The Civil War Federal Army Surgeon   Source of below: "The Photographic History of the Civil War, Volume IV" Article by Edward L. Musnson, M.D. Major, Medical Department, United States Army "However brilliant the tactics and strategy, it should be remembered that an essential factor in all warfare must be the physical efficiency of the man behind the gun. Despite this fact, historians give but slight attention to the medical men whose ability and self-sacrifice largely make possible the military reputation of others. Although the surgeons are regarded as non-combatants, their efficiency must always have a powerful influence upon military tactics. The Nation selects its popular heroes wholly for service on the battlefield. But it should not be forgotten that it is only through the unwearyingly and unobtrusive efforts of the surgeons that men and armies are kept in fighting trim and physically able to execute the will of the commanders. In any critical inquiry into battles and campaigns, the careful student will not overlook the fact that the conflict under consideration might not have occurred at all, nor in the place where it actually did occur, nor might the military tactics have been the same, had not one or the other force been weakened by preventable diseases or rendered more or less immobile by the crippling incubus of the wounded, for whose removal and care no adequate provision had been made before the conflict occurred. "   At the outbreak of the war, the national army was inadequate to meet military needs, especially those relating to the critical Indian situations west of the Mississippi, which had been developed in large part by the influx of gold-seekers and colonizers into that territory. It is not to be wondered at, then, that the war should have found the military establishment of the United States deficient as regards its medical organization and equipment.    At the opening of hostilities between the States the personnel of the Medical Department of the regular army was composed of one surgeon-general with the rank of colonel, thirty surgeons with the rank of major, and eighty-four assistant surgeons with the rank of first lieutenant for the first five years of service, and thereafter with the rank of captain, until promoted to the grade of major. There was no hospital corps, but the necessary nursing and other hospital assistance were performed by soldiers temporarily detailed to hospital duty from organizations of the line of the army, and here it may be parenthetically remarked that the qualifications and character of the soldiers so detailed were usually far from satisfactory.   The Medical Department, with the above personnel, formed one of the coordinate branches of the general staff of the army as it existed in 1861. Its members were not permanently attached to any regiment or command, but their services were utilized whenever required. Although a separate regimental medical service still existed in many foreign armies, as it did in our militia, experience had demonstrated that our national system of a separate department was better adapted to the needs of troops when scattered over an immense area, and usually serving in small and isolated commands. The latter requirements explained the unusually large proportion of surgeons necessary at the time, amounting to about one per cent. of the total strength.        U.S.A Surgeon in Uniform This little force of one hundred and fifteen trained medical officers theoretically available at the beginning of the war was, however, materially depleted. Many of its members were of Southern birth and sympathy, and no less than twenty-seven resigned from the army at the outbreak of hostilities. Three who so resigned entered into the practice of their profession, declining to assist either against their Southern kindred or their friends in the Northern States and former military associates remaining under the old flag. But the remaining twenty-four merely transferred their services to the military forces of the Confederacy, where they were promptly given the positions of responsibility and power which their previous experience and training warranted. These men formed the nucleus about which the Medical Department of the Confederacy was created, building it up along the administrative lines to which they were accustomed, and even adopting the same blank forms and reports, as, for example, that for the sick and wounded, which they had formerly used in the Federal service.  In many particulars the organization was identical.   But, the army Medical Department, always a corps d'elite, still contained able men after the resignation of Surgeon Moore and his Southern associates. A mere handful in number, it made up in quality what it lacked in quantity, and furnished the germ from which developed the vast medical service which came to be required. It included many men whose natural administrative and military abilities, in many cases developed by the experiences of the war with Mexico, if employed in other than the direction of non-combatants, would probably have made them national figures in the military history of the United States.   Contrary to the usual idea of the general public, army medical officers have many important duties outside he actual the professional treatment of sick and wounded. Far-reaching health measures, under the direction of the commander, are in their hands. Vast hospitals must be organized, equipped, supplied, and administered, to which sick and wounded by the hundreds of thousands must be transported and distributed. This latter problem can advantageously be met only in the light of broad knowledge of military organization, methods, and purposes. There are subordinates to be enlisted, equipped, cared for, trained, and disciplined. An elaborate system of records, upon the accuracy of which the whole pension system of the Government rests, must be maintained. And upon the handful of trained regular medical officers the responsibility for efficient direction of the above-mentioned business management of the Medical Department had, at the outset of the Civil War, to devolve. From it, as a nucleus, there developed a scheme of organization of the medical service for war which remains the prototype upon which similar organization in all the armies of the world is now based, while administrative methods were worked out which still remain our standard for the management of similar conditions and emergencies. Union uniforms: Regulations dictated that Union Surgeons (Majors) and Assistant Surgeons (Lieut and Capt) wore single or double bordered straps with green background with silvered MS representing 'Medical Staff'.  