Hume, Edgar Erskine. "Chimborazo Hospital, Confederate States Army, America's Largest Military Hospital" Virginia Medical Monthly (July 1934), pp. 189-195.

CHIMBORAZO HOSPITAL
CONFEDERATE STATES ARMY—
AMERICA'S LARGEST MILITARY HOSPITAL*

By MAJOR EDGAR ERSKINE HUME, M.C., U. S. Army

(With two illustrations)

THE honor of speaking on this historic occasion is one which any Southern man would appreciate. It is also to me a privilege because, a military surgeon myself, I am at present the librarian of the Army Medical Library in Washington, the largest medical library in the world, an institution which from 1904 to 1913 was directed by Brigadier-General Walter Drew McCaw, the distinguished son of the founder of the Chimborazo Hospital. As it fell to my lot during the World War to have charge of the hospitals of the United States Army in the Italian War Zone, I know something of what it means to conduct an institution of this kind, though under the conditions of the World War with no shortage of supplies, equipment, or personnel, I can sense only at a most respectful distance, the difficulties under which the Chimborazo Hospital functioned so efficiently.

The site of the Chimborazo Hospital, here on an elevated plateau above Jeemses River, as I am sure most of its inmates called it, was well chosen. It was separated from the city of Richmond by Bloody Run Creek, significant name given it by the Indians in Colonial days. It came into being in 1862 when General Joseph E. Johnston reported to the War Department that with the enemy's move in force on Bull Run, some nine thousand men would have to be sent back to Richmond. The distinguished Surgeon General of the Confederate States Army, Dr. Samuel Preston Moore, a former officer of the regular United States Army, knew to whom to turn in the emergency. He went at once to see Dr. James Brown McCaw, one of the most noted of Richmond's physicians. Dr. McCaw was already in his country's service, having early in the war joined a company of cavalry. But a greater duty lay before him, and unhesitatingly he assumed the great task.

He selected the site, and with almost unbelievable speed, the hospital was made ready to receive patients. At the time of General Johnston's warning to the Surgeon General, that officer had only 2500 beds at his disposal. To he ready to receive 9000 and probably many more patients within a brief period required great skill in administration and organization. Surgeon General Moore and Surgeon McCaw had these qualities. Work began immediately, and 150 wooden buildings were completed. These were, of course, not all set up at once, but, as is usual in war time construction, as fast as needed and as fast as materials and workmen could be supplied. It must not he supposed that the entire construction of the Chimborazo Hospital was completed in a few days' time. The buildings had in many eases merely to be remodeled, for they had been constructed as winter quarters for the Army of Northern Virginia, but the enemy's drive on Richmond forced the Confederate Army to fight the winter out at Manassas.

The buildings measured approximately 100 feet in length by 30 feet in width. They were of one story, seven feet in height. Each building had ten windows. From forty to sixty patients were accommodated in each building.

Not only were the buildings themselves airy, but they were not placed too near together, and ample space for drives and walks was allowed. Realizing the necessity for proper ventilation, the Commandant ordered an allowance of approximately 800 to 1000 cubic feet of air space per patient, and that attendants and others be not permitted to sleep in the wards, for they would in that way have reduced the amount of fresh air available to each patient. The prevailing breeze from the Southwest from the nearby woodlands was always a source of comfort. This regulation is exactly what we required in the World War during the epidemic of influenza.

In addition to the 150 hospital buildings, the post included 100 Sibley tents in which eight to ten convalescent men could be quartered. These tents were spread upon the slope of the hill.

"The hospital," wrote Surgeon John R. Gildersleeve, C.S.A., "presented the appearance of a large town, imposing and attractive, with its alignment of buildings kept whitened with lime, streets and alleys always clean, and with its situation on such an elevated point, it commanded a grand, magnificent, and pleasing view of the surrounding country for many miles." In the first week two thousand patients were received, and in two weeks' time there were in all four thousand.

The site was well chosen and had an ample supply of good water. There was natural drainage on the east, south and west. There were five large ice houses, Russian bath houses, and adequate provision for the disposal of wastes. Dr. McCaw profited by the hard lessons learned in the first year of the war when there was general confusion and the belief that the war would he of brief duration. He stressed the importance of cleanliness and that the mental attitude of the patient had much to do with his recovery.

