Dates: n. d.
Notes: THE NATIONAL HOSPITAL, BALTIMORE, MD. — Extracted from a report of ROBERTS BARTHOLOW, Ass’t Surgeon, U.S. Army. — Notwithstanding the dissimilarity in uses, there is much similarity in the needs of a large hospital and a hotel. In both the business of cooking, eating, sleeping are important concerns, and the manner of doing these with the greatest regard to the personal well-being of the inmates involves all the manifold relations of sanitary science. The National Hotel was organized for hospital purposes by Ass’t Surgeon W.A. HAMMOND, U.S.A., in September , 1861. The prominent reason probably for the selection of this building was the convenience of the situation, being in the immediate vicinity of the Baltimore and Ohio Railroad depot and within six hundred yards of the harbor. The relation of the city to the great lines of communication with our armies in the field then and subsequently vindicates the wisdom of the selection. Some sanitarians have objected to this locality on account of its lowness and vicinity to tide-water. A hospital for the reception of sick and wounded patients obviously should be as near rail and water transportation as possible; and such objections should be held secondary to this necessity. Besides the hotel a large piano factory and eleven dwelling-houses, situated on both sides of Camden street, have been hired for hospital purposes. The National contains the appointments usual in a modern hotel. It is five stories high and contains fifteen wards, various offices, kitchens, store-rooms, laundry and bake-house, as follows: A large hall on the first floor communicates with the office, dispensary, water-closets, lavatory and dining-room; a broad circular stairway passes from this hall through the centre to the top of the house, and has opening into it the corridors between the wards. The wards open from opposite sides into the corridors and consist chiefly of suites of rooms. The front or rear of these rooms have large windows opening externally above the elevation of surrounding houses. The basement contains liquor and commissary store-rooms, coal-cellars, furnace, bake-house and pastry-room. In this part of the hotel building the defects of the situation appear. From the lowness of the ground and defective drainage or original imperfections in the water-pipes permitting leakage, water constantly rises in this basement and a deep well and pump have been always necessary to prevent overflow. The expensive attempts to remedy this evil have had but partial success, and the flow of water requires the more or less frequent use of the pump. The dwelling-houses are all on the same general plan, having hall, parlor, dining-room and kitchen upon the first floor, and rooms of various sizes in the upper stories. The piano factory is five stories in height and has a large and small ward on each floor. The large wards contain twenty beds each and the small ones eight, allowing to each patient 800 cubic feet of air. For convenience of administration the houses on the north side of Camden street are connected with the hotel and on the south side with the piano factory. All the buildings are of brick and, excepting five wards of the factory, have plastered ceilings. Many of the wards in the dwelling-houses have papered walls, but the principal wards in the hotel are hard-finished.Natural currents of air have been wholly relied upon to ventilate the hospital. All the wards in the hotel having ample window-space, and nearly all open grates, there is nothing to be desired as to artificial arrangements. Moreover, the passages between the wards being connected with the central hall and stairway, and having windows at on extremity and transom-windows over the doors of the suites of rooms, an upward current of air from without inward is constantly passing to the ventilator in the roof in addition to the local currents in each room. To prevent interference with this system of currents a block of wood large enough to secure an inch of space is attached to the top of each window and the transoms are removed from the doors. Soldiers are not regardful of the necessity for fresh air and sunshine, and the opportunity of shutting out both must be denied them. A large furnace in the cellar suffices to heat the entrance-hall, dispensary, dining-room and stairway; but as the air supplying the pipes is obtained from the cellar, the furnace is not a desirable addition to the means of ventilation. The wards of the piano factory have large windows at either extremity, and hence are abundantly supplied with air and sunshine. The dwelling-houses were not built with reference to these points. To produce as favorable a sanitary condition as possible the windows of the houses are kept open by blocks of wood, as in the hotel, and wood fires maintained in the open fireplaces. The elevation of the hotel and piano factory being considerably greater than the surrounding houses, the supply of air and sunshine is not hindered from any quarter.
