When soldiers of the South massed around Richmond at the beginning of the Civil War, the city needed more than drill fields and barracks. Richmond needed hospitals, lots of hospitals.
Casualties came by the trainload from the first big battle at Manassas in July 1861. Even more debilitating than the battlefield injuries were the day-in, day-out illnesses that could put half a regiment on the sick list.
Homes in the city became hospitals. Tobacco warehouses became hospitals. Hotels became hospitals. Churches became hospitals. Even a saloon became a hospital.
More than 50 Richmond hospitals took care of the sick and wounded during the war, some for weeks at a time and others continuously.
Perhaps none was more famous than Chimborazo, the hospital that opened 150 years ago this month. Some 76,000 soldiers would be treated there before the war ended in April 1865, giving Chimborazo claim to being the largest hospital North or South. Saturday, that legacy was commemorated by Richmond National Battlefield Park, which includes the Chimborazo Medical Museum.
"The deadliest time in the Civil War is not when lots of battles are raging. It's when lots of soldiers have just joined up, in the fall of 1861," said Mike Gorman, park ranger at Richmond National Battlefield Park. New recruits from isolated farm communities had never been exposed to childhood diseases, so measles and mumps were killers. Poor sanitation in the camps allowed outbreaks of typhoid and dysentery.
"Sick soldiers were dropping like flies," Gorman said. "There was no hospital system. You take the sick soldier into your back parlor and do your patriotic duty nursing him back to health."
Officials soon realized that a professional, centralized hospital system was required.
"Richmond becomes pretty much the hospital center for the Confederacy," Gorman said. The state's railroad network made it possible to evacuate the wounded from Virginia's major battles to the capital.
The city had 28 numbered hospitals, each of which could hold a few hundred patients, and five very large military hospitals such as Chimborazo, which had beds for 5,000 patients in 150 buildings and tents spread across a prominent hill east of town.
Like most of the large military hospitals, Chimborazo grew out of a camp for soldiers coming to defend the city. Its simple frame buildings initially were intended to be winter quarters, but the need for hospital beds was more acute.
Winder Hospital opened in 1862 with a capacity of 6,000 beds in 98 buildings near the city reservoir west of town. Closer to Hollywood Cemetery, Jackson Hospital opened in 1863 and could take about 2,500 patients in 49 buildings. Howard's Grove near Mechanicsville Turnpike was transformed in 1862 from a picnic area into a hospital for up to 1800 smallpox patients in 62 buildings. Stuart Hospital, with 500 beds in 16 buildings in 1864, grew out of the home camp of the City Guard at what's now Monroe Park.
General Hospital No. 9, in the Seabrook Warehouse, became the central receiving hospital because it was close to the Virginia Central Railroad depot. Few of its 900 patients stayed long before being transferred.
The Medical College of Virginia had an influx of students who withdrew from Northern schools, raising its enrollment from about 70 students in the 1850s to 228 students in 1859-60. The college got $30,000 from the state to build a separate hospital facility.
A city with a prewar population of 38,000 was taking care of possibly 10,000 patients.
"How do you feed and clothe them?" asked Bob Krick, Richmond battlefield historian. "There's a whole apparatus they had to create."
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Medical care during the Civil War was better than the myths that surround it, said Dr. T. Adrian Wheat, a retired Army physician who portrayed a Civil War physician at Chimborazo on Saturday.
Anesthesia was available and was used, he said. Chloroform would leave the patient semi-conscious but feeling no pain. "It was like the twilight sedation we use today" for some outpatient procedures, he said.
Alcohol was thought to be a stimulant.
"When you find a man on the battlefield who's been wounded, is weak and has bled heavily, the first thing you want to do is give him a stimulant, to rally the patient," Wheat explained the medical reasoning of the time. Alcohol now is known to have the opposite effect, depressing the nervous system and dilating the blood vessels.
More effective treatments included quinine to treat malaria, and morphine for pain.
Antibiotics, however, were far in the future. The germ theory was a decade away from acceptance. The inevitability of infections meant that amputations became the preferred treatment for bullet wounds that shattered bones in the arms or legs.