The Secretary of War saw the desirability of having the Chimborazo Hospital function as a unit, free from the usual army routine. To accomplish this, he made the institution and its grounds an independent army post, with Surgeon McCaw as Commandant. An officer of the line and thirty men were stationed there to assist him in maintaining discipline. There being no precedent for such a military post, the Secretary of War was somewhat perplexed about a suitable name for the station itself and title for its commanding officer, who was not an officer of the regular Confederate States Army. At Dr. McCaw's suggestion the institution was given the name Chimborazo from that of the hill where it stood, and its director, Surgeon McCaw, called Commandant and Medical Director-in-Chief. Dr. McCaw held this position during the whole existence of the hospital.

The Chimborazo Hospital, or, as we should in modern military terms call it, ''The Chimborazo Hospital Centre,'' was built and operated not only in accordance with the best medical opinion of that day, but it will hear comparison with large military hospital centres even of the World War.

The hospital centre, using the modern term, consisted of five separate hospitals or divisions, thirty wards or buildings to each. A Surgeon was in charge of each of the five divisions, with Assistant Surgeons or Acting Assistant Surgeons in charge of the several wards or buildings. When the wounded were first brought in, soldiers were assigned to vacant beds without regard to their homes or their military organizations. Later separate divisions were appropriated to men from different sections of the country. Schedules showing where patients from different states were quartered were published in the Richmond newspapers. This made it possible for State and private organizations to send supplies to their men and supplement those received from the Government. This organization of the hospital upon a geographical basis proved an effective means of keeping up morale. Many of the wounded and ill men were thus treated by their regular family physicians or others of whom they had heard or known. The value of this system in a provisional government with slender resources must be realized.

In the conduct of the Chimborazo Hospital the director bore in mind the fact, often overlooked by Northern historians, that the number of men of the upper classes of the South serving in the ranks was great. The division of the hospital into wards and larger units for those of each local community was appreciated by such men.

There is something inspiring about a military hospital. Any hospital demands our respect as an institution dedicated to the relief of suffering, to the restoration to health, to the demonstration of highest Christian ideals. But a military hospital is more. Here are treated not only those who have fallen victims to disease such as might occur at any place and at any time, but also those who have been but recently in the best of health but who suddenly have been stricken down by a man-made agent of destruction. They have of their own accord gone to the scene of danger borne along by idealism, by love of country, by unselfishness. In a military hospital the patients are all men—mostly young men, and in this lies the most heartbreaking cruelty of war. Schiller has said Der Krieg verschlingt die Besten—War engulfs the best. And so it seems, though in the words of the Spartan, "The arrow would be of great price if it distinguished brave men from cowards." The best of the land arc offered on the altar of patriotism, and even in a hospital as admirably conducted as the Chimborazo Hospital, many cannot recover. They die; they pass on to the great beyond, endowed with the grateful -love of the nation which bore them. But they have something more. They are endowed with immortal youth. No matter how long parents live, their boy who has made the supreme sacrifice will never grow old to them. Had he and they lived together for a few decades, the youth would have become an old man. But once he has given his life for his country, he passes from the Realm over which Time holds sway, and he knows not decay nor decline. He enters Eternity and remains forever a youth.

As soon as the hospitals were opened, the large tobacco factories of the Grants, Mayos, and others were secured, their trade being practically at an end for the period of the war. The great boilers from these factories were effectively used in making soup in the kitchens. The factory workers were employed in the construction not only of the hospital buildings but also furniture and other equipment for them. There being, at least at first, no shortage of seasoned wood, for the tobacco factories had a large supply intended for the making of crates and packing cases, serviceable beds and other articles were made by the carpenters.

The patriotic Mr. Franklin Stearns lent the hospital his celebrated farm Tree Hill for the pasturage of 200 cows and 300 to 500 goats. The latter supplied kid venison, a meat popular with the patients. A large bakery was kept in almost constant operation, having the capacity of 7000 to 10,000 loaves daily, though even this quantity proved insufficient to insure one loaf per man per day. The grease from the "soup houses" was saved and lye brought through the blockade when possible, so that soap could be made. Beer was made on a large scale. As much as 400 kegs were brewed at a time, and stored in the caves or cellars at the eastern end of the hill.

To us who witnessed the expenditure of enormous sums of money in the construction and maintenance of military hospitals during the World War, it is a source of wonder and of admiration to read that no funds were drawn from the Confederate States Government for the conduct of the Chimborazo Hospital. The institution was entirely maintained by the commutation of rations. It had its own subsistence department, and possessed a canal boat, the Chimborazo, which under the command of Lawrence Lottier, plied between Richmond, Lynchburg, and Lexington, bartering yarn, shoes, etc., for provisions. This was but one of the many resources of the hospital. At the close of the war the Confederate Government owed the hospital $300,000 which Mr. Memminger, the Secretary of the Treasury of the Confederate States, agreed to pay in gold on March 29, 1865. On April 3, the city surrendered.

