CHIMBORAZO HOSPITAL AND J. B. McCAW,
SURGEON-IN-CHIEF

by FRANK S. JOHNS and ANNE PAGE JOHNS^(*)

~FROM~

THE VIRGINIA MAGAZINE of HISTORY AND BIOGRAPHY

VOL. 62 April, 1954 NO. 2

The story of Chimborazo Hospital, Richmond, Virginia, has been neglected. It is not listed in the general index to The War of the Rebellion: A Compilation of the Official Records of the Union and Confederate Armies, yet this Confederate hospital was the largest military hospital in the history of the world. In the three years from April 1862 to April 1865 it treated 76,000 patients, 17,000 of them battle casualties, with an overall mortality of "a little over 9 per cent."(1)

This was before the day of modern surgery. Bloodletting was still a respected procedure. Surgeons had no antibiotics, transfusions, or x-rays; they knew only the rudiments of anesthesia. Moreover, this huge hospital, which had at one time 8,400 beds, was successfully conducted during a disastrous war in which all drugs and medical supplies were held contraband by the blockading enemy.

In the belated spring of 1862 the Confederate Army lay encamped in the March mud at Centerville, a strategic village some twenty miles southwest of Washington, D. C., and directly between it and Manassas Junction. There, facing the Confederates under General Joseph E. Johnston, General Irvin McDowell with 40,000 United States troops had spent an uneasy winter. The Northern debacle at Bull Run the previous July 21 still lurked traumatic in his memory.

General Johnston's army was still new and green. It held the flower of the Confederacy, not yet inured to the hardships of campaigning and the deficiencies of army diet. At Centerville were 9,000 sick and wounded.(2) These had to be hospitalized elsewhere before Johnston's army could move to the Peninsula to join General John B. Magruder's hard-pressed defenders of Richmond. Urgently, General Johnston referred his problem to the surgeon general.

Dr. Samuel P. Moore, late of Charleston, South Carolina, already had his hands full, charged with the administrative responsibility of the Medical Department, the government of hospitals, and the regulation of medical officers at the front." On August I 2, i86i, the Confederate Congress had appropriated $50,000 for "the establishment and support of military hospitals during the current fiscal year" ending February 18, 1862, (3) but it had not been enough. Only 2,500 hospital beds were as yet available.(4) A congressional committee had reported in January that it was "deeply impressed with the inadequacy of the preparations and provisions for the comfort of sick soldiers."(5)

In the emergency the Surgeon General turned to Dr. James Brown McCaw (1823-19066), of Richmond, already known to him as "a man of most distinguished presence, magnetic and successful." Not yet forty, McCaw had for years been editor of the Virginia Medical and Surgical journal and was professor of chemistry and pharmacology at the Medical College of Virginia. After the war he was to become dean of the college and later President of the Board of Visitors.(6) Dr. Moore also knew of McCaw as author of a useful and widely read paper on "The Diagnosis of Typhoid" and as co-translator in 1856 of Pajot's "Obstetric Tables."

The fourth of his name in a direct line of physicians, Dr. McCaw was "a typical Virginia gentleman ... devoted to the highest interests of his native city and State."(7) This versatile yet modest man was deemed in his wordy time a princely person, "sweet, gentle, tender and true.... brave, generous and loyal; just, honorable and upright."(8) He had also a lifelong Oslerian passion for work, another for order, and a genius for getting things done.

The story of Chimborazo Hospital is the story of the admirable doctor. Planned, organized, and directed by him, this huge humanitarian project owed its success to its surgeon-in-chief. He considered it the greatest thing in his life,(9) and for it he was well prepared by 1861. "The idea of such an organization as this resulted," he remembered, from a study of the 'Phalanxing' of Robert Dale Owen, who contended that give us 5,000 human beings of a fair average, and you would have a self-supporting institution." Chimborazo Hospital proved the correctness of the theory, at least when military discipline could be employed.(10)

