Center Building 1852 - 1877

St. Elizabeths Hospital (SEH) in Washington, D.C., originally was known as the Government Hospital for the Insane (GHI). It was established through the Civil and Diplomatic Appropriation Act of 1852, and admitted its first patients in 1855. Dorothea Dix, its founder and the leading mental health reformer of the 19th century, wrote the law that articulated the hospital’s mission "to provide the most humane care and enlightened curative treatment of the insane of the Army, Navy and the District of Columbia."

Located on a hill in southeast Washington, D.C., overlooking the Anacostia and Potomac rivers, it offers a panoramic view of the city. St. Elizabeths was built as a 250-bed hospital based on the Kirkbride plan. Thomas Walter, Architect of the Capital (1851-1865), drafted the architectural plans for Center Building. In 1852, on the recommendation of Dorothea Dix, Charles H. Nichols, M.D., was appointed as the first Superintendent of the hospital. He was responsible for the building and administration of the hospital. It was built in three phases– west wing, east wing and the center building last.

On October 10, 1861, the United States Congress authorized temporary use of the unfinished east wing as a 250-bed general hospital for the sick and wounded soldiers of the Union Army. The West Lodge for colored insane males was converted into a 60-bed general and quarantine hospital for the sailors of the Potomac and Chesapeake fleets. There were three distinct hospitals, each headed by a different physician.

In 1862, an artificial limb manufacturing shop (patented by B.W. Jewett) was set up to fit amputees with artificial limbs. Amputees from neighboring hospitals were transferred to St. Elizabeths Hospital to fit the prostheses free of charge. Soldiers stayed at the hospital until their wounds healed and they learned to use their artificial limbs. During this period, a portion of the hospital’s farm was converted into a cavalry depot and an encampment for a marine company.

Lithograph Rear View of Center Building Circa 1862 East Wing (right) with Tents for Convalescing Soldiers in front, West Lodge on far left

Overcrowding was inevitable during the war. Tents were placed on the ground for the convalescent patients. President Lincoln frequently visited the hospital to see the sick and wounded soldiers, and a room was reserved for his overnight stays. During the fall of 1862, General Joseph Hooker was wounded and admitted to the hospital. Dr. Nichols and his wife personally cared for him. Dr. Nichols, a volunteer Surgeon for the St. Elizabeths Army General Hospital, would often ride out to major battlefields around the Washington, D.C. area to treat casualties. He was introduced as one of General McDowell’s staff at the Battle of Bull Run. Approximately one-fourth of St. Elizabeths’ male employees divided their time between the battlefields and the hospital. The patients stepped in to assist in providing hospital services.

During the Civil War, the wounded soldiers were reluctant to write home that they were being treated at the "Government Hospital for the Insane." They began referring to the asylum as the St. Elizabeths Hospital after the colonial name of the tract of land where the hospital was located. Congress officially changed the hospital’s name in 1916.

The GHI was the first and the only federal mental health facility in the United States at that time. Soldiers were referred there for treatment after they were thoroughly evaluated for malingering and deception. The way for a Union soldier to get discharged on the basis of mental disability was through GHI. The admissions and discharges were controlled and authorized by the Adjutant General’s Office. However, not all Union soldiers were treated at St. Elizabeths. Dr. Nichols observed that the majority of these cases had both mental and bodily diseases. After the war, the Army and Navy general hospitals were closed and the artificial limb manufacturing shop was dismantled. But the hospital continued to care for the mentally ill Civil War veterans.

Following the Civil War, there was an increase in the number of mentally ill veterans. On July 13, 1866, Congress passed an act that permitted the GHI to admit all men who had served as Union soldiers in the Civil War and were found insane within three years of discharge by reasons of continuation of mental illness, relapses after recovery, or mental illness relating to military service. The hospital gradually received veterans from all parts of the United States. Many of these former soldiers were chronically ill and required custodial care. To relieve congestion and overcrowding, the hospital continued to construct new buildings. The Dawes* extension to Center Building was built in 1871 to house 100 males. In 1872, another wing named Garfield* was added. In 1878, Atkins* Hall was built. The hospital’s expansion continued with the 1880 construction of the Relief Building to house 250 chronic male patients.

