Thursday, March 27, 2014

Organization of the Hospitals in the Department of Washington

Excerpted from:
By Susan C. Lawrence

"At the outbreak of the civil war," the author of the chapter on general hospitals in "The Medical and Surgical History of the War of the Rebellion" wrote, "this country knew nothing practically of large military hospitals; indeed, most of our volunteer medical officers knew nothing of military hospitals, small or large."

In fact, most of the volunteer medical officers would have known nothing of hospitals at all unless they had practiced in a city large enough to have had one or more charity hospitals, such as New York, Boston, Philadelphia or Washington, DC. Both volunteer and newly recruited medical officers must have quickly discovered that they needed to learn something about the military as well as something about hospitals in order to work in some of the ad hoc, transitory establishments that housed the sick and wounded at the start of the war. It was the military, after all, that requisitioned space, built new hospitals, provided supplies, and needed regular, complete reports of the numbers of sick and wounded. The military imposed order (or at least tried to) on the proliferation of hospital sites, working along both military and medical chains of command.

In theory, every regiment had a hospital (a regiment was 10 companies of 100 men each). For armies on the march, these were field hospitals, with supplies carried along in wagons and set up in whatever quarters could be found or organized around ranks of tents.

For armies encamped, there were post hospitals created out of tents or wooden barracks; these were organized at the regimental or brigade (3 to 6 regiments) level. The District of Columbia hosted huge camps for mustering the troops moving through the city to form the armies operating to the south and southwest, and so had flexible camp hospitals.

As the army constructed fortifications around the District, it also established post hospitals to serve those who garrisoned the forts. Field and post hospitals served only the companies and regiments assigned to them, and were under the authority of the highest ranking military officer in the specific command. Given the number of troops needed to garrison the posts and batteries, and to be held in reserve in case of attack, these post and camp hospitals provided care for tens of thousands of soldiers. They held those too sick or injured to remain in their camp or post quarters, but not sick or injured enough to be transferred to one of the general hospitals in Alexandria, Washington or Georgetown.

General hospitals, in contrast, primarily took care of the sick and wounded left behind as troops moved out and, more importantly, to deal with the influx of sick and wounded transported in from field hospitals for longer term care than could be managed near battlefields or by soldiers on the march. General hospitals took in soldiers from any company, and so had a place outside of direct military authority. The surgeon in charge of a general hospital held an officer's rank and reported to the Medical Director of the relevant Department. Medical Directors, in turn, reported to the Surgeon General. From the very beginning of the war, however, tensions flared between the surgeons-in-charge and local officers of higher rank over who had the authority to manage the general hospitals' organization and administration. The War Department had to send out several reminders that the surgeons in charge of general hospitals followed the orders of the Surgeon General, not the orders of higher ranking military officers around them, and that they were totally in charge of all medical decisions within their institutions.

The Defenses of Washington: Organization of the Post Hospitals
The defense of the capital preoccupied Washingtonians throughout the war. How many troops and resources were needed to march against the South and how many were required to protect Washington became significant bones of contention within the army and among politicians.

General Mansfield, placed in charge of the Department of Washington at the start of the war, began construction of new defensive forts in May, 1861. In late July, the task of defending the District fell to Major General George B. McClellan. Under McClellan's authority, construction began on the series of forts, redoubts, and batteries that would eventually encircle Washington and Alexandria with sixty-eight forts and one-hundred batteries by the spring of 1864. Brigadier General James S. Wadsworth organized all of the post hospitals in March of 1862. Then, on February 2, 1863, the defenses were formally divided into two divisions of the 22nd Army Corps, one for those forts north of the Potomac (Washington) and one for those south of the river (Alexandria). Forts were manned by specific volunteer regiments, organized into three to four brigades. Clusters of forts (and redoubts and batteries) shared one or more post hospitals, with a hospital usually (but not always) found at the fort serving as brigade headquarters. In July of 1864, the brigades north of the Potomac were again reorganized, with the 1st Brigade becoming the 2nd Brigade and vice versa; the 3rd Brigade remained the 3rd Brigade.

The location of post hospitals moved according to the distribution of regiments among the various forts, as well, with more or less consistent attempts to keep them equally accessible to all of the positions they covered.

