Chimborazo Hospital


Chimborazo Hospital, located in the Confederate capital of Richmond, was the largest and most famous medical facility in the South during the American Civil War (1861–1865). The hospital admitted nearly 78,000 patients suffering from battlefield wounds and diseases. Of this number, approximately 6,500 to 8,000 died, resulting in a mortality rate of about 9 percent. Few hospitals in the Confederacy had lower mortality rates, and those that did generally received patients who were further along in their recovery. The best-staffed and equipped Union hospitals, in comparison, achieved a 10 percent mortality rate. With no model to draw on, Chimborazo Hospital’s success can be attributed to a combination of its open-air, pavilion-style design; the comparatively good quality of care; innovative practices; and the supreme dedication of the caregivers—men and women, black and white, slave and free. Their efforts contributed to one of the great advancements in mid-nineteenth-century medicine: the acceptance of hospital care for the sick and injured, which was a concept not embraced in America prior to 1865.

Early Construction

During the summer of 1861, Confederate troops inundated the capital city. In Richmond’s east end, the undeveloped forty-acre plateau known as Chimborazo Hill was selected as a camp for soldiers from half a dozen Southern states. Those soldiers inquisitive enough to ask were told that the name originated with the Ecuadorian volcano Mount Chimborazo. Richmond is surrounded by seven hills, but this high prominence above the James River stood out so majestically that the name seemed appropriate. To accommodate the recruits late in September and early in October 1861, a workforce consisting of slave labor began erecting permanent winter quarters on the site. The plans included soldiers’ barracks, officers’ quarters, three hospitals, and a large bake house.

Dr. James B. McCaw

Not long after this construction began, the newly appointed surgeon general of the Confederacy, Samuel P. Moore, recognized Richmond’s lack of capacity to care for the army’s sick and wounded. This fact, coupled with the realization that many soldiers died that first summer of the war because of the crowded conditions in the spaces that were selected for hospitals—including hotels, warehouses, stores, and private homes—led the surgeon general to look elsewhere for suitable hospital spaces. With many of the Chimborazo structures in place, and the vast majority of the Confederate army wintering in Northern Virginia, Moore determined to convert the barracks to a hospital facility. He placed a prominent Richmond physician and Medical College of Virginia professor, Dr. James B. McCaw, in command with the rank of surgeon-in-chief.

A native Richmonder, McCaw was born in 1823 into a family of physicians. He earned his medical degree from the University of New York in 1844, and immediately went into private practice. In 1858, he joined the Medical College of Virginia staff as professor of chemistry, while also serving as the editor of the Virginia Medical and Surgical Journal. His contemporaries viewed McCaw as incredibly competent, extremely modest, and a great organizer and administrator. “He was energetic—capable—skillful … Difficulties melted away beneath the warmth of his ready interest,” recorded a hospital matron. All these traits served him well as Chimborazo’s head surgeon.

Surviving records suggest that McCaw converted the nearly complete winter quarters into Chimborazo Hospital. Details about the facilities, particularly the patient wards, are plentiful. Evidence suggests that they measured about eighty by twenty-eight feet. The walls were crudely constructed by nailing two-inch-thick boards vertically to a simple frame, then applying a coat of whitewash to both the interior and exterior. The roofs were shingled, and the floors covered with wood planks. Three doors and ten windows ran along each side, providing both access and necessary ventilation. To soften the crudeness of the rough-hewn interior, every window had a white curtain, and often a growing vine or shelf of plants. A woodstove provided warmth, and a single candle lit the interior for the nighttime shift of attending physicians.

The ninety hospital wards accommodated approximately forty beds each, giving the hospital a capacity ranging from 3,400 to 3,600 patients. Wide avenues separated the rows of ward buildings to take full advantage of the fresh air that McCaw believed necessary to speed patient recovery. With the buildings arranged in this fashion, Chimborazo became the first of the pavilion-style hospitals in America. In addition to the patient wards, McCaw’s workmen constructed bake houses, kitchens, a soap house, five ice houses, a large stable, a guard house, a chapel, a bathhouse, five dead houses, and carpenter, blacksmith, and apothecary shops, bringing the total number of buildings to nearly 150.