Confederate Records, now in the National Archives, show that on October 11, 1861, a military hospital had been established in some unfinished buildings on Chimborazo Hill on the eastern edge of Richmond. By October 26 Dr. McCaw, who had been appointed a surgeon on the ninth, was at work in the hospital. On November 16, 1861, he was "in charge of the General Hospitals on Chimborazo Heights."(11) He still retained his civilian status, however, and continued his busy medical and surgical practice, perhaps the best in the city. In April 1862 he was about to leave it to join a Confederate cavalry troop which he states "was being organized and equipped at our own expense." At the Surgeon General's behest he determined instead to do what he could to meet the emergency occasioned by the sick and wounded of Johnston's army. He suggested that Dr. Moore "take the hill forming the eastern prolong of Broad street and use it for hospital purposes."(12) Thus Dr. McCaw proposed to expand the hospital which he headed to care for Johnston's men.

The site selected by Dr. McCaw for his expanding hospital complied precisely with a committee's recent recommendation to Congress: "hospitals and stations for the wounded, sick, and convalescent should be provided at a distance from the camps or crowded cities wherever pure air, good water, and an abundance of food would recommend them."(13) Chimborazo, a high forty-acre plateau on a James River bluff, was one of Richmond's "seven hills," thought to have been so named long ago by some local world-traveler because of its topographical likeness to a peak of the Andes in Ecuador. Thick woodlands stood behind it. Facing south the hill sloped steeply on three sides. Watered by three good springs, Chimborazo Hill was separated from the town by the deep and wide ravine of Bloody Run. A student of history, Dr. McCaw perhaps knew the origin of the creek's bad name. On an evil day in 1656 in this frontier gulch of pipe clay and fuller's earth the savage Senecas defeated Colonel Edward Hill of "Shirley" and his allies, the Totopotomoi Indians.(14)

On a summer morning in 1862, after weeks of hurried building, Surgeon-in-Chief McCaw could look up from his well ordered headquarters desk in Richard Laughton's former home on Chimborazo Hill to view with satisfaction the scene around him. Much had been accomplished (figure 2). During the first two weeks of April 4,000 patients from the army at Centerville had been admitted, and there was room for more."(15) Through his tree-shaded window opening on the future extension of Broad Street, the first ten wards presented their decent and comfortable aspect. Across the plateau, aligned in neat geometric rows behind the first wards, were many others. More would be built as needed, each well constructed and ventilated, one hundred feet long, thirty feet wide, and one story high. As an assistant surgeon long remembered, "the hospitals presented the appearance of a large town, imposing and attractive, with its alignment of buildings kept whitened with lime, streets and alleys clean.... The buildings were separated from each other by wide alleys or streets, ample spaces for drives or walks, and a wide street around the entire camp or hospital."(16)

By this time Dr. McCaw had organized his 150 wards into five large well-ventilated hospitals or "divisions," 30 wards to each hospital, 40 to 60 patients in each ward. He insisted on a minimum of 800 to 1,000 cubic feet of air space for each patient. Uniquely he had named and organized the five divisions on a state basis as far as possible, with "troops from the same State being thrown together and cared for by officers and attendants from their own State." He appointed the following Division Surgeons:

                    First Division, Virginia, Surgeon P. F. Browne of Accomac.
                    Second Division, Georgia, Surgeon S. E. Habersham of Atlanta.
                    Third Division, North Carolina, Surgeon E. Harvey Smith.
                    Fourth Division, Alabama, Surgeon S. N. Davis.
                    Fifth Division, South Carolina, Surgeon E. M. Seabrook of Charleston.

In addition to the hospital's 150 buildings the Surgeon-in-Chief had secured 100 Sibley tents to be erected on one of the slopes, in each of which eight to ten convalescents could be cared for. (17)

Chimborazo was not officially a "General" Confederate hospital, but an army post. The Secretary of War had so ordered, appointing Surgeon-in-Chief McCaw as Commandant, with an officer of the line, Captain Thomas E. Ferrell, and 30 soldiers stationed there to maintain law and order. Looking west, Dr. McCaw could see their tents and small headquarters building on the other side of Mr. Ellington's piece of ground. Behind them, hidden from his view, stood the guardhouse, a building sometimes needed in such a community, as were also the five nearby "dead-houses."

