The Civil War saw an estimated 600,000 deaths between the years of 1861-1865. It is thought that roughly two thirds of all deaths resulted from disease or infection (Backus). No one was prepared for such chaos and medical professionals everywhere were quickly overwhelmed. As the months turned into years, hospital systems changed in order to meet the ever present demand for a place to heal. In this post we will be looking at the various types of hospitals, some of the challenges that they faced, and how they changed overtime.

A nurse tending to some bed-ridden patients in a general hospital. Image credit: Friends of Wilderness Battlefield.

Hospital Types:

There were two main types of hospitals during this time period, field hospitals and general hospitals. Field hospitals were established near the front lines in order to provide emergency care for those wounded in battle. Men usually arrived at these stations either by wagon carts or on stretchers carried by comrades. In many instances, these makeshift hospitals were set up in churches, businesses, homes, barns, and anywhere else that could be made available (Backus). The second type of hospital, general hospitals, were commonly established in cities. They were set up with different wards and could house more patients. 

Carver hospital in Washington. Take note of the open interior. Image credit: National Museum of Civil War Medicine.


One of the most sinister challenges that medical professionals faced during the war was germs. As you can imagine, it was incredibly difficult to keep up standards of cleanliness in makeshift hospitals. Surgeries were often performed on dinner tables and on top of wooden doors. Some surgeries were even held outside when the weather permitted due to better lighting conditions. Just a fun fact, some men would whimper or cry out during these outside operations despite the fact that they were under anesthesia. Other soldiers would see this and write in letters home about the sorrows of the wounded in the hands of battlefield surgeons. These documents and first-hand accounts led to the common misconception that anesthesia was not used at all during the war. Another problem was the fact that beds were not available in most field hospitals. This resulted in men laying in masses on the grass, and on the hard floors wherever they could fit (Backus). 

This photograph shows just how overwhelmed the field hospitals became. Men would lay on the ground in agony, waiting to be treated. Image Credit: Confessions of an Oral Historian.

Fortunately though, general hospitals had more space, supplies, and staff. On top of that, it was much easier to maintain sanitary standards in the general institutions. One other major challenge that both types of hospitals experienced overall was a lack of medical staff. In most places the number of patients far exceeded the manpower of the staff on hand. This led to surgeons and nurses running themselves into the ground. They operated on small bites of food and very little sleep. Nurses typically worked shifts anywhere between 12-16 hours. While working they were constantly on their feet, scrambling to offer some comfort to the men that needed them. 

“You must never so much think as whether you like it or not, whether it is bearable or not, you must never think of anything except the need, and how to meet it.”

-Clara Barton (Hospital Nurse and founder of the American Red Cross)


Both sides utilized the pavilion design for their general hospitals, an architectural style already popular in Europe (“The Innovative…”). They usually consisted of a central hub with spokes that housed various wards (Thompson). By 1865, over 200 hospitals of that type had been constructed across the country (Thompson). These pavilion-style hospitals allowed for cross ventilation and sunlight. Patients in similar conditions were housed in spaced out beds in large, airy rooms. In 1859, Florence Nightingale’s book, Notes on Nursing, was published. In it, she emphasised the need for strict standards of cleanliness and fresh air in order to ensure a speedy recovery. No doubt, her book was influential to the medical professionals in the United States. Nowadays, the pavilion design has become obsolete and has since been replaced in favor of individual rooms for patients (“The Innovative…”). It is safe to assume that good ventilation and sunlight are still taken into account when designing modern hospitals.

“…a more awful sight I never witnessed than that as I went among the dead and wounded of both sides.”

-Dr. Hunter McGuire (Confederate surgeon).

If you enjoyed this post, please check out my post about Tuberculosis (the great white killer of the 19th century) HERE!

If that doesn’t make you thankful for modern medicine then I don’t know what will!

Until Next Time



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