for railroads, roads, and shipping, and was near the fighting. When
the shooting started sick and wounded poured into the city, overwhelming the
hastily established hospitals. Dr.
James McCaw, a professor at the Medical College of Virginia, advised Moore to
utilize a hilltop near the city (where a brewery had
existed) for a new and
larger hospital. Moore authorized its construction and put McCaw in charge. Constructed
with slave labor, Chimborazo was the first pavilion-style hospital in the U.S.,
composed of separate wooden buildings, each with its own ward (for maximum
ventilation), a design suggested by Florence Nightingale after the Crimean War.
 |
| James McCaw (from National Library of Medicine) |
Eventually 150 buildings went up in a gridded arrangement, most of them
30-bed wards. Included were a centrally located storage building, along with
repair shops, apothecary, kitchen, bakery (that could bake 10,000 loaves a day),
stables, grazing cattle, and vegetable gardens. Tents were erected around the
periphery to house convalescents (who were given hospital duties later in the
war). It was the largest hospital in the world when completed, and at its peak
held 3000, sometimes more, patients.
Dr. McCaw, the
Surgeon-in–Chief was organized and knowledgeable. He employed resourcefulness,
tact, and a knack for skirting restrictions to keep the hospital going to the
end of the war. As the Union Army closed in supplies were ever scarcer, forcing
doctors to improvise, and experiment with whatever was at hand – turpentine
instead of quinine for malaria, for instance.
 |
| Model of Chimborazo Hospital, without tents (National Park Service, through Wikipedia) |
A major advantage of the pavilion system was the ability to assign
patients to groups. At first they were grouped from the same state. Later they
were sorted by disorder: febrile diseases in one ward, other medical diagnoses
in another, certain wounds in some, etc. Specialized care naturally developed,
a trend seen in both North and South and continued after the war. Tents were used to isolate those with
smallpox, rubella, etc.
The hospital comprised five “divisions”, each with its own staff. The
“matron” took care of food and cleaning, the nurses (comprised mainly of
convalescent soldiers and volunteer women) nursed the sick, and the stewards
handled procurement of supplies. The matron held the key over the monthly “whiskey
barrel”, that officers frequently tried to requisition “for patients”. One
chief matron, Phoebe Pember, relates this struggle in a memoir. Most of the
kitchen personnel and orderlies (and some nurses) were
African-Americans,
impressed into service from both slave and free status. All blacks were paid
(not to exceed a soldier’s pay), and received extra pay on major holidays.
 |
| Phoebe Pember, Chief Matron (from A Southern Woman's Story, at Hathi Trust) |
Altogether during the war 77,889 were admitted to Chimborazo. Reflecting
the ignorance of germ theory, 50,350 were for medical illness (mainly
infectious and “camp” diseases – diarrhea, dysentery, typhoid, etc.), 14,661
for wounds and injuries, 12,000 with no diagnosis, and a few others. Pneumonia,
tuberculosis, malaria, and skin diseases were also common. Scurvy broke out
later as food supplies dwindled. Nineteen other new hospitals went up in
Richmond, replacing the original makeshift ones.
“Hospital gangrene” was a feared complication of wounds. Though caused
by various mixtures of bacteria, surgeons then knew only that it seemed to be
contagious and was most common where tissue was devitalized. Swift isolation of
fresh cases, irrigation, debridement, covering wounds with clean dressings, and
the use of antiseptics, especially nitric acid (which had to be applied under
anesthesia), seemed to control spread – techniques used in both the North and
the South, and all before the germ theory was known. Patient records indicate
that stethoscopes were used with some frequency. Rats and maggots were frequent
pests.
The hospital staff maintained a close relationship with the nearby
Medical College of Virginia (the only southern medical school that remained
open during the war). Doctors attended lectures to keep abreast of new
developments. Medical students gained experience on the wards as stewards. The
Association of Army and Navy Surgeons of the Confederate States was organized
in mid-war to read and discuss papers, many published in the newly created Confederate States Medical and Surgical
Journal. Access to outside literature was limited.
After the war Chimborazo was used as a school for freed blacks, holding
day and night classes, and as a refuge where destitute ex-slaves could be fed
and clothed. It later was replaced by a brewery (that failed) and eventually
was turned into a National Park and memorial to a unique hospital.
SOURCES:
Cunningham, H
H. Doctors in Gray: The Confederate
Medical Service. 1958. Louisiana
State
Univ Press
Green, C C. Chimborazo:
The Confederacy’s Largest Hospital. 2004. Univ of Tennessee
Press.
Pember, P Y. A
Southern Woman’s Story: Life in Confederate Richmond. 1959.
McCowat-Mercer
Press.