Water is obtained from the street mains and is distributed in lead pipes. In the hotel there are four bath-rooms supplied with hot and cold water, a bath-room and lavatory in each of the dwelling-houses and a bath-room and lavatory connected with each of the large wards in the piano factory. On the first floor of the hotel, adjoining the main hall, there is a lavatory containing six porcelain bowls, each supplied with hot and cold water, a urinal having an uninterrupted water-supply, and in the same apartment six water-closets either self-acting or operating by a knob, containing porcelain bowls and traps. On each floor above there is a single water-closet similarly arranged and supplied. The discharges from these water-closets are conveyed through iron pipes to the main sink in the rear of the hospital, where the solid portions are deposited, the fluids passing through on earthen pipes from the sink into a street-sewer. The water-closets in the piano factory have cast-iron bowls, and the water is let on the will of the operator — both objectionable arrangements. The water-closets in the principal dwelling houses are attached to the bath-rooms and are in all respects like those in the hotel; but in several the latrines are primitive in style, consisting of wooden seats and a receiving barrel sunk in the ground. Gas-pipes extend throughout the hospital.
In the hotel there are two kitchens, a small one for the lady superintendent of the female nurses, where the delicacies for the sick are cooked, and the principal kitchen. The former is furnished with an ordinary cooking-stove and the latter with a range having sufficient capacity to cook for three hundred men; the piano factory kitchen has a range of the same capacity, and each dwelling-house has either a range or a cooking stove. All of these kitchens contain the necessary appliances, hot and cold water, wash-rooms, closets and cooking utensils.
The laundry has twelve fixed tubs with hot and cold water laid on, a large copper boiler for boiling clothes, and washing-machines. The ironing-room is in the basement next to the bake-house; the range for heating the irons contains the water-back for the laundry.
The bake-house has an excellent oven for baking 200 one-pound loaves, and is supplied with the necessary mixing-boxes, trays, malt-tubs, baking-pans, baker’s scales, bread-tables and shelves.
There are store-rooms for subsistence supplies, liquors, medical stores, unissued clothes, soiled clothes, knapsacks, unclaimed arms and accoutrements and the effects of deceased soldiers.
Compared with the limited ward-space, the complexity of the hospital arrangements in very great and the administration of the hospital proportionally difficult. Allowing to each patient 800 cubic feet of space, the whole number of beds is 700. The average daily number of patients is not probably more than 450, consequently the allowance of atmosphere is ordinarily much greater than that indicated above. Assuming 1,200 as the minimum and 1,800 as the maximum allowance of cubic feet of atmosphere to be given each patient in permanent hospitals, the Camden street hospital, if full, would be too much crowded. Medical Inspector PERLEY, U.S. Army, has mentioned a deficiency of air-space as one of the objectionable features of this hospital.
The sudden importance given to sanitary science in its application to the construction and arrangement of our military hospitals has had the effect of developing various crude, undigested and indigestible options. The maximum allowance of air-space may not prevent the occurrence of hospital gangrene, pyaemia and erysipelas, as the history of some of the new civil hospitals in Europe, built with especial regard to hygienic rules, will show. The 1,800 cubic feet of air allowed a patient may be foul air, and hurtful simply because stagnant. Sufficient space between the beds and a constant renewal of air are more important elements than the number of cubic feet per bed. With respect to these two elements this establishment is not greatly deficient.
The patients in this hospital being distributed in small wards over a great extent of buildings, the medical and administrative service requires a force of physicians, wardmasters and attendants greater than a pavilion hospital of the same capacity. * * * It is not easy to transport a patient, ill or badly wounded, up five stories of stairway. It was therefore one of the earliest cares of Dr. HAMMOND to have constructed an admirable arrangement for elevating patients — a large dumb waiter. When the piano factory was converted into a hospital the same mechanical contrivance was adopted. Not only are these elevators useful in transferring patients, but they are constantly employed for manifold purposes in the daily economy of the hospital services, for carrying up food and clothing and for sending down the dead, soiled clothes, utensils, etc.
