Chimborazo: The Confederacy's Largest Hospital.

Chimborazo: The Confederacy's Largest Hospital. By Carol C. Green. (Knoxville: University of Tennessee Press, 2004. Pp. xii, 200. $29.95, ISBN 1-57233-316-2.)

One of the principal contributions of the Civil War to medicine was its impact on the evolution of the hospital. Previous military and public experience with the hospital had been largely unsatisfactory. But mounting numbers of sick and wounded forced both sides early on to build large fixed hospitals. The success of these facilities in saving lives and restoring health helped change attitudes and promote hospital development.

The largest and best-known Civil War hospital was the Confederacy's Chimborazo. Located in Richmond, Chimborazo opened in October 1861. Patients were housed in revolutionary pavilion-style buildings--America's first. Tents for the convalescent and slightly wounded raised capacity to eight thousand. James B. McCaw, Chimborazo's talented and resourceful head, was a prominent Richmond physician and professor at the Medical College of Virginia. He was ably assisted by a dedicated staff of physicians, stewards, and matrons. Designated an independent army post by the Confederate surgeon general, Chimborazo was largely self-sufficient and remained in continuous operation until the evacuation of Richmond in April 1865. During its three-and-a-half-year history approximately seventy-eight thousand patients were treated here with a death rate of slightly over 11 percent (the comparable Union figure was 10 percent). Several drug and treatment trials for the Confederate Medical Department were also conducted at Chimborazo.

In Chimborazo: The Confederacy's Largest Hospital Carol C. Green contends that the general hospital has received insufficient attention in works on the Civil War and nineteenth-century medicine. The result is an incomplete understanding of the war's large-scale medical challenges and their effect on medicine. A fuller picture requires going beyond the usually studied field medicine to take into account other pieces of the puzzle, the general hospital in particular. Chimborazo, the conflict's most extensive hospital and a model for similar facilities, is a good case in point.

After a detailed examination of the history and accomplishments of Chimborazo, Green evaluates the facility using five criteria: "quality of [its] organization, its quality of patient care, its level of innovation, its compliance with military regulations, and its perceived success or failure as seen through the eyes of those who lived and worked there" (p. 153). With the single exception of compliance with military regulations, which McCaw frequently circumvented for the benefit of the hospital, Chimborazo is given high marks. Medical treatment received here, Green asserts, "was as good or better than at any other hospital during the Civil War" (p. 153). Like other general hospitals, Chimborazo influenced the development of modern medicine in two important ways: the invaluable experience doctors received in the treatment of all classes of patients led to improved medical care; and the generally positive view of the institutional setting in which treatment took place helped transform Americans' perception of hospitals.

The work is extensively researched, engagingly written, and calls needed attention to the importance of the Civil War general hospital and its role in the advancement of medicine. It is a significant contribution to Civil War history and the history of medicine. Hopefully, it will encourage studies of other Civil War general hospitals.

JAMES O. BREEDEN

Southern Methodist University