From William A. Carrington CSR (M331): Inspection report, dated 10/21/1862, for Samaritan Hospital
Report No VIII
Richmond, October 21st 1862
Surgeon E. S. Gaillard, Medl Director,
I have the honor to report that I have inspected (Oct 15th) the private Hospital called the Samaritan, on Clay between 5th & 6th streets, occupied since Oct 14th, 1861. The building is owned by Thos. R. Price, and rented at $20 per month, being paid by the Young Mens' Christian Association. The neighborhood is healthy and consists of private residences entirely. The Building is of brick, well ventilated, lighted and supplied with water and gas. There is but one ward, but two small rooms (used as Pantry, and Baggage rooms) are out off from one and of it. The room is of light pitch, and has a capacity for 20 patients. In a small back yard are water-closets and store rooms. Doctor Gwathney is acting Surgeon in charge, giving his services gratuitously. One Steward, one nurse, and one Laundress are the compliment of attendants. Mrs. Mayo, a patriotic lady, is acting as Matron and superintendent, gratuitously supervising the institution of food, the superintendence of the beds and bedding &c and keeping the register.
Medl supplies are drawn on requisition from the Medical Purveyor - Rations are drawn from the Commissary.
The furniture of [the] ward is supplied by the Young Men's Christian Association.
The Surgeon in charge visits the Hospital once or twice daily - There are no regulations or organization proper for a Military Hospital - no guard posted - cleanliness and order exist and this in large part due to the presence & influence of the excellent ladies who have visited and nursed at this Hospital since its organization - No hospital fund exists except that arising form the sale of supplies and provisions, and bread of officers at rates of $7 per week and this is expended.
I can report the Hygienic condition of the Hospital as good, with the exception of the privies which are in bad order and not policed properly. The cooking is done at private houses in the vicinity, and there being no laundry, the washings of clothes is done in the neighborhood. The Register is the only Hosl Record exhibited.
I would recommend that the support of the Government be withdrawn from this Hospital - if the Patrons should keep it in operation, the patients must be subject to the regulations for patients remaining in private quarters; reporting at some Hospital, and some Physician becoming responsible for them, in which condition there are few more than 500 in this city. When this and similar Hosls were established, no one could compute what the demand for Hospl accommodation would be. Now there are 3358 empty beds in this city, and if it will be necessary to open this and other such Hosls hereafter, economy alone would render it best that the inmates now occupy those empty beds - In institutions where a military organization exists, surgeons are constantly on duty, and that military discipline, so well indicated in the first (1st) act of war, secures strength, efficiency, and order by systematic justice, firmness, & kindness.
It is the opinion of some of our most experienced surgeons that, of the sick, "start back" to one Hosl, 1/3 are sick; 1/3 broken down, weary & sore foot; & debilitated by previous disease; and 1/3 a motley class composed of the naturally spiritless, the dissolute & abandoned and those disheartened by hardships or demoralized by the neglect & ill-treatment of their officers - It is found that a long course of discipline & training is necessary to make good soldiers of a no of undisciplined individuals, & it is just as certain that when these individuals are isolated, they are demoralized & return to their original condition, losing the "esprit de corps" which they have attained - and some from the 1st two classes above referred to, as well as the third, dreading the wholesome restraint of military discipline become frequently skulkers at Home, or stragglers with the army - cowards in the field & cumberers of transportation, or mysterious healing cases in the Hosls. All Surgeons know that in the Hospitals, as well as the field, Discipline is the first element in Hygiene.
I have no individual reference to these seven, therein to effect private Hosls, but in all of them I think that the abscence of Military discipline weans many soldiers from the habits they have formed in the army, being more or less miseries for stragglers & skulkers - that they are entirely inadequate as a means to accomplish the end desired, and that the whole purpose is affected by 1st; the large, orderly, economical, & well disciplined Hosls (Military) in which I have elsewhere recommended the use of female supervision over some departments, in subservience to the Surgical; 2nd - in furloughs or leaves of abscence; & 3rd and intermediate between the two, a system by which the sick may be allowed to be treated in private quarters under certain restraints.
In the Samaritan, Soldier's Home, Robertson & Clopton Hospitals the capacity is estimated at 144, said at this time the nos of patients is 94. These four separate institutions may transfer all their inmates to two of the wards at Chimborazo or Winder or any of the Genl Hospls of the City. At those institutions, where the large mass of our sick & wounded soldiers are treated, I believe they will receive (what every soldier deserves) the best treatment & regimen possible or that is required - Some of them, I believe, approach the perfection of Military Hospls. Such as appear to me as deficient in organization, as in executive administration, it is my duty to investigate minutely & report to you in detail elsewhere. If any advantage can be gained by our defying the established system or by any addition to it, let it be adopted, so that all can have the benefit of it.
[In "Ledger of Confederate Hospital Practice," this paragraph is substituted for the two below - obviously the document in Carrington's CSR is a draft version: A report of the mortality in the various Hospl in & around Richmond has been published & some unstated in the estimation of medical evidence its complexities & sources of error, or preferring rather to cater to popular fallacies, have reasoned post hoc ergo proptu hoc that the varying treatment & regina were the influencing causes. – Considering the many other influences on the date role (one of which is above referred to) the nearly equal advantages in the skill & knowledge of Surgeons & Attendants & the really slight variations in the Surrounding circumstances of patients in different Hospitals, when critically wounded the decision must be attained that the difference depended upon the varying nature of the diseases & the ability of the patient to react against them from their previous condition.]
Of the 225 patients admitted in to the Samaritan Hospl, 51 were furloughed, 8 discharged, & 21 died.
Someone skilled in the estimation of the complexities and sources of error of Medical evidence, have reasoned from the tabular statement of the results of the cases treated in the various Hospls in and around Richmond, compiled to Sept 17th, 1862, that the difference of treatment and regina was the differencing cause - But, considering other influences in the death rate, above referred to, the nearly equal advantages in the knowledge & skill of Surgeons and attendants, and the really slight variations in the surrounding circumstances when critically viewed, the decision must be attained that the difference depends upon the varying nature of the diseases and the ability of patients to reach(?) against them.
Your Obedient Servant,
Wm. A. Carrington
Surgeon & Inspector of Hospitals