Source: Medical and Surgical History of the Civil War, Vol. VI [Formerly entitled The Medical and Surgical History of the War of the Rebellion (1861-1865)] Wilmington: Broadfoot Publishing Co.: 899-901
Dates: n. d.
Notes: The next seven cases are from the NATIONAL HOSPITAL, Baltimore, Maryland, Assistant Surgeon George M. McGill, U.S.A., surgeon in charge. The notes of sixty-one post mortem examinations, made by Dr. McGill while in charge of this hospital, were printed by him on a hand-press in the hospital, and forwarded to the Surgeon General’s Office.* From these notes the following abstracts have been made, which include all the autopsies reported by Dr. McGill from the National Hospital on cases of diarrhoea or dysentery:Case 193.– Private C.B. Kittle, 10th Wisconsin battery; age 32; admitted from the medical director’s office January 10, 1865. Diarrhoea, with extremely irritable stomach and pain in the right iliac fossa. About the third day after admission low fever set in, with muttering delirium at night, and slight cough. Some fine crepitation was heard over the lower portion of the right lung. Died, Janury 16th.–Acting Assistant Surgeon J.G. Keller. Autopsy: Body emaciated; right side of chest, anteriorly, larger than the left. The brain was normal. There was red hepatization of the posterior third of the upper lobe of the right lung, the whole of its lower lobe, and the central portion of the lower lobe of the left lung; on pressure, the hepatized portions yielded an abundance of grayish puruloid fluid. Inflammatory spots and ulcers were observed in the lower portion of the ileum, and in the large intestine. One of the ulcers in the caecum had perforated, and communicated with a small abscess containing about two ounces of dark-colored, offensive, caseous, puruloid matter, which burrowed between the illiacus internus and psoas magnus muscles; extravasation into the abdominal cavity had been prevented by adhesion of the caecum and ascending colon to the abdominal parietes. The liver was congested, and about one-fourth larger than natural. The spleen was a little hard, of natural size; the lower part of its anterior border congested and black. The kidneys were pale, except in their inferior portions, which were congested and cherry-colored.–Assistant Surgeon George M. McGill, U.S.A. [No. 618, Medical Section, Army Medical Museum, is from this case. The specimen is a portion of the caecum, with the ileo-caecal valve and two inches of the ileum. There were several ulcers in the caecum, one of which had perforated.]
CASE 194 — Private John Kreul, company K, 199th Pennsylvania volunteers; age 20; admitted December 2, 1864. Chronic diarrhoea. This patient had typhoid symptoms and partial coma at the time of admission. He was treated with emulsion of turpentine and beef-essence; his condition improved somewhat for a while, but the diarrhoea continued until death. His mind was not clear at any time after admission. — Acting Assistant Surgeon W.G. Smull. [This man appears on the prescription-book of the 199th Pennsylvania volunteers as admitted to regimental hospital October 13, 1864, with acute diarrhoea. October 20th the entry, intermittent fever, appears opposite his name; October 23d, catarrh; October 25th, intermittent fever; October 26th, sent to field hospital. He appears on the register of the field hospital of the 10th Army Corps, admitted October 26th — intermittent fever — sent to Base hospital October 27th. He appears on the register of the Base hospital, 10th Army Corps, Jones’s Landing, Virginia, admitted october 27th — intermittent fever; but there is no record of his disposition.] Died, January 23, 1865. Autopsy same day: Slight rigor mortis; considerable emaciation. There was about an ounce of serum in the subarachnoid space, about a drachm in each lateral ventricle, and a small quantity in the fourth ventricle; the substance of the brain was flaccid. The pericardium contained about two ounces of fluid. The heart was small and contracted; both sides contained white fibrinous clots, which extended on the right side into the pulmonary artery, on the left into the aorta. The lungs were dark-colored, and congested hypostatically; the upper lobe of the left lung was adherent to the thoracic parietes, its lower lobe of the diaphragm. The stomach was flaccid, its mucous membrane grayish. There were patches of congestion in the jejunum and ileum, especially the latter. The mucous membrane of the caecum and ascending colon was thin, and presented large spots of congestion; in the transverse colon there were a number of ulcers which corresponded in position to the line of one of the longitudinal muscular bands. The sigmoid flexure and the upper part of the rectum were studded with small whitish ulcers. The liver was small and hard; the gall-bladder contained some light-colored bile. The spleen was a little larger than normal, tough, dark-colored, and full of blood. The kidneys were congested; the urine slightly albuminous. — Assistant Surgeon George M. McGill, U.S.A.