"It converted what would have become a deep infection in a ragged wound to a superficial infection on a fresh stump," Wheat said. When nurses painted the stump with chemicals that made it smell better, they were also, unknowingly, killing germs.
Disease was more deadly than wounds. In the first year of the war, about a dozen men died from disease for every man who died in battle, Wheat said.
The Daily Dispatch lamented the toll on Oct. 11, 1861: "The Confederate army has now nearly finished a summer campaign, in which the battle of Manassa was merely an episode, not to be compared in its tragic features to the silent and deadly struggles with sickness and privation which constitute the real battles of every war. We cannot expect our gallant soldiers to triumph over disease and climate."
Some regiments from cities, such as the 1st Virginia from the Richmond area, had less trouble with sickness because their soldiers had already been exposed to childhood diseases, Wheat said. That entire unit had more combat casualties than disease casualties during the war, he said. By the last year of the war, he said, all units had more deaths from battle than disease.
Poor sanitation was also a scourge of both armies. Dysentery and typhoid fever were known as camp diseases, because they were much more prevalent in military camps than in any civilian population, said George Wunderlich, executive director of the National Museum of Civil War Medicine in Frederick, Md.
New recruits didn't follow Army regulations in setting up their camps, sometimes digging latrines that contaminated their water source or not bothering to use the latrines. Disease spread like wildfire.
"Medical officers had trouble enforcing the rules," Wunderlich said. "Once you got sick, it's too late because there's no drug that will take care of you."
The body had to heal itself.
"Nutritious foods were one of the main things that made people get better" from disease, Wheat said. "Scurvy (lack of Vitamin C) delays wound healing."
Poor diets were a shared problem, too, Wunderlich said.
"During the Peninsula campaign attacking Richmond, there was very little in fresh produce getting to the Union Army," Wunderlich said. "There were thousands of cases of scurvy. They had to immediately ship in potatoes and onions to reverse the trend."
When the armies clashed around a city, they often brought disease with them, Wunderlich said.
"In Gettysburg, where two armies came together and lived together for four days, many people died of diseases the armies brought with them. Sharpsburg, Md., and Fredericksburg would have been much more affected (than Richmond) by the troops living in among them and fighting in among them for days at a time. It was devastating."
Except for those brief periods, health statistics didn't change appreciably for civilians, he said.
In the 1850s, life expectancy had been 39.5 years for whites and 23 years for blacks, according to Michael Haines of Colgate University on the Economic History Association website. By the 1860s, whites could expect to live 43.6 years. (No figures were available for blacks.) Infant mortality was about 1 in 5 for whites and 1 in 3 for blacks in both decades. An average white woman would have five children; an average black woman would have seven.
Blacks had their own healing traditions. As the Union blockade hindered the import of medicines, some of the herbal remedies of black and white folk medicine were adopted by the medical mainstream.
"Ironically the Union blockade was good," Wheat said. "A lot of the more drastic purges done to rid your body of ill humors, they couldn't get the medicines, so they used botanical substitutes that were less harmful, and some even had properties that made them useful."
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Even without a germ theory, medical professionals had recognized that cleanliness was related to health. Sally Tompkins gave proof in the small hospital she ran at Third and Main streets.
"She was a huge believer in sanitation," said Marilyn Iglesias, who portrayed Tompkins Saturday at Chimborazo. "When soldiers came in, their clothes came off in the yard. The clothes were boiled and the soldiers were bathed before they came in. Of the 1,333 soldiers treated at her hospital during the war, only 72 died.
When the Confederacy decided that all soldiers should be treated in military hospitals, Tompkins appealed and was commissioned a captain to allow her hospital to continue.
The pavilion style of the new military hospitals allowed air to circulate among the buildings, and the separate buildings also helped slow the spread of infectious disease. The mortality rate at Chimborazo was less than 10 percent, which was good for the time, Krick said.
Much of what we know about that hospital comes from the memoir of Phoebe Pember, chief matron at Chimborazo. A widow, she didn't have to play the game of Southern belle. She told the good and the bad, including the rats that ate poultices applied during the night and dragged away pads stuffed with bran from under the arms and legs of the wounded.
"They even performed a surgical operation," she wrote.
