![]() ![]() Florence Nightingale famously attributed the high death rate of British soldiers during the Crimean War to, among other things, lack of proper ventilation around their bodies. 4 A rising tide of medical opinion, however, emphasized the fact that hospitals needed to be specially designed to optimize the free flow of air throughout all the wards to dispel air tainted by the sick and wounded. This implicit definition served the army well during the Civil War, when hospitals had to be created at a moment's notice. 3 In practice, then, a military general hospital was not a specific type of building but a type of organization headed by a medical officer. Then the traditional pattern of medical care for sick and wounded troops on the move quickly reemerged: field hospitals dealt with immediate casualties and then sent the wounded to general hospitals that the army established in large civilian buildings at strategic sites. Surgeons were assigned to these posts, rather than to regiments, and managed the sick and wounded in post, rather than field, hospitals, except during the large-scale engagements of the war with Mexico from 1846 to 1848. Since the main duty of the military after the War of 1812 had been to deal with conflicts on the frontier and with Mexico, the army organized its efforts around forts and their garrisons. Formed in 1775 to deal with the sick and wounded of the Continental army, the army's medical department and hospital system evolved through decades of confusing and sometimes contradictory enabling legislation. Military hospitals had their own historical trajectory that shaped their structures and management at the outset of the Civil War. Such arrangements, typical for fledgling medical schools, suited both the needs of the poor and the needs of medical education. Indeed, the doctors who attended patients in the Washington Infirmary were the select few who ran the medical faculty at Columbian College and used the Infirmary for clinical instruction for their students. Doctors served their paying patients in the patients' homes, even for those who could not pay very much, and so few practitioners had spent any time in hospital wards at all by 1861. Because prewar charity hospitals were devoted to the poor and were places of last resort for those who had no friends or family capable of supporting them through their illnesses or injuries, no respectable citizen wanted to end up in one. The county funded these institutions through taxes, while citizens funded the Infirmary through charitable donations, although it may also have received county or city funds for treating the local poor. Elizabeth's), where the city sent the insane poor who could not be managed in their homes or at the almshouse. Washington, like other American communities, had two other institutions where doctors dispensed medical treatment: the poor house, or almshouse, where the city sent indigent citizens and had doctors take care of basic medical needs, and the local insane asylum (St. The Washington Infirmary was typical of the hospitals that graced antebellum cities large enough to have civic support for a place where the deserving sick poor could receive free or very inexpensive medical aid. In the face of the war's first casualties, the military co-opted space in the Washington Infirmary, the only building in the city devoted to general medical care, and it became-at the stroke of a pen-the first military hospital established in the Civil War. When a Baltimore mob wounded some of the first recruits on their way to Washington DC in May 1861, several were cared for on the spot, while others were transported to the nation's capital. ![]()
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