With further satisfaction Commandant McCaw could review his excellent arrangement with Messrs. Grant, Mayo et als. The business of those large tobacconists was at an end; thus he had been able to buy their factories to advantage. Their large boilers were being put to good use in the five Chimborazo "soup-houses." There too, thanks to the blockade-runners, enough lye was still available to convert the cooks' surplus grease into soap. The manufactories' supplies of well seasoned lumber intended for tobacco boxes had proved invaluable for contriving bedsteads, tables, partitions, and other needed furnishings. Best of all, Commandant McCaw had taken charge of the hands, the factory workers no longer needed to process tobacco, and had used them all for the manual labor incident to building his hospital.

This construction included besides the wards, a bakery big enough to supply the 10,000 loaves of bread needed each day, the five large icehouses, storehouses, the Russian bathhouse, and the hospital's system of sewage disposal. Five deep wells had been dug. Also, in the southeast comer of the property beside one of the springs, the Commandant had erected the Chimborazo brewery. Its capacity was 400 kegs of beer at a brew, and "in order to keep it" he had built several "caves or vaults" just over the eastern brow of the hill.(18)

Such was the extensive physical plant of Chimborazo Hospital as Dr. McCaw could survey it on July 6, 1862 (figure 3). Wisely he had kept his subsistence and medical departments organized to themselves. His herds of 200 cows and from 200 to 500 goats were being hospitably pastured on Franklin Stearn's fine farm nearby. The good doctor valued not only the milk supplied from "Tree Hill" farm, he considered kid meat "the most nutritious and palatable for sick and wounded men."

To procure fresh vegetables, poultry, eggs, and other necessities there was the hospital's canal boat, with Lawrence Lottier in command, which tied up regularly at the foot of the bill. Each week on orders from the commandant that canny skipper plied the sturdy Chimborazo up and down the fertile James River Valley. He went as far as Lynchburg and Lexington bartering cotton yams, shoes, "newbys," etc. for those necessities of patients' diet not to be bad in Richmond.(19)

At Chimborazo each division surgeon-in-charge had from five to eight assistants. Thus the medical staff numbered about 40 or 45 in all. There were also ward masters, a chaplain, and 45 matrons. "Each ward had its corps of nurses, unfortunately not practiced or expert in their duties, as they had been sick or wounded men, convalescing and placed in that position ...till strong enough for field duty.... [Also] the hospital contained an endless horde of stewards and their clerks; apothecaries and clerks; baggage-masters; forage-masters; wagon-masters, cooks; bakers; carpenters; shoe-makers; ward-inspectors; ambulance-drivers; and many more . . . to whom the soldiers gave the name of 'hospital rats' in common with would-be invalids who resisted being cured from a disinclination to field service."(20) Tempered by time and distance a former acting assistant surgeon remembered that: "Every man did his whole duty, and everything went on without a hitch. The total staff, one hundred and twenty."(21)

To his subordinates Dr. McCaw was "energetic - capable - skillful. A man with ready oil to pour upon troubled waters. Difficulties melted away beneath the warmth of his ready interest.... However troublesome daily increasing annoyances became, if they could not be removed, his few and ready words sent applicants and grumblers home satisfied to do the best they could."(22) Here no doubt was the key to his great administrative success, combined with his singular ability in his profession. "Dr. McCaw has always been my example," said Dr. George Ben Johnston, himself a founder of hospitals and the father of aseptic surgery in Virginia.(23)

A Medical Examining Board composed of the surgeons of divisions was appointed by the Commandant to pass on the vexed and somber problems of furloughs and discharges. The desperate need of manpower for the Confederacy's dwindling gray lines is told in the orders constantly received from the War Department, demanding "lists of men fit for duty," and "certificates of men to be discharged from service."(24) It is found again in a statistician's careful assertion that "each Confederate soldier was, on an average, disabled for greater or lesser period, by wounds and sickness, about six times during the war."(25)