Ground Plan for the Government Hospital for the Insane, designed by Charles H. Nichols M.D., Superintendent 1852 - 1877

In 1882, Congress passed legislation directing transfer of insane persons from the National Home of Disabled Volunteer Soldiers to St. Elizabeths. The following year, the Home Building was built to accommodate 150 patients, 450 patients soon occupied it. The veterans were now elderly, disabled and in poor health. To separate the military prisoners and criminally insane, Howard Hall was built in 1887. Between 1898-1899, four Allison** Buildings were constructed to care for infirm and bed-ridden Civil War Veterans. The hospital always maintained high standards in caring for the Civil War soldiers. As stated by Dr. Nichols, "the patriotic sacrifices of the military patients will always entitle them to our best endeavors to promote their comfort and their restoration to health."

St. Elizabeths Hospital has two cemeteries where soldiers from the Civil War are interred. The Civil War cemetery on the west side of the grounds has approximately 500 graves. White and African American soldiers from the Union army and soldiers of the Confederacy are interspersed throughout the cemetery. Many of the stone markers are worn, cracked or broken. Some have been destroyed. The cemetery is in a poor condition. On the east side of the hospital grounds is another cemetery for Civil War veterans. Records listing names, ranks and the branch of service of the soldiers are maintained at the National Archive and Records Association (NARA). In 2005, during St. Elizabeths Hospital’s 150^th Anniversary celebration, the hospital is planning a ceremony to recognize the sacrifices of the Civil War soldiers and their service to the nation.

* Buildings were named after Henry L. Dawes, Republican Massachusetts, Chairman of House Committee on Appropriations from 1869 to 1871; James A. Garfield, Republican Ohio, Chairman of House Committee on Appropriations from 1871 to 1875; and John D. C. Atkins, Democrat Tennessee, Chairman of House Committee on Appropriations from 1877 to 1881.

** Buildings were named after William B. Allison, Republican Iowa, Chairman of the Senate Appropriations Committee from 1881 to 1893 and 1895 to 1908.

© Terry Reimer
Director of Research
National Museum of Civil War Medicine

Smallpox was one of the many diseases challenging medical personnel during the Civil War. Unlike most other diseases, the surgeons of the time had an effective way to prevent smallpox using vaccination, and to control outbreaks through the isolation of its victims.

Inoculation and Vaccination
Inoculation was in widespread use by the 1720's. It is the introduction of disease agents into the body to produce a mild form of the disease, usually done by using pus or scabs from infected persons which was administered to the patient through small cuts made in the skin. It was intended to confer immunity by producing a mild case of the disease. Unfortunately, not all cases were mild and deaths were associated with inoculation, but at a far lesser rate than among those naturally acquiring the disease. Despite the danger, inoculation was widely practiced throughout the eighteenth century.

Vaccination was developed in 1798 by Edward Jenner. For smallpox, cowpox serum was used, since cowpox is a closely related disease and created a resistence to smallpox. Like inoculation, the vaccine was administered through a series of small cuts in the skin, usually in the arm. The cowpox virus was obtained from animals infected with cowpox either naturally or by intent. By the 1830's, vaccination was widely accepted, especially among physicians. Inoculation was still practiced in some places until it was outlawed by individual states. New York banned inoculation in 1816, and in 1850 Maryland followed suit. The bans were based on the fear of spreading the disease through inoculated persons since they were infectious, unlike vaccinated persons. By the outbreak of the war, inoculation was illegal in most places, but still occasionally practiced.

The preventive measures of vaccination and isolation drastically reduced the occurrence of smallpox in the early to mid-nineteenth century. By the 1840's, vaccination was beginning to be neglected and there was a generation of Americans who had never been exposed to the disease. As a result, the incidence of smallpox began to rise in the decades before the Civil War.

Smallpox and Vaccination During the Civil War
From May 1861 to June 1866, there were 12,236 reported cases of smallpox among white troops in the Union Army, or 5.5 per thousand men annually. In addition, there were 6,716 cases among the U.S. Colored Troops, or 36.6 per thousand men annually. The death rates from the disease were approximately 23 per cent for the white troops and 35 per cent for the colored troops. Quarantine, vaccination, and the destruction of infected clothes and bedding were the primary tools used to control the spread of smallpox in the armies. Most hospitals had a separate ward, or even a separate hospital, in which to isolate smallpox patients since the disease was known to be contagious.