However, these regulations really applied to Regular Army (U.S.Army Hospital Corps) surgeons.  The majority of State Militia Regimental surgeons used the same style straps, but with the standard blue background and not green.  All surgeons wore green sword sash and mostly wore the Model 1840 Medical Staff sword.  Hat devices were a bit varied also.  Many surgeons used non-regulation gear as they saw fit.  See: Education of medical doctors during the Civil War To the support of this little group, insignificant except in ability, the outbreak of the war promptly brought a vast number of the better type of medical men of the Northern States. Some of these physicians and surgeons had already achieved great fame and success in the practice of their profession, and their enrolment for the assistance of their country gave powerful incentive to similar action on the part of others of equal or less prominence. The younger medical men, lately graduated, flocked to the colors almost en masse, not only from motives of patriotism, but also because the practical training to be gained in the vast military hospitals was far more comprehensive and valuable than could be gained in any similar civil institution or walk of life. When, at the conclusion of the war, they undertook the practice of their profession in civil life. they found that their military experience placed them at once among the foremost of the local physicians and surgeons.         To give even brief mention of the self-sacrifice and achievements of the ten thousand medical men who, thus to aid their country, gave up the relative ease and the greater financial rewards of practice in civil life for the dangers and hardships of war, would require volumes. But it would be unfair not to recall the names of a few, whose services may have been of no whit greater value than those of others, who, for lack of space, must remain unmentioned, but whose professional standing during and after the war was such as to render them worthy of selection as representatives of the great volunteer medico-military class to which they belonged.         Dr. Martyn Fonds attending surgery at Gettysburg, Pa., during the Civil War.  The Union surgeon above is applying a bandage to a shoulder resection as the ether mask is being removed by the assistant.  There are two surgery sets in the photo.  A rare view of an actual surgery during the War. Photo courtesy of Trent Valley Archives, Peterborough, Ontario Under the agreement of the Geneva Convention, medical officers are now officially neutralized. This status cannot free them from the dangers of battle, in which they, of course, must share, but operates to exempt them from retention as prisoners of war. Such was not the case in the first year of the Civil War, when surgeons were captured and immured in military prisons like combatant officers. Medical officers were thus often forced to make the hard choice of deserting the wounded under their care, often including patients from both sides who were urgently requiring attention, or of remaining and submitting to capture, with all the rigors and sufferings that this implied. But General Jackson, after the battle of Winchester, in May, 1862, where he had captured the Federal division hospitals, took the ground that as the surgeons did not make war they should not suffer its penalties, and returned them unconditionally to their own forces. The neutral status of the surgeons, thus recognized f or the first time, was subsequently formally agreed upon between Generals McClellan and Lee, though later the agreement was for a time interrupted. The idea that those engaged in mitigating the horrors of war should not be treated like those who create them, met with instant popular approval in both North and South, was subsequently advanced in Europe, and the humanitarian idea developed in this country was advocated until officially taken up by the great nations and agreed upon by them under the Geneva Convention. In connection with the foregoing, the record of the casualties among the regular and volunteer Federal medical officers during the Civil War is of interest. Thirty-two were killed in battle or by guerillas; nine died by accident; eighty-three were wounded in action, of whom ten died; four died in Confederate prisons; seven died of yellow fever, three of cholera, and two hundred and seventy-one of other diseases, most of which were incidental to camp life or the result of exposure in the field.   The medical and surgical supplies for the Federal hospital establishments not accompanying troops were practically unlimited as to variety and amount. But with the material taken into the field with troops, considerations of transportation were paramount. Generally speaking, ammunition was forwarded first, rations second, and medical supplies third. Owing to the tremendous number of men engaged, it was early demonstrated that road spaces occupied by marching troops had to be studied so that organizations could be moved and deployed as rapidly as possible. Nothing except the barest necessities could be brought to the front where large armies were contending. In spite of every effort, transportation always tended to increase. For example, when Grant entered upon his Wilderness campaign, it is said that his trains contained between five thousand and six thousand wagons, which, on a single road, would have made a column over fifty miles long. The first tendency of new troops is to overload, and to this neither the Civil War as a whole nor its medical service in particular proved exceptions. All finally came to realize that the nature and degree of sanitary relief which could be provided for troops at the front must partake of a compromise between what might be desirable and what was possible.         At the beginning of the war, each regimental surgeon was furnished with suitable equipment for his regiment for field service, in quantities regulated by the supply table. This table, which was revised about a year later, seemed to contemplate the medical and surgical outfitting of regiments on the basis of independent service, and when they became brigaded much of the equipment so supplied was found to be not only unduly heavy and cumbrous but also unnecessary.  