The oldest burial ground at Saint Elizabeths was created in 1856 on the wooded western slope of the West Campus. In most cases, funeral arrangements for patients who dies at Saint Elizabeths were made by family members of the deceased, and the remains were not interred on the hospital grounds. In some cases, however, when no next of kin could be found or other arrangements made, deceased patients were interred in cemeteries on both the West and East Campuses.
Poor recordkeeping of the period make it difficult to determine the exact number of graves in the West Campus cemetery. In addition to the approximately 450 graves of the Civil War veterans there is an unknown number of civilian burials. Most of the veterans buried in the West Campus cemetery were patients of the hospital and not causalities of the war, who passed away at the army or navy hospitals that were set up on the campus during the Civil War. Both African American and white veterans are buried here. It is also possible that Confederate soldiers were buried in this cemetery, but a lack of concrete evidence or records leaves this up in the air.
Early interments were marked by wooden slabs, with civilian graves only identified with numbers. Stone markers were provided for military graves by the US government after 1873. In that year, the three-quarter-acre West Campus burying ground was deemed full, and a new cemetery was opened on the East Campus. Approximately 2,050 military and 3,000 civilian interments took place in the nine-acre cemetery on the East Campus over the next 120 years.