Both Union and Confederate regulations required the vaccination, and re-vaccination if necessary, of all troops. Often this objective was not met since most regiments were raised by the individual states and the regulation was disregarded in the rush to send large numbers of men into battle. Since there had been no systemic vaccination of the civilian populations, many of the recruits had never been vaccinated or exposed to smallpox. Re-vaccination was recommended after seven years had elapsed from the last vaccination, or when men were directly exposed to the disease.

The best and purest source for vaccine was from cows or calves; the crust from the cowpox pustules were used as the source of the virus. The pressing demands of war often led authorities to institute programs which obtained the scabs from vaccinated humans. The Union medical dispensaries of the northern cities supplied vaccine virus in the form of crusts taken from vaccinated infants, each with a certificate listing the dispensary and the child’s name. Crusts were also supplied from cows, in at least one instance from calves infected with the "humanized" virus, not naturally occurring cowpox.

In the Confederacy, many programs were set up to assure an adequate supply of vaccine scabs for the army. Every hospital had a medical officer whose job was to search the surrounding populace for children on whom they could propagate the virus. Ads were taken out in local papers offering free vaccination to children if the crusts were then allowed to be harvested. Both white and African American children were used to supply scabs, and in at least one instance a small group of African American children were kept vaccinated to provide usable material. The children were vaccinated in six places in each arm. In two weeks the crusts were removed, wrapped in tin foil, and shipped to army surgeons. Late in the war, a shortage of virus material led to an authorization to pay private physicians five dollars per usable scab.

Children and cows were the safest sources for crusts, but there were many documented instances where other methods were used. Surgeons often used the scabs from recently-vaccinated men to vaccinate other soldiers. Soldiers did the same among themselves, sharing the crusts and using knives to make the incisions in their arms. Some men even sent scabs home for the use of their families. In most of these cases, the appearance of the scab and the proper number of days from the initial vaccination were not taken into account.

Spurious Vaccine
Unfavorable results from vaccination were all too common. Even pure vaccine, obtained from official Army dispensaries, had instances of complications. Possible reasons were that faulty preservation of the crusts made them lose effectiveness, or that they had been contaminated in some way. Occasionally, the vaccine did not "take" and did not produce the major reaction at the vaccination site that was expected from a successful vaccine. In other cases the site of the vaccination became overly sore and swollen, and abnormal pustules developed. These uncharacteristic developments made the surgeons question whether the vaccine had been effective.

Complications from using a scab from a recently vaccinated adult were even more deleterious. Since many vaccinations took place in the hospitals, crusts from men who were sick with other conditions were occasionally used, spreading disease rather than preventing it. The surgeons also noted that vaccinating men who were in poor condition due to other illnesses led to a higher number of patients suffering constitutional effects, some even fatal. Many times, vaccination was not done until smallpox appeared in a hospital or prison. Vaccinating at this time was effective, but increased the chance of spreading disease in already-indisposed populations.

Perhaps the worst, and unfortunately common, form of spurious vaccination was the use of scabs that were syphilitic in nature. This occurred both in the hospitals and among the soldiers who self-vaccinated. Mis-diagnosing a scab, or harvesting crusts from the arm of a soldier who had syphilis, would spread this disease to everyone vaccinated from that source. In one notable case, two brigades were affected by a vaccination infection which was thought to be syphilitic in nature. The men were so sick that the brigades were unfit for military service. The epidemic was traced to a single soldier who had obtained vaccination material from a young lady of possibly questionable character.

The Confederate Medical department attempted to prohibit soldier-to-soldier vaccination in order to limit these deleterious effects. Harmful results were much less likely with crusts harvested from children or cows. Even civilians were discouraged from self-vaccination, as the consequences of spurious vaccine had spread to the general population as well, leading to a mistrust of the vaccination process.

Conclusion
Research into the history of smallpox vaccinations led to the discovery that the actual virus used in vaccinations was the vaccinia virus, of the same family as the smallpox (variola) and cowpox viruses, but genetically distinct. The origins of the vaccinia virus are unknown, but it is believed to have originated in the nineteenth century.

The preventive measures of vaccination and isolation taken by the Union and Confederate Medical Departments curbed the occurrence of smallpox during the war, and averted any major outbreaks. The success of the vaccination of soldiers during the Civil War lead to widespread vaccination of the civilian population after the war, further helping to control this serious disease.