CASE 195. Private John Jordan, company H, 173d New York volunteers; age 30; admitted December 21, 1834. Chronic diarrhoea. [This man appears on the register of the hospital of the 173d New York as having been treated for malarial fever in April, 1864, while the regiment was at Alexandria, Louisiana, and for diarrhoea and fever from November 24th to December 6th at Camp Russell, Virginia.] He stated that he had been suffering from diarrhoea for two months. His tongue was dry and thickly coated; skin dry and yellow; bowels moved nearly every hour. Enlargement of the liver was diagnosticated. He was treated with small doses of blue mass combined with vegetable astringents, but the diarrhoea was not checked by these measures. January 17, 1865: Symptoms of pneumonia on the right side were observed; counter-irritants were applied and stimulants administered. Died, January 3lst. — Acting Assistant Surgeon J. G. Keller. Autopsy twenty hours after death: Body extremely emaciated. Brain normal; it weighed thirty-eight ounces and a half. Heart pale and flabby. The lungs were unusually black, and contained a number of small abscesses; the right lung was oedematous, and contained, besides the abscesses, a few miliary tubercles. The right lobe of the liver was adherent to the diaphragm; just below the adhesions was a large firm-walled abscess containing about a quart of gray odorless pus; the gall-bladder was quite fall of yellow bile. Spleen very firm and dark-red; it weighed nine ounces and a half. Kidneys light-colored; weight six ounces each. The ileum was somewhat congested, and there were a number of small dark-bottomed ulcers in its lower portion, but Peyer’s glands were not diseased. The colon was ulcerated; in the transverse and descending colon the ulcers were circular, a line or two in diameter, and most of them had dark bottoms. — Assistant Surgeon George M. McGill, U. S. A.
* Assistant Surgeon McGill was subsequently transferred to the Hick hospital, Baltimore, Maryland, where he printed the accounts of twenty-three additional post mortem examinations. These, with the sixty-one referred to in the text, were bound under the title “Observation Book — Ante-mortems and Post-mortems.” Of this little work its author says: “This book is only a printed note-book intended for the Surgeon-General’s Office, and for the officers of National and Hicks hospitals, who have desired copies. Criticism upon it, therefore, would be wholly out of place.” In using the material contained in this Observation book, considerable condensation has been necessary, and some corrections of names and dates have been supplied by the register of the hospital.
Source: Woodward, Joseph Janvier, The Medical and Surgical History of the War of the Rebellion. Part II. Volume 1. Medical History. Being the Second Medical volume. Prepared under the direction of Joseph K. Barnes, Surgeon General, United States Army. Washington: Government Printing Office: 125-
![McKims Mansion. Medical and Surgical History of the Civil War, Vol. VI [Formerly entitled The Medical and Surgical History of the War of the Rebellion (1861-1865)] Wilmington: Broadfoot Publishing Co.: 911.](http://msa.md.gov/megafile/msa/speccol/sc4800/sc4800/000002/000000/000013/images/h28.jpg)
Medicine in Maryland, 1752-1920 