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AUTHOR:  Dr. Phoebe Ann Pollitt, RN

(Excerpted from Dr. Pollitt’s book African American Hospitals in North Carolina: 39 Institutional Histories, 1880-1967 [pp. 9-12, McFarland Books, 2017])

Civil War Hospitals in North Carolina

At the outbreak of the Civil War, in the spring of 1861, no trained nurses or general hospitals and few physicians existed in the state of North Carolina. The leaders of the Confederacy were busy organizing a new government, establishing foreign relations and fighting the War.  A common misconception was that the Civil War would be quickly and easily won.  Because of this error in judgment, little provision was made for the care of wounded and sick soldiers. Instead, the Civil War produced an unprecedented number of sick and wounded soldiers creating a medical crisis.

The Confederate States of America quickly established 13 large military hospitals around North Carolina with the largest facilities in Charlotte, Fayetteville, Goldsboro, Raleigh, Salisbury, Wake Forest, Wilmington, and Wilson. Smaller, temporary hospitals—often run by local women and known as “Wayside Hospitals”—sprang up along railroad lines. Hotels, churches, and schools served as these makeshift hospitals. Some military camps established their own small hospitals for soldiers who fell ill during training. Despite the heroic efforts of doctors and nurses, conditions in Civil War hospitals were grim and overcrowded. Amputations were common and diseases spread rapidly. There were neither antibiotics to stop infections, nor immunization to prevent outbreaks of measles, tetanus, diphtheria, and other diseases that took more lives than the battlefields. None of these facilities allowed African American patients through their doors.  (Pollitt & Reese, 2002, Humphreys, 2013).

Early in the Civil War, much of coastal North Carolina fell to Union troops. Five Union hospitals were established in this area. These were the first hospitals in the state to offer more or less equal care to white and African American patients. In addition to Foster and Stanley Hospitals in New Bern, Hammond Hospital in Beaufort, the U.S. Army General Hospital for Colored Troops in Wilmington, smaller Union hospitals were located in Morehead City and on Hatteras Island (Giri, 2014; Hutchinson, 2002; Williams, 2011). Union troops captured Raleigh in the spring of 1865. Within days, the Union Provost Marshall ordered the first African American patient, a Union soldier, be admitted to Dix Hospital. Local African American residents soon followed. Dix Hospital was racially integrated until 1880 when the state built the North Carolina Asylum for Colored Insane (now Cherry Hospital) in Goldsboro, North Carolina (Dorothea Dix Hospital, 2014).

A great irony of the American Civil War is that its enormous toll on human health—over a million casualties, approximately 660,000 deaths from war and disease, 60,000 amputations, untold thousands suffering from a variety of physical and mental disorders—produced vast advances in scientific knowledge.  Caring for hundreds of thousands of soldiers and civilians suffering from a wide array of ailments resulted in innovations in surgery, medicine, nursing, psychiatry, and public health.  The benefits of hospitalization were evident during the Civil War. Many Civil War nurses incorporated ideas of sanitation, hygiene and nutrition advocated by British nurse Florence Nightingale, in their nursing care, while many surgeons used new Listerian surgical techniques.  Patients who received antiseptic surgeries had better outcomes than those receiving traditional surgery (Humphreys, 2013). Soldiers who convalesced in a clean environment with nutritious food and continuous oversight by skilled attendants fared much better than those in less healthy settings. These lessons would lead to the burgeoning of hospitals in North Carolina in the decades around the turn of the twentieth century (Pollitt & Reese, 2002, Humphreys, 2013).

Freedmen’s Bureau Hospitals in North Carolina

On March 3, 1865, close to the end of the Civil War, the federal government established the U.S. Bureau of Refugees, Freedmen and Abandoned Lands. The Freedmen’s Bureau, as the agency was popularly known, was created to help formerly enslaved people deal with the economic and social destruction and displacement caused by slavery and the Civil War. One function of the Freedmen’s Bureau was the provision of health care services (Cimbala & Miller, 1999). In North Carolina, a medical division of the Freedmen’s Bureau was created on June 16, 1865. It operated eight hospitals in the state—located in Wilmington, Raleigh, Beaufort, New Bern, Roanoke Island, Salisbury, Greensboro, and Morganton—usually in buildings that were former Confederate military hospitals. An additional Freedmen’s Bureau clinic or dispensary was housed in the former Moravian, African American log church in Salem (“Negotiated Segregation,” n.d.).  Their combined total capacity was 600 patients. Four full-time medical officers were assigned to the North Carolina Bureau’s Medical Division, and another 14 contract surgeons were intermittently hired to treat and prevent the spread of communicable diseases (Pearson, 2002). Medical attendants were hired as needed with a peak of 45 employed in 1867. During the first full year of service, 24,130 people received hospital care, 11,525 were vaccinated against small pox, and 598 women were given obstetrical care. In the 25 months of the North Carolina’s Medical Division’s existence, 40,343 people were treated and 4,798 of those died, resulting in a mortality rate of slightly over 10 % (deRoulhac, 1909). In March 1868, the US Congress voted to defund most of the functions of the Freedmen’s Bureau, including its medical division. This left North Carolina with “no hospitals … neither are there any medical men employed to attend to the poor, sick, and destitute freedmen” (Doherty (1868) as cited in Pearson, 2002).

From the closing of the Freedmen’s Bureau Hospitals in 1868 until the founding of St. Peter’s Home and Hospital in Charlotte in 1876, no general hospitals existed in North Carolina. The North Carolina Board of Medicine’s online timeline described the era:

Patients and their families create their own remedies, or they seek medical assistance from herbalists, “granny women,” or lay midwives. Medicine is practiced by anyone claiming to be a physician, and quackery is rampant. All doctors are generalists, and they usually travel to treat patients at patients’ homes. A doctor may have a home office, which doubles as a compounding pharmacy. Technology is limited to what can be carried in a doctor’s bag. (“Doctors,” n.d., p.1)

These conditions were soon to change.

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