At the time of the War between the States the Chimborazo Hospital was the first military hospital in point of size in the world. The second largest was the Lincoln Hospital in Washington. The total number of patients received and treated in the Chimborazo Hospital was 76,000, of whom 17,000 were wounded soldiers. The Lincoln Hospital reported a total number of 46,000 patients. The Scutari Hospital in the Crimean War was the largest prior to the War of 1861-5. It reported a total of 30,000 to 40,000 patients.

The enormous work of the Chimborazo Hospital may be realized somewhat in the light of the experience of the United States Army in the World War. The Justice Hospital Centre at Toul, France, which was the largest in the American Expeditionary Forces treated in all 67,866 patients up to the time of its closing at the end of March, 1919. It is interesting to recall that one of the eight base hospitals constituting this centre, was Base Hospital No. 45, organized at the Medical College of Virginia and commanded by Lieutenant-Colonel Stuart McGuire, U.S.A., son of Surgeon Hunter Holmes McGuire, C.S.A. of General Jackson's staff.

Even though we consider the shorter time of America's participation in the World War, we must likewise remember the enormously increased killing and wounding power of modern weapons and also the ravages of the pandemic of influenza. Truly great was Chimborazo, to this day America's largest military hospital.

Because of the destruction by fire in 1865 of the records of the Surgeon General's Office, we cannot give the names of all of the medical officers, averaging forty-five in number, who labored for the relief of their countrymen at the Chimborazo, nor of the devoted nurses and the forty-five matrons whose skill and untiring energy made its success possible. We can give only the names of the chiefs:

Commandant and Medical Director-in-Chief: Surgeon James Brown McCaw;
In charge of the first division (Virginia): Surgeon P. F. Browne of Accomac, Virginia;
In charge of the Second Division (Georgia): Surgeon S. E. Habersham of Augusta, Georgia;
In charge of the Third Division (North Carolina): Surgeon E. Harvie Smith;
In charge of the Fourth Division (Alabama) : Surgeon S. N. Davis;
In charge of the Fifth Division (South Carolina): Surgeon E. M. Seabrook of Charleston;
Chief Matron: Mrs. Minge (wife of a physician)
Commissary: John Herbert Claiborne;
Quartermaster: Colonel A. S. Buford;
Chaplain: Rev. Mr. Patterson.

There were in all two apothecaries, one clerk, and one general ward-master or assistant steward. Each division had a chief matron with three or four assistants.

"The duty of the matron," wrote Surgeon S. E. Habersham, in charge of the Second Division, "was to superintend the preparation of all the diet for the sick not convalescent, and supply it upon the requisitions furnished by the assistant surgeon of each ward; to take charge of the laundry department, and see that the wards were supplied with clean bedding, etc.'' These women rendered most valuable services.

The task of feeding the large group of patients has been graphically told by Mrs. Phoebe Yates Pember, one of the matrons at the Chimborazo Hospital. The men were fed from the general kitchen with special provision for the preparation of special diets for about six hundred patients in need of such care. These patients were fed from the ''matron's diet list,'' as it was called. The ones who were in the most dangerous condition were fed from the matron's own kitchen. As supplies became more and more scarce by the summer of 1864, the men in the ranks were always hungry. Fighting men had to be denied in order that their stricken comrades might be fed. The hospital matrons had a most difficult task to be just to all. No articles of food were wasted, and Mrs. Pember even gives a recipe for cooking rats, which she says she learned from men who had had experience. Fortunately the patients in the Chimborazo Hospital never had to be fed on such delicacies.

The conduct of the Chimborazo Hospital may fairly be called one of more noteworthy achievements in military medicine in America's history. When we consider its size, the number of soldiers admitted as patients, its successful work for four years, its excellent discipline, the tremendous difficulties that had to be overcome in the procurement of supplies, especially towards the closing days of the Confederacy, the comparatively low mortality (slightly over 9 per cent), we must recognize its director as a genius of first rank.

Despite the loss of so many of the Confederate medical records in the fire in Richmond in 1865, Surgeon S. E. Habersham of Augusta has left us some valuable statistics of the Chimborazo Hospital for the period October 10, 1861 to November 1, 1863. By divisions we have the name of the disease or injury, number treated, and the number of deaths. As we read today the names of the maladies, we realize the advancements in medical science, for many of the terms used are all but unknown now. Dr. Habersham concludes that the most serious diseases were: Adynamic fevers, sloughing phagedaena, phagedaena gangrenosa, pyaemia, erysipelas, and the neuralgic affections following continued fever.

