History of Medicine

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

Samuel Preston Moore (from National Library
of Medicine)

(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.

     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

James McCaw (from National Library
of Medicine)

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.     

     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

Phoebe Pember, Chief Matron (from A
Southern Woman's Story, at Hathi Trust)

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.

     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.