Chimborazo: The Confederacy's Largest Hospital (review)

It is a pleasure to read a "success story" about Civil War medicine. Carol Green's history of Chimborazo helps counter the popular belief that Civil War medicine was always characterized by filth, disorganization, and brutal surgical practices. Green also provides a compelling story of Confederate administrative success. Although the Confederacy lacked the established medical department of the Union Army, the absence of existing medical bureaucracy had unexpected advantages. Because Confederate surgeons viewed their service to the Confederate Army as a temporary situation rather than a career, there was greater continuity of staff in Confederate hospitals than in Union hospitals, where surgeons often requested transfers in the interest of advancing their military careers. Samuel Preston Moore served as Surgeon General for the Confederacy for the duration of the war, whereas four men filled that position for the Union.

Chimborazo was a new facility, located outside the city of Richmond on a plateau with good ventilation and easy access to the York River Railroad. Dr. James Brown McCaw, a respected Richmond physician, was responsible for the planning and administration of Chimborazo. The pavilion plan that McCaw adopted was based on British hospital design, influenced in part by Florence Nightingale's writing after the Crimean War. Large-scale hospitals were regarded with suspicion at the beginning of the war since most men had never experienced medical care outside the home. Patients and families alike feared that the care in a hospital would be inferior to home care, and many soldiers preferred to stay in camp and be nursed by their comrades rather than risk the dangers of a hospital. The success of Chimborazo, Green argues, can be measured not only by its relatively low mortality rate of 11.39 percent but also by the positive reports of the patients who received care at the hospital (65).

Although patients with similar ailments, especially those with infectious diseases, were housed together, the hospital wards were more broadly organized by state. This arrangement allowed comrades to remain together, and it eliminated jealousy when food and supply shipments were sent by individual states. As supplies became increasingly scarce, the staff of Chimborazo had to fall back on their own resources and discrepancies between state contributions caused significant tension. By careful management, McCaw was able to continue to provide adequate care even in the face of substantial shortages of medicine, fuel, and food by the last year of the war.

Despite concerted efforts to maintain sanitary surroundings, rats remained a common part of ward life. Rat stories abounded. One matron controlled a group of unruly and unhappy patients by "reminding them of her willingness to stew the rats they had caught when the cook refused" (76). Another patient attributed his successful recovery to the assistance of a "rat surgeon," who chewed off a troublesome growth on his wound during the night, revealing the healthy flesh beneath (141). These stories help illustrate the unsavory realities of hospital life that even the most diligent administrators and nurses could not prevent.

Unlike Union hospitals, which increasingly relied on women to provide a workforce of nurses, much of the nursing done in Confederate hospitals was done by male slaves, who were hired for wages by their masters. Women served as matrons, and did their share of nursing care in that role, but they did not make up the majority of nurses. This demographic difference from Northern hospitals may explain why Green's story of doctor-nurse relations seems more harmonious than its Northern counterpart.

Dr. McCaw's ties to the Medical College of Virginia and his editorship of the newly founded Confederate States Medical and Surgical Journal contributed to the professional quality of medical care at Chimborazo. Green's discussion of McCaw's compassion and professional interests help to counter the image of Civil War physicians as incompetent, drunken hacks and the notion that administrators routinely turned a blind eye to these abuses. By challenging common assumptions about administrative incompetence and medical negligence, Green makes an...