Given the capital's location, it became a major point of care for Union soldiers. Indeed, by December, 1864, the Department of Washington (twenty-four of the twenty-five general hospitals in the Department of Washington were in the District of Columbia) had more beds (21,426) in its general hospitals than any other department in the war.

The organization of the general hospitals in the District fell to the Medical Director of the region, Robert O. Abbott. At the start of the war, the military simply requisitioned the civilian city hospital (the E Street Infirmary) and the Union Hotel to serve as general hospitals when needed for the first casualties, who arrived in May of 1861.

Other sites were soon located, such as rooms in the Patent Office, but the big push to claim sites for general hospitals started in March of 1862. The general hospitals in Washington and Georgetown were loosely organized throughout the war, with no clear hierarchical structure.

In contrast, nearly all of the general hospitals located in Alexandria were grouped into three divisions on September 20, 1862. The surgeon placed in charge of all of the division hospitals supervised the surgeons responsible for each of the divisional hospitals' branches. (It must be emphasized that the divisional structure of the hospitals in Alexandria had no relation to military divisions within the army, but only represents an unfortunate use of parallel terminology.)

The Union Hotel was only the first of the buildings that the military took over to use as a hospital. Churches, schools, homes, and warehouses had crews come in to fill them with beds and to organize rooms for managing hospital functions: kitchens, stores, laundries, surgeons' rooms and, of considerable concern, water closets. Next in use were the wooden barracks abandoned by troops moving out on campaign. Commentators, both during and after the war, complained bitterly about how inappropriate such makeshift accommodations were for hospitals.

Ventilation and sanitation were the watchwords of up-to-date hospital construction in the early 1860s. By the end of the war, however, the military had constructed relatively few buildings designed from the start to be hospitals. None were built in Alexandria, for instance. Indeed, only five institutions were erected specifically as hospitals in Washington itself: Judiciary Square (built on the site of the burnt-down City Infirmary), Harewood, Armory Square, Mount Pleasant, and Lincoln general hospitals. Yet even the latter three incorporated some existing barracks buildings or tents into their plans.

All five of these general hospitals were constructed in 1862, with Judiciary Square and Mount Pleasant opening in April of 1862, Armory Square in August, Harewood in September and Lincoln in December. Their plans followed contemporary wisdom: wards, with fourteen foot ceilings, a window between each bed, and floors raised off the ground, contained 60-63 beds each. They were built as separate buildings linked by open-sided covered walkways, all in order to maximize the circulation of fresh air. In overall design intention, if not in precise detail, these hospitals presaged the requirements for purpose-built, pavilion style hospitals laid out in a War Department Circular printed on July 20, 1864, and were sent to all departments to direct the future construction of general hospitals.

As the census figures for December 17, 1864 show, 7,783 (39%) of the hospital beds in the District of Columbia were in "proper" hospitals over two and a half years into the war. These numbers do not include the number of beds found in the District's post hospitals, moreover, so there was an even lower percentage of beds in facilities designed with medical goals in mind within the District and its circle of fortifications. Most sick and wounded soldiers, in short, spent their days in makeshift accommodations, from well-appointed houses to tents in muddy fields.

The Hospitals in Space and Time
The locations of all of the District's hospitals, including all of those established as part of the defenses of Washington, even if slightly outside the District's boundaries, are displayed on our maps, in the context of the District's fortifications, churches, bawdy houses and other institutions vital to the life of a city at war. The time slider allows the user to examine the chronological arc of the hospitals' presence, and reveals how these institutions were one of the dominant features of Washington's and Alexandria's landscapes during the intense years of 1862 to early 1865. A closer examination of the hospitals that appear and disappear from May 1861, to early 1863, documents the initial use of temporary housing, particularly of churches and government buildings (the Capitol and the Patent Office), and then the shift to the large hospitals positioned in barracks or purpose-built on empty sites. When the fiercest fighting of the war moved away from Washington, some of the post hospitals and smaller general hospitals began to close. At the end of the war, hospitals closed more rapidly, with only three remaining to serve regular army needs after September of 1866. Churches and chapels all returned to being churches and chapels, re-purposed barracks hospitals were torn down, and the purpose-built hospitals, for all their up-to-date design, ceased to exist. From constant reminders of the war's presence, and its human costs, to empty spaces in the District's terrain, hospitals were, ironically, one of the most transitory of features in the District's infrastructure.


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