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21.47.02 Commentary on Medicine, the CSA Hospital in Bristol, Tennessee, by Jack E. Butterworth, a 2014 S. I. S. H. publication.

The American War Between the States is one of the most researched and recorded events in the history of our nation. Detailed events are published and often re-enacted across the regions annually. Hundreds of stories and sites of courageous feats are not recorded or made known to the public.   One of these little known and narrowly researched facilities of this War is that of a Confederate Hospital which was established and operated in Bristol, Tennessee. The following review is a recounting of that hospital’s story according to existing information identified over 120 years after the fact. Hopefully, more details surrounding this hospital can be found with time and attention. This writing has the intent of consolidating some of the evidence of the presence of that hospital and its impact on the community of Bristol.

The adjunctive account of East Hill Cemetery in Bristol, Virginia is a necessary part of this review.  Both entities are herein noted for those individuals interested in the War’s local impact outside of the major theaters so widely described. Primary sources are difficult to uncover but oral history as well as secondary sources provide convincing evidence and local color to this history.  

East Tennessee was never a primary site of significant battles of the War as no strategic target existed to attract the attention of large forces either Federal or Confederate. Smaller engagements designed to disrupt railway transit along with episodes of “brigand led attacks” were more common in this region of divided loyalty.  Much of the population in this border location felt no devotion to the Cause of the Southern States with their fertile agricultural industry. Slavery was not a significant issue to the rural populace and they saw no rationale for separating from the nation their grandfathers had carved from the mountains of North Carolina and Tennessee. The residents were independent descendents of pioneer ancestors, Scots, Irish, and German who made their decisions based on family bonds and possession of land. However, there was a single important activity in the region that led to the placement of a hospital and ultimately a cemetery for the Confederates. That activity was the Railroad!

The early battlefields of the War Between the States were located in Virginia and then followed by Confederate ventures into Maryland and Pennsylvania. These engagements were located on the northern extremes of the Confederate States while the essential source of supply and men lay to the south. Transport of men and supplies was a critical requirement of the Confederate Army in 1861. Fortunately a rail line had been initiated from Lynchburg, Virginia to the Tennessee state line as early as 1831. The Virginia legislature had created the Lynchburg and New River Company in 1832. Bristol, Virginia was the terminus of this line long before the onset of conflict.

After much political debate as to the best choice of commercial transportation in East Tennessee, river or rail, the river route which was preferred by conservative politicians prevailed. Dredging and clearing of the Holston River east from Knoxville and of the French Broad and Nolichucky upstream to Kingsport was the declared the plan. This route for trade and migration had been used on the frontier since pioneer days. Produce from the farms of East Tennessee and western North Carolina had been shipped to market by Flatboat or Keelboat over two thousand miles down the Tennessee River and its origins to the Ohio, Mississippi, arriving finally in New Orleans. Appalachian farmers would walk or ride horseback back to their home along the Natchez Trace. Then the process would begin once again, often after they squandered their profits in the Big Easy.2 The initial legislative decision for the river route caused delay in starting the rail system in Tennessee. Finally on January 27, 1848 the Tennessee legislature chartered shares for an East Tennessee railroad company. Dr. Sam B. Cunningham was a primary mover in seeing the E.TN & VA and the E.TN and GA rail system carried to completion. In the fall of 1854 the Knoxville Cholera epidemic devastated the region and stalled the construction of the railroad even more. It took 7 years and 45 days to build the Knoxville to Bristol route. Finally the connection was made at the state line in Bristol, TN/VA. 3

At the start of the War the rail line was in active business transporting passengers and merchandise from the northern trade sites to Knoxville, Chattanooga, and Atlanta and back again. This was the exact route necessary to fulfill the Confederate Army’s requirement to carry soldiers and supplies to the northern battlefields. This rail line passed through Bristol, Tennessee-Virginia at the site of the junction of the Virginia and Tennessee companies. Cars and engines were switched at Bristol and often passengers were transferred to cars of the alternate companies. This caused much commercial activity in the little town. Hotels had opened to accommodate the travelers. Although a rural and remote city, Bristol was an ideal location to place a hospital facility for men traveling north to battle or back south to recuperate from wounds. What more likely site for a hospital than a large existing hotel sitting adjacent to the rail tracts. In 1864 such a facility, The Exchange Hotel, was donated to the Confederate Army for that purpose.