Dr. McCaw, the director of the hospital, demonstrated the truth of Osler's dictum: "Work is the master word in medicine." "Towering physically and mentally above his associates," says one of his admirers, "princely Dr. James B. McCaw, sweet, gentle, tender and true, and brave, generous and loyal, he was just, honorable, and upright, an exemplar worthy of emulation."

He came of a family of physicians. The first of his name, Dr. James McCaw of Newton-Stewart, Wigtonshire, Scotland, came to live at Norfolk, Virginia, in 1771, practicing surgery. He was commissioned a Captain by Lord Dunmore and was present at the Battle of the Bridge. But like some others who remained loyal to the Mother Country in the American War of Independence, his house was plundered and destroyed by revolutionists, and he was compelled, with his family, to take refuge on board a British ship in Chesapeake Bay. He took his family to Scotland but returned to America and died in New York, still in British hands, in 1778.

His son was Dr. James Drew McCaw, born in Virginia, apprentice in surgery to Benjamin Bell of Edinburgh, where he received his M.D. in 1792, and returned to Virginia to practice his profession until his death in 1846. He had two sons who were physicians, Dr. William Reid McCaw and Dr. David McCaw. The former of these was the father of Surgeon James Brown McCaw, the Commandant of the Chimborazo Hospital.

Surgeon James Brown McCaw was born in Richmond on July 12, 1823; studied under Dr. Valentine Mott who first successfully ligated the Innominate Artery; graduated a Doctor of Medicine at the University of the City of New York in 1844 and practiced his profession in Richmond for fifty-seven years, retiring in 1901. He was for twelve years, ending in 1872, Professor of Chemistry in the Medical College of Virginia, and for the next sixteen years was Professor of the Practice of Medicine and Dean of that institution. From 1853 to 1861 he was editor of the Virginia Medical and Surgical Journal. From 1864 to 1865 he was editor of the Confederate States Medical and Surgical Journal, the only medical journal in the South during this period, fourteen issues having appeared in all. In April 1871 he became one of the editors of the Virginia Clinical Record. He wrote many medical papers on many subjects, publishing them chiefly in the journals which he edited. A lover of music, he was President of the Mozart Society of Richmond, and was a charter member of the Medical Society of Virginia (1870). He was called "A typical Virginia gentleman of the old school, and the beloved physician of three generations." He must have had what President Eliot of Harvard called "the durable satisfactions of life." As three of his sons became physicians, Dr. Walter Drew McCaw, Dr. James Henry McCaw and Dr. David McCaw, they represent the fifth generation of this distinguished medical family, while Dr. James McCaw Thompkins of Richmond represents the sixth generation. Dr. Walter Drew McCaw became a military surgeon himself, rising after a long career of usefulness to the rank of Brigadier-General. He was Chief Surgeon of the American Expeditionary Forces and of course had under his direction the many large hospitals established by the United States Army overseas. His citation for the Distinguished Service Medal states that ''as Chief Surgeon of the American Expeditionary Forces, he maintained the splendid efficiency of that department at a critical time and solved each new problem presented with wisdom and marked ability." His father's mantle descended upon him indeed.

Surgeon J. R. Gildersleeve, C.S.A., a member of the staff of the Chimborazo Hospital, has left an interesting account of the circumstances surrounding the surrender of the Chimborazo Hospital when Richmond was occupied in 1865:

General Godfrey Weitzel's brigade of the Federal army was in the van of the advancing army. The General rode up the hill, and when he came through the post he was received by our whole corps of officers in full dress uniform. Dr. Alexander Mott [of New York, Surgeon of Volunteers], chief medical director of the staff of General Weitzel, exclaimed:

"Ain't that old Jim McCaw ?"

"Yes," said Dr. McCaw, "And don't you want a drink?"

Mott's answer was, ''Yes,'' and he added, ''the General will take one too, if you will ask him." The invitation was duly extended and accepted.

General Weitzel gave a free pass to the Commandant of the Chimborazo Hospital for himself and all of his officers, and ordered that all Confederate patients in the hospital be taken care of under all circumstances. Surgeon Gildersleeve tells us that the General even offered to place the Commandant in the general service of the United States, so that he might issue requisitions, etc., and have them honored in the same way as those of any other Medical Director in the United States Army. General Lee not having surrendered, Dr. McCaw respectfully declined this generous offer, but voluntarily continued to perform all of the duties incident to the position that he held.