Hospital Organization

In the Hospital

A first order of business for McCaw was organizing the massive hospital facility. He divided the wards into five divisional hospitals, and appointed a surgeon-in-chief for each of the divisions. With the absence of hospital administrators or a board to direct the facility, McCaw and his medical officers ran Chimborazo, making patient care their first priority. Under the divisional surgeons were a team of surgeons, assistant surgeons, and acting assistant surgeons who interacted with the patients. One of the requirements for these officers included the practice of medicine for no less than five years. Some were medical school graduates and others were active students at the Medical College of Virginia.

This medical corps was supplemented by hospital stewards, ward masters, nurses, druggists, cooks, dentists, and matrons. These ranks were filled with convalescing soldiers, free blacks, slaves, and women. To this list was added contract surgeons as needed, and civilian doctors occasionally volunteered their services. During one month alone in 1864, Chimborazo’s Hospital Number 4 employed six medical staff members, six nurses, one druggist, ten detailed soldiers, six stewards, six matrons, and twenty-eight African American servants functioning as cooks and nurses.

While medical regulations imparted strict supervision at all levels of the organization, the proficient Chimborazo staff was encouraged to practice innovation in order to provide the best quality of care available during the mid-nineteenth century. For those who didn’t survive their treatment, the nearby city cemetery known as Oakwood received the dead. By 1865, they totaled more than 16,000.

Patient Care

Providing nourishment for the patients was a nearly insurmountable challenge. Hospital rations were purchased from local suppliers, and McCaw arranged for the cultivation of a large vegetable garden on a nearby farm, where he also pastured the Chimborazo herd that consisted of hundreds of goats and milk cows. McCaw even acquired a canal boat, which he christened Chimborazo, that traded between Richmond and Lexington, bartering products made or acquired in Richmond for provisions. McCaw employed fiscal savvy when he commuted the daily value of rations authorized to each patient and placed the money in a separate account. In 1863 he filled each division with soldiers from the same state, thereby allowing supplies and mail to be distributed with orderliness. Taken altogether, these sound strategies ensured that Chimborazo had a good chance of operating smoothly, even as wartime conditions deteriorated.

The hospital’s first month of operation was anything but calm. More than 1,000 patients arrived in October 1861. That number fluctuated until the summer of 1862, when the Seven Days’ Battles, fought on the outskirts of Richmond, filled the hospital beyond capacity.

Oakwood Cemetery

To accommodate the overflow, Sibley tents were erected in the small amount of open space that remained. Approximately eight to ten soldiers could be placed in each tent. Fortunately, supplies were plentiful in 1862, and despite the overcrowding, McCaw’s patients received ample food. Throughout the war, patient numbers varied, and at times some of the empty wards were shut down until lines of ambulances marked the beginning of a new campaign

Medical care varied tremendously in all hospitals and Chimborazo was no exception. Numerous patient accounts offer glowing praise for the doctors and the care provided by the female matrons. Yet ample evidence also exists from other letters that the organization sometimes broke down. At times food was unavailable, and certain wards suffered from poor supervision. The result, according to eyewitnesses, was a negligent medical staff and a filthy, foul-smelling environment that did not foster healing.

The Fall of Richmond

The Last of Chimborazo Hospital

On April 2, 1865, Confederate defensive lines around Petersburg were penetrated by Union forces. The ensuing retreat of Confederate general Robert E. Lee‘s Army of Northern Virginia signaled the need to evacuate Richmond. Chimborazo’s patients began leaving on their own, if possible, while others too sick or feeble to be moved awaited the arrival of Union troops. Early on April 3, McCaw surrendered the hospital to a contingent of Union surgeons. Their inspection found Chimborazo suitable for use by the Union army. Soon after, Union patients began arriving by ambulance and were placed in separate wards from the Confederates.

By early summer, the patients were removed and a portion of the wards breathed new life as classrooms for a Freedmen’s Bureau school. Nearly 200 recently freed slaves were enrolled in an afternoon session, and their number grew to 345 by fall. Other wards were inhabited by up to 1,500 ex-slaves, some of whom were employed by Union authorities to begin the cleanup of the city. By 1874, few of the wards remained when the city purchased the property for a park. In 1909, a United States Weather Bureau Station was constructed on the site. In 1959 the National Park Service acquired six acres of Chimborazo that included the weather station building to use as a visitor center for Richmond National Battlefield Park. Today, the facility interprets the story of the Confederate Medical Service.