"A Virginian had been wounded in the very center of the instep of his left foot. The hole made was large, and the wound sloughed fearfully around a great lump of proud flesh which had formed in the center like an island. …
"Poor Patterson would sit on his bed all day gazing at his lame foot and bathing it with a rueful face, which had brightened amazingly one morning when I paid him a visit. He exhibited it with great glee, the little island gone, and a deep hollow left, but the wound washed clean and looking healthy. Some skillful rat surgeon had done him this good service while in the search for luxuries."
Maggots also could be disgustingly beneficial.
"I have never found an instance where someone purposely introduced maggots into a wound," Wheat said. "Many, many wounds got maggots. It didn't take a genius to figure that the wounds with maggots were cleaner than the ones without. I think the surgeons learned to leave maggots alone. There are some that eat only dead flesh.
"The patients would just as soon get rid of them."
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Richmond's women also nursed the sick and wounded, not medically but maternally. They wrote letters, wiped a fevered brow, made bandages, changed beds, did errands and brought "delicacies." Men and slaves took care of most medical needs.
Sara Rice Pryor, whose husband Roger became a general, was in Richmond during the Seven Days Battles in 1862 and wrote about volunteering at a makeshift hospital in Kent & Paine's warehouse. After fainting on her first visit, she resolved to overcome her weakness.
"Why had I fainted?" she wrote. "I thought it was because of the sickening, dead odor in the hospital, mingled with that of acids and disinfectants. Of course this would always be there — and worse, as wounded men filled the rooms. I provided myself with sal volatile [smelling salts] and spirits of camphor . . . and thus armed, I presented myself again."
Women such as Pryor tried to provide little luxuries requested by the men.
"One day," she wrote, "a . . . man said to me, 'What would I not give for a bowl of chicken broth like my mother used to give me when I was a sick boy!' I perceived one of the angelic matrons of Richmond at a distance, stooping over the cots, and found my way to her and said: 'Dear Mrs. Maben, have you a chicken? And could you send some broth to No. 39?'
"At noon I happened to look toward cot No. 39, and there was Mrs. Maben herself. She had brought the chicken broth in a pretty china bowl, with napkin and silver spoon, and was feeding … [him], to his great satisfaction."
Most of the hospital workers would have been blacks. A wanted ad in the Daily Dispatch in March 1862 asked for "500 NEGROES (tobacco hands preferred) at Chimborazo hospital, to be employed by the month, at liberal wages."
"If you rolled up to Chimborazo, you'd be surrounded by women but they wouldn't be white," Gorman said. Black women were cooks, laundresses and other household workers. Black men did much of the personal care of patients. "[A white woman] would not be going to a place where men were in their undies and surrounded by black men. It would be degrading. Women would make pies and send them, but rarely go."
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As in most wars, the Civil War produced medical advances.
"It was a watershed in medical history on both sides," Wunderlich said.
The first documented amputee of the Civil War, James Edward Hanger of Churchville, replaced his wooden peg leg with a lighter leg he designed from whittled barrel staves, placing hinges at the knee and ankle. Hanger Prosthetics and Orthotics, the company he founded, continues.
Both armies developed better ways of managing and delivering medical care to the wounded.
"The Confederates came up with a better system for transferring casualties to the hospital by using intermediate hospitals that could stay behind when the army marched off to another battle," Wheat said.
The triage system of deciding who gets immediate attention, development of a field hospital system similar to that portrayed in the TV show "M*A*S*H," and modern medical record-keeping were among the accomplishments on the federal side, Wunderlich said.
Plastic and reconstructive surgery, use of iodine and bromine to fight infection, occupational therapy and the roots of modern nursing and modern neurology can also be traced to the war, Wunderlich said.
The pavilion-style hospital developed at Chimborazo remained in use until World War II, Wheat pointed out.
"It makes you question the standard line about the Confederates never being able to take care of themselves. They're coming up with the exact same solutions that they came up with in the North," Gorman said. "The North didn't have a hospital system, either. The same ideas are being put into practice, and they're doing it remarkably well.
"It's one more step toward further professionalism of the medical field. It's fascinating to watch that happen.
"Who needs a hospital with 5,000 beds before the war? Nobody expected this to happen, and it does. It works."