Paper work then as now was a bane of hard-pressed army surgeons as the following directive proves:

January 16, 1863
Surgeons in charge will hand in on 1^st of Feb. and on the 1^st of each month in future the following report:
    1^st. An accurate list of all the servants stating the names of owner and rate of hire.
    2^nd. A list of medical officers noting all changes during the past month and giving the ranks and date of appointment of those who came in during the month.
    3^rd. A monthly report of the sick and wounded accompanied by a list of the patients vaccinated and a report of the surgical cases.
    4^th. All other reports required by the Regulations.

All requisitions as far as possible must be made according to regulations stating length of time and number of patients it is meant for. It must also state the quantity of each article on hand.

The patients, nurses, and attendants must be carefully counted on the 10^th, 20^th, and 31^st of each month and the morning reports corrected thereby.

J. B. McCaw,
Surgeon (26)

Fortunately for history, under Dr. McCaw's strict command no neglect of record keeping was condoned (figure 4). The assumption is still hazily believed that in the great fire of April 3, i865, following the evacuation of Richmond by the Confederate forces, all records were lost, but this is not true of Chimborazo Hospital. As stated by Dr. McCaw, "Complete records were kept and are still in existence ... upon which the name of every patient can be found."(27) These records, formerly preserved in the Office of the Surgeon General at Washington, D. C., are now in the National Archives. There with other priceless documents the 168 manuscript volumes of Chimborazo Hospital records may be read. Some of these are in the fine practiced chirography of Dr. McCaw's chief clerk, William E. Trahern,(28) and his assistants; others in the hurried scrawls of operating surgeons There are the Morning Reports, the Reports of Surgical Cases, and Record Books of each hospital division; there are volumes of Orders and Circulars Received and Sent; the Record of Clothing Issued to Patients, of the Commissary Stores Received, Bakery Accounts, Prescription Books; there is the Register of Deaths and Effects, the Lists of Paroled Prisoners, of Employees, and Accounts for Food Purchased, also the Memorandum Book of William E. Toombs, Steward. One notebook contains a single article, "Five Cases of Hospital Gangrene," by Surgeon G. E. Fuller.

Most impressive today is a small brown account book entitled "Treasurer of the Confederate States in Account with J. B. McCaw." Its final entry is: "October 15, '63. Balance $316,712.14." It contains authority for Dr. McCaw's awesome statement, "We never drew fifty dollars from the Confederate States Government, but relied solely upon the money received from commutation of our rations."(29) On November 25, 1862, the commuted value of rations for the sick and wounded soldiers in hospitals was $1.00 per day. This was increased on May 16, 1863, to $1.25 and on February 29, 1864, to $2.50. (30)

In the fall of 1864 a letter somewhat petulant in tone reached the harrassed Confederate surgeon general. It came from Georgia complaining that "unless some remedy is applied soon the hospitals of this department will have to furlough all their inmates to secure for them appropriate diet." S. H. Stout, the medical director who signed it, warned, "If the Treasury Department does not furnish the currency the sick and wounded cannot be fed."(31) Still unhappy is the temper of Dr. Stout's memoir published in 1903.(32) He had congratulated himself in Richmond in 1864 on the superior ventilation of his own hospitals to that of Chimborazo. This he deemed "very faulty" and evidently an imitation of the buildings long in use in the Federal service. Dr. Stout disapproved of wards wide enough to allow two rows of bunks on either side. History records, however, that Dr. McCaw's hospital remained open, and solvent, and that his patients did not starve.