May—September 1861
Newly enlisted Confederate troops and militia organizations make camp on Chimborazo Hill.
October 1861
Richmond contractor Joseph Powell begins construction on Chimborazo winter quarters. Confederate surgeon general Samuel Moore directs Richmond physician Dr. James B. McCaw to take command of Chimborazo and convert the buildings into a hospital complex. The facility is named Chimborazo Hospital by McCaw.
October 11, 1861
Chimborazo Hospital in Richmond officially opens. By the end of the month nearly 1,000 Confederate soldiers arrive there for treatment.
November 1, 1861—November 1, 1863
The Confederate States Medical and Surgical Journal reports that 47,176 soldiers were admitted to Chimborazo Hospital in Richmond during this period, and of that number, 3,031 died. This produced an aggregate ratio of mortality of 6.62 percent for those two years.
November 11, 1861
The Richmond Dispatch describes Chimborazo Hospital as a city that "has suddenly sprung up," and suggests that it is "worth anyone's trouble to go and see the new city of Chimborazo."
November 16, 1861
Dr. James B. McCaw, head surgeon at Chimborazo Hospital in Richmond, directs that ambulance drivers are not to unload their sick soldiers until they are certain that there are accommodations for them. He demands that no soldiers will be simply dropped on the streets.
January 29, 1862
Construction for a bathhouse is authorized for the patients at Chimborazo Hospital in Richmond.
April 9, 1862
Dr. James B. McCaw, head surgeon at Chimborazo Hospital in Richmond, orders that every Chimborazo division hospital will have a dead house.
May 13, 1862
The Richmond Dispatch appeals to the ladies of the city for rags and worn-out cotton garments to be used as bandages at the city's Chimborazo Hospital.
May 17, 1862
Dr. James B. McCaw, head surgeon at Richmond's Chimborazo Hospital, reports to his superior that he has nearly 4,000 patients and 256 employed slaves to help care for the men. He now requests that these slaves be impressed into military service in order to avoid their inevitable return to their owners during this critical time.
July 24, 1863
Chimborazo Hospital's sick and wounded are moved, when possible, into separate hospital units established for their respective states.
August 13, 1863
Orders are issued forbidding the practice of allowing Chimborazo Hospital matrons to use the ambulances as pleasure carriages.
June 3, 1864
William A. Carrington, the chief inspector of Richmond area hospitals, begins preparing for the large number of wounded from the Overland Campaign by reducing the space allotted to each patient at Chimborazo Hospital from 800 to 500 cubic feet. He also sends more tents for the overflow, instructing Dr. James B. McCaw to prepare to pitch them.
April 2, 1865
Confederate patients are removed from Chimborazo Hospital in Richmond in advance of the capital's evacuation by Confederate authorities.
April 3, 1865
Chimborazo Hospital in Richmond is surrendered to Union authorities.
June 1865
Chimborazo Hospital in Richmond is used by the Freedmen's Bureau as classroom space for recently freed slaves.
The National Park Service acquires six acres of the former Chimborazo Hospital site to be used as a visitor center for Richmond National Battlefield Park.
  • Bollet, Alfred Jay, MD. Civil War Medicine: Challenges and Triumphs. Tucson, Arizona: Galen Press, Ltd., 2002.
  • Furgurson, Ernest B. Ashes of Glory, Richmond at War. New York: Alfred A. Knopf, 1996.
  • Green, Carol C. Chimborazo: The Confederacy’s Largest Hospital. Knoxville: University of Tennessee Press, 2004.
  • Lankford, Nelson. Richmond Burning: The Last Days of the Confederate Capital. New York: Penguin Books, 2002.
  • Pember, Phoebe Yates. A Southern Woman’s Story: Life in Confederate Richmond. Jackson, Tennessee: McCowat-Mercer Press, Inc., 1959.
APA Citation:
Ruth, Dave. Chimborazo Hospital. (2020, December 07). In Encyclopedia Virginia. https://encyclopediavirginia.org/entries/chimborazo-hospital.
MLA Citation:
Ruth, Dave. "Chimborazo Hospital" Encyclopedia Virginia. Virginia Humanities, (07 Dec. 2020). Web. 20 Jul. 2024
Last updated: 2020, December 07
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