On September 27, 1862 a legislative amendment in the Confederate government “directed the Surgeon General to establish … a number of ‘way hospitals’. Such institutions were to be located along the routes of important railroads and were to furnish rations and quarters to the sick, wounded, furloughed, and discharged soldiers during the course of their journeys. They were to be administered in the same manner as general hospitals…Seventeen Way hospitals were established in Virginia and North Carolina alone”.4  It is likely that the Bristol hospital fit some aspects of this description and was established for the same purpose, being selected for its rail location. In actuality, the Bristol Hospital was a General Hospital which cared for both medical and surgical conditions. It has been estimated that five men died from disease for every one due to war wounds in the War of Northern Aggression. It is concluded that severely ill men with medical conditions as well as war wounds were managed in this hospital. The medical information on the men subsequently buried in East Hill Cemetery demonstrates the hospital was not merely a domiciliary unit. One soldier recently identified as being buried in East Hill Cemetery died from an infectious condition acquired just as he was leaving Alabama to join a unit in northern Virginia. His illness worsened as he arrived in Bristol and he was admitted to the hospital with a subsequent demise.  His family related that story held in family archives as they placed his marker in East Hill.

The history of the Confederate hospital in Bristol has been told by many individuals. These stories describe how Joseph Rhea Anderson outlined the structures of the town he developed in the mid 1800s very precisely. A well planned city was laid out emphasizing the presence of the Train Depots in Tennessee and Virginia. Apparently there was a depot for both the Tennessee and Virginia rail systems adjacent to the Main Street of the town. Anderson described in detail the site of both of these Depots. Several buildings used as hotels were constructed but as they were massive wooden structures, they became subject to fire and destruction.

“The Exchange Hotel was first built by J.R. Anderson for a grain Commission House in 1858, remodeled by him in 1859, and opened as a hotel by Thomas W. Farley in 1860.  Farley continued operation until it was taken off his hands by L.  A. Womack in 1862.  In 1864 he quit and it was taken as a Hospital for the Confederate sick. J.R. Anderson then sold it to Walter H. Nichols for 3000 bushels of salt and the Federals (later) stole and burnt the salt up.”3 The hotel held the name of Exchange Hotel and then Nickel’s House depending on the ownership. Both are cited in local papers of the era as prime locations for weddings of young ladies of both Bristols and Abingdon, VA as well.   Mr. T.W. Preston collected historical writings in his book  “The Story of Bristol” which was printed by the King Printing Company of Bristol. This work represents a written collection of the oral history as well as documentation of events which surrounded the formation and development of the town. The Civil War raids by Stoneman in Bristol and the surrounding communities are recounted in this little book.    

“…The train depots located in Bristol were a stopping point for many soldiers traveling to the Deep South or northern Virginia. In the later years of the war, the trains brought soldiers to Bristol for medical attention. The Exchange Hotel, which once stood in historic downtown Bristol, served as an Army hospital for the Confederacy. The local residents made sure the hospital was supplied with food, medicine, bandages, and fuel until the end of the war. Many recuperating soldiers were placed in private homes when the hospital began to overflow with patients. Many patients died there and are buried in historic old East Hill Cemetery.” 5

Mr. Bud Phillips suggests in several of his writings that the Exchange Hotel was turned over to the Confederate Army in 1862. However definitive evidence for that early date is evasive. Much of the detail of this history is repeated recollections from memory without documentation.

“The location was ideal for the purpose. Bristol was near midway point between the battlefields of Northern Virginia and those of the Deep South. There was also rail service virtually to the front door. Indeed the old ramp that was long used to deliver grain to rail side was still in place. Soon, many a wounded soldier was brought over it-for many the last trip they ever made.”5

The U.S. National Archives contain a copy of a Pay Rolls of Confederate Hospitals in their War collection. Entry 28 of Group 109 shows a record for 27 February 1864 labeled Bristol and signed by Captain R.H Hill. The document reports 15 members of the hospital staff receiving pay for services. This pay roster establishes verification of the activity on that date for the Bristol hospital.

In addition to documentation such as those reported above, the September 1864 issue of the Confederate Medical and Surgical Journal contained a section titled Army Medical Intelligence-Official which listed the hospitals in operation along with the individual Surgeons in charge. In Tennessee only one hospital is listed, likely due to the military situation in the State. That hospital under the Generalship of Hood was located in Bristol, Tennessee. Dr. R.D. Hamilton was named as the Surgeon with Dr. J.T. Love as the Assistant Surgeon. 6 Definitive records of the surgery done at the Bristol hospital are not available. Word of mouth history is a primary source and that did not record medical details. Information is known from the families of men hospitalized there and of the dead that were buried in East Hill Cemetery just up the hill from the hospital.