About 7,000 of the 17,000 wounded men received at Chimborazo Hospital died there.(33) Considering the limitations of Confederate surgery this record is good. Another Confederate hospital surgeon, Dr. John R. Buist, declares justly: "The chief cause of our deficiency was that surgery as a science had not advanced far enough. We knew nothing of the present-day [1903] bold and daring operative measures." He adds, "I saw little of either head or abdominal surgery. I do not recall a case in which I attempted to open the abdomen for perforating gunshot wound.... I rather think that nearly all of the head and abdominal wounds were quickly fatal."(34) It was much the same at Chimborazo. In "The Case Book of Dr. Hubbell, May 1864-April 1865" is the record of a young soldier admitted October 1, 1864, with a wound of the lung. The ball entered four inches from the sternum between the third and fifth ribs and came out from the lower angle of the scapula. The patient died in great distress without operation on October 4. Penciled heavily on the line below this case report are three words: "War is Hell."(35)

A "fistula in ano," an "hereditary" cancer of the lower jaw, and the case of a soldier who had "shot himself accidentally in the foot" make up the surgical cases besides amputations recorded by Dr. Hubbell. In another volume, among 200 cases admitted to Division IV we find one case of the ligation of the temporal artery, two legations of the brachial artery. All three recovered, and except for amputations and "the laying open of wounds" are the only operations performed.(36)

However, no study of this scope can justly appraise Dr. McCaw's surgical work at Chimborazo Hospital. The huge obstacles he met and surmounted in securing and preparing fit surgical supplies, the operating techniques he and his valiant assistant surgeons employed, his meticulous pre-Lister attention to "scrupulous cleanliness," as well as to post-operative care and diet, his sound opposition to routine field and hospital amputations,(37) these and other aspects of Chimborazo Hospital history await the work of medical scholarship.

In January 1864 the first issue of the Confederate States Medical and Surgical Journal was circulated. Its editor was the busy Commandant and Surgeon-in-Chief of Chimborazo Hospital. Undeterred by war and blockade this admirable scientific monthly appeared fourteen times, the only medical journal of the Confederacy.(38) Few complete sets of this rare publication exist. One is owned by the family of the late Dr. James McCaw Tompkins of Richmond, a grandson of the editor, but Virginia libraries have only broken files.

Six scientific reports from Chimborazo Hospital appeared in the Confederate States Medical and Surgical journal. They provide a fair cross section of the best Confederate surgery.
    "Case of Tetanus - Recovery," by Surgeon W. A. Davis.
    "Report of Cases of Gun-shot Fracture of Femur treated without operative procedure, Chimborazo Hospital," by Surgeon Wm. A. Davis, Surgeon S. E. Habersham, and Surgeon E. M. Seabrook.
    "Ligature of the Right Subclavian Artery," by Surgeon P. F. Browne.
    "Report of Cases of Compound Comminuted Fracture of Femur," by Surgeon E. H. Smith.
    "Eleven Cases of Compound Fracture of Cranium by Gun-shot Wound Treated at Chimborazo Hospital." (No author is given; perhaps it was written by the editor, Dr. McCaw.)
    "Gun-Shot Wound of the Chest Treated by Hermetically Sealing," by Surgeon P. F. Browne.

The historian Fielding H. Garrison wrote of Chimborazo Hospital in his sketch of Dr. McCaw: "Here, with poor facilities and scant medical supplies, the success in operating and the number of recoveries was remarkable, and when Richmond was entered by the Federal troops the hospital was turned over to them in perfect working order."(39)

The sadness of that transfer is lightened by the legend of General Godfrey Weitzel's reception at Chimborazo Hospital. Encouraged by General Weitzel's aide, an old prewar friend and comrade, Commandant McCaw proffered traditional hospitality. A tray of mint juleps was brought out to Richmond's victorious visitors. Pleasant relations were established, but the Commandant of Chimborazo politely refused General Weitzel's offer to put him in the general service of the United States.(40) On April 3, 1865, General Lee had not surrendered, and the Confederacy which Dr. McCaw still nobly served, was not yet dead.

