Nosokomia to sacred infirmary: legacy of the Knights Hospitaller and Chimbarazo Hospital in the evolution of hospitals from medieval to modern.

With the onset of hostilities in early 1861, most thought the fighting would be short-lived, a few months at most. This unfounded optimism was quickly laid to rest in July with the first major battle of the American Civil War at Manassas (Bull Run), when Brigadier General PGT Beauregard’s Southern forces prevailed in a bloody conflict that would presage the carnage to come. Thousands of sick and wounded combatants poured into Richmond, the newly established Confederate capitol, from the surrounding countryside. Only a small number found their way into hospitals. One firsthand report described “the whole country . one vast hospital, . scattered throughout hotels, private houses, public halls and wherever it was possible to spread a blanket”; leading one English visitor to observe, “There was scarcely a gentleman in or about Richmond who had not from one to four patients in his house.” As a result, Richmond itself resembled a vast city of improvised hospitals with little or no planning or organization to provide needed medical services and little to build on, as all 5 existing hospitals in Richmond at the start of the war were small facilities with patient capacity of only 30 to 100 beds. Clearly, this would be inadequate for the future. The newly appointed surgeon general of the Confederacy, Dr Samuel Preston Moore, a native South Carolinian who had resigned his commission with the US Army when the war began, was charged with the creation of a Confederate medical department with no existing bureaucracy or infrastructure to build on and limited funds. He designated Richmond as the center for a hospital system because it was in proximity to all the fighting in the east, and was both the largest city in the region and a major transportation