 Bristol, in the eastern off-set geography of Tennessee, bordering on the Virginia state line, seems a surprising and unlikely site for the sole operating hospital in the entire State. Further study of Bristol, however, lends an understanding for the placement of the facility. The remoteness of the East Tennessee region from the primary military action possibly accounts for the continuing operation of the hospital in the latter years of the War.

  Mr. Bud Phillips has functioned as the “Bard of Bristol” for several decades. He held extensive interviews with individuals who were either immediately involved in the making of Bristol history or were closely related to those who were immediately involved. As such he has published several books on local history which serve as the source of the Bristol story for many interested individuals. One of his books is devoted to activities in town during the War Between the States, titled Between the States: Tennessee/ Virginia During the Civil War.

Mr. Phillips collected many vignettes from the personal writings of Mr. J. B. Palmer and Ms. Ann Bachelor who described how individual soldiers were cared for in the town. It was said that the diary of J. B. Palmer recorded how he gave his entire turnip crop to the hospital. Ann Bachelor wrote that one local citizen would donate every other pail of milk from his cow to the hospital. In “Between the States” Phillips quoted an old Confederate veteran who noted that the biscuits made by “Aunt Pricilla Davis” were unsurpassable.5 That information came to Bud from an aged daughter of one of the cooks for the hospital. While these diaries and family histories are not currently recoverable, they add to the flavor of the times and show the participation of the local populace in supporting the hospital.

One description provided in Phillips book is of the colorful Pocahontas Hale, an Indian woman and an expert in herbal medicine. She had gained local fame as the operator of the Black Shawl, the grandest and largest house of ill repute in the vicinity. One tuberculosis patient credited his recovery to the brew Pocahontas concocted from collections of sycamore bark, Elm ooze, and dogwood root for his condition. He is said to have achieved total recovery from his ‘consumption’. As medications became scarce for the hospital, which was typical during the War, a supply of herbs, barks, and roots to the educated doctors of the hospital were used for medicine.

Rev. J.W. Miller was appointed Chaplin at the hospital. He was a Methodist minister.  A newspaper article commented that Rev. Miller was “… eminently competent to impart instruction and give consolation of the Christian religion to the sick and wounded and dying men who have so bravely defended their country.”  Dr. Frank Ramsey the surgeon in charge of the Bristol operation was a brother of noted historian Dr. J.S.M. Ramsey and was an uncle of Lt. John Crozier Ramsey who had served under President Buchanan as Attorney General of the United States. Both Ramsey and Miller lived within a half block of the hospital during the time of operation. This information has been discovered and reported in Mr. Phillips’ book. He took a special interest in the hospital history and at his home in Bristol, Pleasant Hill, Mr. Phillips still treasures items used in the hospital.

While most immediate care of battle wounds were conducted in field hospitals near the site of the battles, hospitals were constructed in private homes, schools, churches, and in Bristol’s case, a large hotel. Delayed treatment of injuries and wounds as well as medical illnesses would have been the mainstay of the patient load in the Bristol hospital. The impact that facility had on the outcome of the war was minimal in all likelihood, but that on the individual soldier often was critical. It is not recorded how many men were transported from train up the ramp to the old hospital. Many also were transported back down that ramp to travel to their final resting site in East Hill Cemetery just up the hill. It is clear that efforts were made by the Confederate Medical and Surgical Department and the doctors and citizens of this small town to diminish the flow to the cemetery. 

The classic book reviewing the Confederate Medical Service was written by H. H. Cunningham in 1957 and titled “Doctors in Gray”. He interviewed the work of many individuals who were involved with the Confederate Medical Department under a grant–in–aid from the United Daughters of the Confederacy. As previously cited, Dr. Frank A. Ramsey was listed as a Surgeon posted at Bristol, Tennessee with Dr. J.T. Love as Assistant Surgeon. Bud Phillips reports that local doctors in Bristol assisted with the medical duties. He includes Dr. R.M. Coleman, Dr. J.A. Murphy, and a Dr. Montgomery in that group.

All this data attests to the presence of the hospital in Bristol and the manner in which it functioned for the care of the soldiers of the conflict. In addition to this primary hospital there apparently were other sites in Bristol used to house and care for the sick during the War. Phillips has determined that the Bristol/Goodson Male Academy building on Virginia Street as well as the Bristol Methodist Church on Lee Street and the Presbyterian Church on Fourth Street were used for treatment of the War casualties. A log building on Oak and Lindsey Streets in Virginia was a house for individuals with contagious disease according to some reports. It is not unexpected to learn that details of these temporary facilities were not recorded except in personal notations and in the fading memory of those immediately involved. Nevertheless it is reasonable to accept that such information is based on actual facts passed from person to person.