---

Footnotes

* Dr. Johns succeeded Dr. James McCaw Tompkins as President of the Johnston-Willis Hospital, Richmond, Virginia, where he is Chief of Surgery. This article was originally delivered by Dr. Johns as his presidential address to the Seaboard Railway Surgeons Association at Miami, Florida, in November 1952. Mrs. Johns is the author of A Fir Tree Prays and Other Poems (Richmond, 1943).
1 "Of Chimborazo Park," a clipping from an unidentified Richmond newspaper of about August 1897 in the Confederate Museum. It quotes in detail Dr. James B. McCaw's reminiscences of the Chimborazo Hospital.
2 "Of Chimborazo Park."
3 The War of the Rebellion: A Compilation of the Official Records of the Union and Confederate Armies, 4th ser., I (Washington, D. C., 1900), 580; hereafter Official Records.
4 "Of Chimborazo Park."
5 Official Records, 4th ser., I, 887.
6 Fielding Garrison, "Dr. James Brown McCaw," Old Dominion Journal of Medicine and Surgery, V (August 1906), 65-66.
7 Ibid.
8 John R. Gildersleeve, "History of Chimborazo Hospital, Richmond, Va., and Its Medical Officers during 1861-1865," Virginia Medical Semi-Monthly, IX (July 8, 1904), 148-154; reprinted as "History of              Chimborazo Hospital, C.S.A.," Southern Historical Society Papers, XXXVI (1908), 86-94.
9 Personal reminiscenses of Miss Nellie Tompkins.
10 "Of Chimborazo Park."
11 Letter, Richard G. Wood for Dallas Irvine, Chief Archivist War Records Branch, National Archives, to Mrs. Frank S. Johns, November 25, 1952.
12 "Of Chimborazo Park."
13 Official Records, 4th ser., I, 885.
14 Virginia Magazine of History and Biography, III, 157.
15 "Of Chimborazo Park."
16 Gildersleeve, "History of Chimborazo Hospital," Virginia Medical Semi-Monthly, IX, 148-149.
17 "Of Chimborazo Park"; Gildersleeve, "History of Chimborazo Hospital," Virginia Medical Semi-Monthly,  IX, 148-154.
18 "Of Chimborazo Park."
19 "Of Chimborazo Park."
20 Phoebe Yates Pember, A Southern Woman's Story (New York, 1879), pp. 12-18.
21 Gildersleeve, "History of Chimborazo Hospital," Virginia Medical Semi-Monthly, IX, 151.
22 Pember, A Southern Woman's Story, p. 15.
23 Gildersleeve, "History of Chimborazo Hospital," Virginia Medical Semi-Monthly, IX, 152; see also Frank S. Johns, "George Ben Johnston and Listerism," Virginia Medical Monthly, LXXI (June 1944), 314-323.
24 War Department Collection of Confederate Records, National Archives.
25 Joseph Jones, "The Medical History of the Confederate States Army and Navy," Southern Historical Society Papers, XX (1892), 115.
26 War Department Collection of Confederate Records, National Archives.
27 "Of Chimborazo Park."
28 Original manuscript map of Chimborazo Hospital in the possession of Major General William F. Tompkins. See figure 3.
29 "Of Chimborazo Park." Italics ours.
30 Official Records, 4th ser., II, 209, 555; III, 175.
31 Official Records, 4th ser., III, 719.
32 S. H. Stout, "Some Facts of the History of the Organization of the Medical Service of the Confederate Armies and Hospitals," Southern Practitioner, XXV (September 1903), 517-526.
33 "Of Chimborazo Park."
34 John R. Buist, "Some Items of my Medical and Surgical Experience in the Confederate Army," Southern Practitioner, XXV (October 1903), 579, 580.
35 War Department Collection of Confederate Records, National Archives.
36 War Department Collection of Confederate Records, National Archives.
37 Confederate States Medical and Surgical Journal, passim.
38 Garrison, "Dr. James Brown McCaw," Old Dominion Journal of Medicine and Surgery, V, 66.
39 Garrison, "Dr. James Brown McCaw," Old Dominion Journal of Medicine and Surgery, V, 66.
40 "Of Chimborazo Park."

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