Thus with scant medical supplies, for they were contraband of war, and poor facilities, the Chimborazo Hospital had been administered for three years with outstanding success and with a remarkable ratio of recoveries. It was at last turned over to the Federal troops in perfect working order, and they were not slow in giving credit where credit was due.

Dr. McCaw knew how to thwart fear and engender courage. He had the deep religious feelings which characterized the leaders of the Southern cause, and without a knowledge of which it is impossible to understand the war. ''A soldier without religion,'' said a Prussian officer, who knows the Confederate as well as the Prussian Army, ''is an instrument without value.'' Even the rank and file were in full accord with the great principles of the war, and were sustained by the abiding conviction of the justice of the cause.

"No one can bring a tribute of words into the presence of great deeds, or try with them to embellish the memory of any inspiring achievement, without feeling and leaving with others a sense of their insufficiency" (Oliver Wendell Holmes). We cannot do more than to mark the place where this great instrument of mercy stood, where a group of faithful men and women of our South did their utmost to repair war's broken victims, where in so doing they enabled many of the men to return to their commands and strike yet other blows in defense of their invaded country.

Nor Mars his sword nor war's quick fire shall burn
The living record of your memory.
'Gainst death and all-oblivious enmity
Shall you pace forth: your praise shall still find room
Even in the eyes of all posterity.
                                                                    Shakespeare, Sonnets, LV.

BIBLIOGRAPHY

Ashburn, P. M.: James Brown McCaw, Dict. of Amer. Biogr. 11:575-576.

Garrison, F. H.: Dr. James Brown McCaw, Old Dominion J. of Med. and Surg., 1906-7, 5:65.

Gildersleeve, John R.: History of Chimborazo Hospital, Richmond, Va., and its Medical Officers During 1861-1865, Fe. Med. Semi-monthly, 1904-5, 9:148-154. also in Southern Hist. Papers, Richmond, 1908, 30:86-94.

Habersham, S. E.: Observations upon the Statistics of Chimborazo Hospital with Some Remarks upon the Treatment of Various Diseases During the Recent Civil War, Nashville, Tenn., 1866, pp. 15.

McCaw, James B.: Of Chimborazo Park (newspaper clipping circa August 17, 1897), in Confederate Museum, Richmond.

Stout, S. H.: Some Facts of the History of the Organization of the Medical Service of the Confederate Armies and Hospitals, Southern Practitioner, Nashville, 1903, 25:91-98; 517-526.

Tebault, C. H.: Hospitals of the Confederacy, Southern Practitioner, Nashville, 1902, 24:499-509.

(Obituary)—Trans. Med. Soc. of Va., 1906, 37:305.

(Personal communications from Brig. Gen. Walter D. McCaw, U.S.A.)

* This address was to have been delivered by the author on May 26, 1934, at the unveiling of the bronze tablet marking the site of the Chimborazo Hospital. On account of illness in his family the author could not be present so that the manuscript was read by Dr. Greer Baughman of Richmond. Miss Sally Archer Anderson, President of the Confederate Memorial Literary Society, presided, and Mrs. Littleton Fitzgerald, chairman of the sites committee, presented Dr. Baughman. The marker was received on behalf of the city of Richmond by Colonel R. Keith Compton, director of public works. Mrs. Dabney H. Maury, daughter of Dr. James B. McCaw, Commandant of the Chimborazo Hospital, unveiled the tablet which was covered with a battle flag and a hospital flag of the Confederate States Army captured during the war, and returned to Virginia by act of Congress.

The tablet, attached to a waterworn boulder on Chimborazo Hill, is inscribed:

ON THIS HILL STOOD
CHIMBORAZO HOSPITAL
1862-1865
ESTABLISHED BY
SURGEON GENERAL S. P. MOORE, C.S.A.
DIRECTED BY DR. JAMES B. McCAW
AT THAT TIME IT WAS THE
LARGEST MILITARY HOSPITAL IN THE WORLD
IT CONSISTED OF 150 BUILDINGS AND 100 TENTS
AND CARED FOR 76,000 PATIENTS WITH A
MORTALITY OF LESS THAN 10 PER CENT
THIS TABLET IS PLACED BY THE
CONFEDERATE MEMORIAL LITERARY SOCIETY

*Published also in The Virginia Medical Monthly The Virginia Medical Monthly for 1934

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