The Goodspeed Publishing Company of Nashville and Chicago issued A History of Tennessee from the Earliest Times to the Present, together with an Historical and a Biographical Sketch (named counties) during 1886 and 1887. Unfortunately, the project was not completed and therefore not all Tennessee counties are represented in this series. Sullivan County where Bristol is located was one of the fortunate ones included in the publication. This document gives the following information of the Confederate Hospital in Bristol.

“The Exchange Hotel, now the Nichols House, was built by J. R. Anderson as a grain commission house in 1858. The next year he remodeled it, and in 1860 it was opened as a hotel by Thomas W. Fancy. During the War it was used as a Confederate Hospital”.7

The Sanburn Fire Insurance Company created maps of the region in 1897. These are located in the U. S. Library of Congress. These maps of Bristol clearly show the site of the Nichols House facing what is now State Street in Bristol adjacent to the railroad. This definitely establishes the location of the building used for the hospital. There is also a photograph taken in 1898 showing the old Nickels House Hotel with the text stating it was used as a hospital during the Civil War. In this picture one can see the proximity of the rail tracks and understand how cars would unload the injured soldiers onto the ramp leading into the former Grain Commission and subsequently the hospital.

The Cemetery in Bristol that was the final resting site for many soldiers treated in the Bristol Confederate Hospital was begun in 1857 to meet the needs of the community of Bristol, Tennessee and Virginia. Bud Phillips has reported the story that the first burial was that of Nellie Gaines in 1857. He describes the site at that time to be a heavily wooded hill top known as Maryland Hill, Round Hill, or Rooster Hill. There is no question that the cemetery sits on a high point of the town of Bristol Virginia. One can survey the entire beautiful basin of Bristol with its surrounding knobs from this commanding position.  General Evan Shelby, a noted Indian fighter of the pre-revolutionary period and an operator of a fort and trading post in what became Bristol, Tennessee was moved to a his final rest in this cemetery. It now is one of the oldest burial sites in the town. The proximity of what was ultimately named East Hill Cemetery was ideal for transfer and burial of the deceased at the Confederate Hospital. The bodies were transported by wagon up the short hill to the cemetery with an early estimate of 120 -180 being buried there. In recent years the number has increased to nearly 300. It is the largest site of Confederate graves between Roanoke and Knoxville.

Lt. William Allen and Lt. Robertson Bryan who were two of the “Immortal 600” are buried in East Hill. James Keeling, the “Horatio of the South” who successfully defended the bridge at Strawberry Plains, Tennessee, with the loss of his arm, and a recipient of the Confederate Medal of Honor is buried in East Hill. Billy Wood the “Last Survivor of the VMI Youth Cadets who fought in the New Market Battle” is buried there also. The commanders of the 63rd and 62nd Tennessee Infantry, Col. Abram Fulkerson and Lt. Col. Parker are interred in East Hill.

A special Memorial section of the cemetery is dedicated to the Confederate soldiers from the hospital. These graves are marked by military headstones although the specific site of each individual’s grave is unknown. A remarkable number of these soldiers’ names, units, and home states have been identified. These soldiers represent service given at some of the most historical battles of the war. Captain Davidson buried there is credited with firing the initial artillery shot at 1st Manassas. The 37th Virginia had many men buried at East Hill and was a part of Jackson’s famous “Stonewall Brigade”. Others in East Hill fought at Fredericksburg, Gettysburg, Spotsylvania, The Wilderness, Shiloh, Vicksburg, Chickamauga, and Atlanta.

Camp 52 of the Tennessee Division of the Sons of Confederate Veterans has worked to maintain the Confederate section of East Hill Cemetery. The members hold memorials each Veteran’s Day, U.S. Memorial Day, and Fourth of July in the cemetery by placing appropriate flags on the graves of each Veteran of every war represented. A special ceremony for Confederate Memorial Day is held annually. A monument has been erected in dedication to the Confederate soldiers buried in East Hill with their names and units identified on plaques along the sides of the monument. The names and monument are identified in the appendix to this writing.  A special gateway marker is erected at the entrance of the Confederate section of the cemetery to guide visitors and descendents when visiting East Hill Cemetery.

