Between 1861 and 1865, the forty acres atop Chimborazo Hill overlooking the James River in Richmond would have been a buzz of activity. Officially opening in October of 1861, the Chimborazo hospital became the largest hospital complex anywhere in the world at the time, and arguably the most successful.
It comprised over 150 buildings including the wards/pavilions where the sick and wounded were kept, and auxiliary buildings devoted to the administrative and supply needs of the hospital. Just a few examples include a bakery, a blacksmith, guardhouses, offices, wash houses, soap houses, stables, carpentry shop, chapel, icehouses, deadhouses, apothecaries, and kitchens. The hospital also operated a small farm that helped to keep the cooks supplied with fresh food and livestock when it couldn’t be bought in town or procured through the quartermaster. The wards were an innovation in themselves, constructed to make use of the natural air flow around the hill to maximize ventilation. The construction and organization of the wards was also unique, taking inspiration from the success and failures of the most recent hospitals established during the Crimean War. The wards measured eighty feet long, twenty-eight feet wide, and seven feet tall and could hold up to 98 patients toward the end of the war. At any given time, they could treat upwards of 3,500 patients, though it was a tight squeeze. Other facilities helped to manage the overflow, such as Winder Hospital, Howard’s Grove, Jackson, and several private homes within Richmond. Over time, some were used specifically for certain cases, like Howard’s Grove which became the quarantine location for patients with smallpox. While many of the structures at Chimborazo were solid and permanent, the use of tents for overflow during “busy” campaign seasons or quarantine scenarios were common.
To run this massive ship took a small army in itself. Between the main Chimborazo campus and the five other major hospitals within its supervision, over 600 people were employed. They included nurses, laundresses, cooks, matrons, ward masters, assistant surgeons, surgeons-in-charge, and one surgeon-in-chief. This last position was held by James Brown McCaw throughout the war and it’s to him that the lion’s share of the credit is due for the efficient and smooth operations within Chimborazo. Unlike hospitals in the Union, which were plagued with political corruption and experienced a high turnover of surgeons and medical doctors, the Confederacy experienced next to none of these vices. As a result, there existed a stability amongst the hospital administrative staff, who were able to focus on their main mission: to ensure the recovery and comfort of their patients. McCaw led the effort, a fourth-generation doctor himself with a great deal of experience in his field preceding his appointment at Chimborazo. He’s credited with implementing creative – though sometimes unorthodox – methods of procuring supplies and medicines for his patients. Even during the worst days of shortages within the Confederacy, the hospital did not lack of anything, and if it did, the suffering was short lived.
The hospital’s payroll included a sampling from all levels of Confederate society from elite white women to black slaves who were hired out from local owners. Slave labor was utilized to build the ward pavilions, which was an unskilled labor thanks to its easy construction, as well as for cooking, cleaning, and nursing. Unlike in the Union, nurses were primarily black men, freed or slave, or convalescent men who were well enough to take care of fellow patients. Women were usually in charge of chores such as cooking, cleaning, laundry, and seeing to the general comfort of the patients without interfering with the medical treatment. They also had a hand in feeding patients who were unable to feed themselves and writing/reading letters to/from home for the soldiers. Other tasks like bathing were reserved for male nurses due to Victorian rules of social etiquette, and redressing wounds left to the assistant surgeons to avoid complications. Ward masters and matrons were over the organization and administrative duties of their respective wards and had a hand in making sure that issues with supplies or efficiency were resolved quickly. A unique task for the matrons of these hospitals was to regulate the whiskey and alcohol supplies, not trusting the surgeons or assistant surgeons who would swipe a bit of the liquor for themselves. Phoebe Pember is one of the most well-known hospital matrons to come out of the Confederacy and she published her diary experiences during her time in Chimborazo No. 2. Her writing has given historians a detailed look, not just into the operations of Chimborazo but in the Confederate medical system as a whole. All the surgeons, doctors, apothecaries (pharmacists), and other medical staff were the best in their field, vetted by strict requirements and examinations. McCaw had a direct hand in making sure that all of his staff were completely competent for their position.