Camp 52, named for James Keeling, applied for a historical marker from the Tennessee Historical Commission for the purpose of identifying the site of the Bristol Confederate Hospital. Permission from the current property owner, Citizen’s Bank, was obtained and the marker was to be financed by the Camp.  Similar markers are placed at sites over the state of Tennessee to identify locations of notable events and structures. These markers assist in informing the population about the history of the State. Four applications have been submitted to the Commission. Each time, additional information has been requested. The first rejection was because only one author was cited for the existence of the hospital. The second application presented several sources of reference and authentication to include a hospital pay roll voucher, several historical references, photographs, and the reference from the Confederate Medical and Surgical Journal of September 1864 which named the Surgeon and Assistant Surgeon of the hospital were included in the application. The fact that it was the only hospital in Tennessee at the time of publication of the last edition of the Medical Journal was emphasized. The Historical Commission again rejected the application requesting the number of patients enrolled in the hospital at the time of the publication of these documents. The last application was rejected because the plaque wording was of insufficient length, when previously the Commission stated the wording was too long. With this last refusal, Camp 52 members determined to seek another source for placement of this plaque as it was obvious that factors other than historical validation were active in the decision making of this Commission. Plans are underway to place a non-state plaque to identify the site of this historical entity for the public to view.

There can be little doubt that a Confederate Hospital was present in Bristol, Tennessee in 1864. The legacy of that hospital truly lies in the old cemetery and the graves of those who gave their lives for the cause they held dear enough to offer the major sacrifice. Many sources of oral and written history establish the facts and make us yearn for more details of the daily activities of those days. We can imagine a very different time and circumstance occurring on the same site where we live today. That vision frames the allure of history.

The event of the War is viewed in differing perspectives by individuals in today’s society. The debate on the causes and purposes of the War joins similar ones of nearly every historical event in human records. The individuals who participated in the struggle for Southern Independence were descendents of ancestors who immigrated into a wild and unknown land in the 17th and 18th centuries, pushing back a frontier and finding improved conditions for their children and grandchildren. Their concept of a nation of liberty and independence was a valid one as viewed through today’s looking glass. Other sections of the American continent engaged in their own struggles for the same goals. The contest for the Spanish and Mexican territories, the Texans’ battle at the Alamo, the American Indian’s displacement, the New York and Philadelphia struggles during the Nativist movement over Irish immigration and Catholicism, and multiple labor contests all find differing drama in the making of the America we know today. These differences are not unique to America. Human history has involved repeated clashes that match differing groups and beliefs when and wherever we look. Such is our human global past. Today we continue to strive to find a middle ground which offers fairness and equal opportunity for as many as is possible, if not all.

 Accurately identifying the geographic sites of our past activities with markers, plaques, and text, accompanied by verifiable stories of the times, is a valuable legacy to leave to those of future generations. Hopefully they will be enlightened by ancestral successes and failures made in this “pursuit of happiness”. Perhaps they will appreciate that we preserved some memory of what went before us in time. With that knowledge guiding them, future generations could with God’s Grace find their peace. 

Jack E. Butterworth

Used by permission, copyright retained by Jack E. Butterworth



  1. The Tennessee, Vol 1. Donald Davidson. 1946.
  2. The Building of the East Tennessee and Virginia Railroad. James Holland University of Tennessee, 1930, East Tennessee Historical Societies, 1934.
  3. Doctors in Gray, The Confederate Medical Service, H. H. Cunningham, 1958.
  4. The Story of Bristol. T. W. Preston, ca. 1920.
  5. Between the States: Bristol Tennessee/Virginia during the Civil War, V. N. “Bud” Phillips, 1997.
  6. Confederate Medical and Surgical Journal, Volume 1, No.1, January 1864.
  7. The Goodspeed Publishing Company of Nashville and Chicago, A History of Tennessee from the Earliest Times to the Present, together with an Historical and a Biographical Sketch (named counties), during 1886,1887.

Appreciation is given to the following individuals who advised and offered information in the investigation of the Confederate Hospital in Bristol, 1864.

  • Mr. Gary Rose ETSU-  eLearning Site Coordinator at East Tennessee State University, Johnson City, Tennessee.
  • Dr. William J. — Wade Emeritus Professor of History, King University, Bristol, Tennessee.
  • Dr. Charles Sydnor — Director of Virginia Holocaust Museum, Past President Emory and Henry College.
  • Dr. Robert Vejnar – Archivist/Specialist Collections Librarian, Emory and Henry College.
  • John “Pappy” Hawthorne — Commander James Keeling Camp 52, Sons of Confederate Veterans.
  • “Bud” Phillips — Author, Historian, Chronicler of Bristol, Tennessee and Virginia.