Though it took a bit of time to get initially organized, by 1862 the patients were separated by their state and their condition (sick, wounded, or convalescing). Problems of morale and infighting arose quickly in the early days of Chimborazo hospital when troops of “rival” states were housed in the same pavilion. Separating further by condition also produced its own results as the spread of contagions was limited and the knowledge of the surgeons increased within their particular ward. That is, if a doctor were exposed only to gunshot wounds for an entire year, he would become a virtual expert in knowing what complications to look for and how to handle them quickly. While medicine during the Civil War was often reactive (treat it as it comes instead of preventing it as we do today), the recovery rate within Chimborazo and its associate hospitals was remarkable for the time. Because of its innovative structure, its commitment to patient care, and the efficient administration, Chimborazo was one of the prime locations for testing new medical methods and remedies to replace or supplement current practices. Much of Civil War medicine progress was a result of trial and error, combined with homeopathic cooperation with pharmaceutical medicine, especially at Chimborazo. Chimborazo admitted 77,889 patients and sustained an 11.39% mortality rate until it was closed.
With the spring campaign of 1865, Chimborazo’s days were numbered. Many of the patients still at the hospital were transferred to other hospitals at Danville, Farmville, and Lynchburg in the days leading up to the Union’s encroachment upon the Confederate capitol. Those convalescing or able to bear arms were formed into militia companies. Records were also burned, though many of the evacuating doctors kept their own notes and records, which were later utilized for medical research or help in their own private practices following the war. When Richmond finally came under occupation in April, Chimborazo was utilized as a place for the Union sick and injured, bedded alongside Confederates who couldn’t be moved. Pember stayed with her patients, even when they were relocated to Jackson Hospital. In the years following the war, Chimborazo was repurposed into a school for freed blacks in Richmond, educating up to 345 at one point and hosting night classes of 200. It also became a refugee camp for newly emancipated slaves, providing charity as they struggled to build new lives for themselves. The property on Chimborazo Hill changed hands, but eventually came into National Park Service possession in 1959.
Much of the former Chimborazo acreage has been cleared and developed into residential neighborhoods, but a small grassy knoll was set apart by the National Park Service. First, it served as the site for the Richmond National Battlefield Park before it was moved to Tredegar Iron Works. Now, the Greek revival style facility is dedicated to telling the story of Chimborazo – or as much as can be told. Due to the mass burning of documentation within Richmond, many records about the Confederate hospital have been lost to time. However, some records within the hospital did survive and were compiled in The Medical and Surgical History of the War of the Rebellion. They were later turned over to the National Archives for safe keeping.
Today, visitors can come to Chimborazo Hill and learn not just about the hospital that was once established there, but about the condition of Civil War/Confederate medicine as well. Their exhibit, while small, houses a wealth of interesting artifacts that help to tell the story. A short film is also provided that gives a brief overview of the hospital. Be sure to check out the information panels on the walls about some notable physicians and nurses from the war, as well as the miniature model of the hospital grounds.
In recent times, the staff with Richmond National Battlefield Park and numerous volunteers have worked tirelessly to transcribe the microfilm records from Chimborazo hospital. Below is an interview hosted by the National Museum of Civil War Medicine, conducted with a few of these dedicated individuals, talking about the transcription effort. If you’re visiting Richmond for a while and have some downtime, inquire about volunteering for an afternoon. They can use all the help they can get, and you’d be playing a role in a great cause to help paint the full picture of what medicine was like at Chimborazo. (see beyond the video for a list of recommended reading about Chimborazo and Confederate medicine)
Chimborazo: The Confederacy’s Largest Hospital by Carol C. Green
Richmond’s Wartime Hospitals by Rebecca Barbour Calcutt
Doctors In Gray: The Confederacy Medical Service by H.H. Cunningham
Civil War Medicine: Challenged and Triumph by Alfred Jay Bollet
A Southern Woman’s Story: Life in Confederate Richmond by Phoebe Yates Pember
Worth a Dozen Men: Women and Nursing in the Civil War South by Libra Hilde
Kate: The Journal Of A Confederate Nurse by Kate Cumming