At the beginning of the Civil War, the U.S. Army had a medical corps consisting of all of 98 surgeons and assistant surgeons.  Assuming the corps owned enough surgical sets for each surgeon, they may have only had 100 'U.S.A Medical Department surgical sets in the whole Army when the War started.  We know the Army ordered something over 4,000 sets during the War, and many of those sets were unused and sold for surplus at the the end of the War. Note: Of the 65,000 patients in general hospitals in June 1865, only 97 remained a year later. The rapid decrease in the number of patients led to a corresponding decrease in the amount of medicines and supplies needed for their care and in the number of facilities designed to shelter them. Surgeon General Barnes was called upon to disband the ambulance corps; to close supply depots; and to sell or otherwise dispose of hospital transports, hospital trains, and general hospitals. Some institutions were turned over to individual states for use as homes for wounded veterans, and others were returned to their original owners. By the end of the fiscal year 1866 the Medical Department had received more than four million dollars from the "sales of old or surplus medical and hospital Property."  (James A. Tobey, The Medical Department of the Army History) Richard Satterlee (1798-1880) , in his role as Medical Purveyor of the United States Army, placed contracts with numerous instrument makes for the fabrication of cased instrument sets and related military surgical equipment.  During his tenure, Satterlee requisitioned over 4,900 amputation and general operating cases, 1,150 cases of trephining, exsecting, post-mortem, and "personal" instruments, 12,700 minor surgery, and pocket operating sets.  (Rutkow, p. 120, Civil War, American Surgery, an Illustrated History) The medical and surgical material available on the firing line was practically that carried by the surgeon in his case, known as the " surgeon's field companion," and by his orderly in the "hospital knapsack," a bulky, cumbersome affair weighing, when filled, about twenty pounds. Wounds were expected-nay, encouraged-to suppurate, and that they could heal without inflammation was undreamed of by the keenest surgical imagination. Their repair was always expected to be a slow, painful, and exhausting process. Nothing in the nature of antiseptics was provided. The cleanliness of wounds, except in respect to the gross forms of foreign matter, was regarded as of little or no importance. Even the dressings carried into action were few and scanty; where the soldier of the present carries on his person an admirable sterile dressing for wounds as part of his military equipment, in the Civil War the injured man covered his wounds as best be might with a dirty handkerchief or piece of cloth torn from a sweaty shirt. Elastic bandages for controlling hemorrhage were unknown, the surgeon relying, except in the case of larger vessels, on packing the wound with astringent, coagulant, and generally harmful chemicals.   Two Civil War surgeons outside their 'field office'  (National Archives)   Medicines were carried in pill form, often largely insoluble and uncertain in result, or else in liquid form, difficult to carry and liable to loss. Soluble tablets were unknown. Crude drugs, like opium, were carried in lieu of their concentrated active principles, like morphine, now almost exclusively employed. Not a single heart stimulant of those regarded as most effective by modern medical science bad place in the surgeon's armament carried in the field. A little chloroform was carried, but the production of surgical anesthesia was still a relatively new procedure, and several hundred major operations were reported during the war in which no anesthetic was employed.         In the first part of the war, each regiment had a hospital of its own, but the medicine-chest, mess-chest, and bulky hospital supplies were transported in wagons of the field-train, and hence were usually far in the rear and inaccessible.             (National Archives)   Panniers containing the more necessary dressings medicines, and appliances were devised to be carried along into action by pack-mules, but they were inconvenient and heavy, and were generally brought up in the ambulances after the fighting. Special wagons for medical supplies were then devised.         Surgical instruments were furnished by the Government to, each medical officer, who receipted for and was responsible for them. They were contained in four cases, one for major operations, one for minor operations, one a pocket-case, and one a field-case to be carried by the surgeon on his person into action. The instruments were well assorted, but they were used indiscriminately and without more than superficial cleansing upon both flesh and festering wounds, with the result that they habitually conveyed infection.               (National Archives) Under the surgical practice of the time, germs of blood poison, gangrene, and lockjaw were conveyed into the body. Moreover, it was the custom for the surgeons to undertake the most severe operations at the front, often under fire, under conditions in which even a pretense of surgical cleanliness could not have been maintained, even if the knowledge of the time bad been sufficient to cause it to be attempted. What we would now term " meddlesome surgery " was not peculiar to the army but was characteristic of general surgical practice of the time. In fact, toward the end of the war the best surgeons in the country were probably those with the military forces, and the admirable results which they frequently achieved bear evidence, not only of their accurate anatomical knowledge and surgical dexterity but of the amount of injury and infection which the human organism can resist.  Source of above: "The Photographic History of the Civil War, Volume IV" Article by Edward L. Musnson, M.D. Major, Medical Department, United States Army   There was an obvious lack of any standard of training among surgical personnel. Medical officers on both sides of the conflict were repeatedly charged with incompetence, ignorance, inefficiency, neglect, cruelty, carelessness and drunkenness. The reasons for this are never more apparent than in the admission standards for the Medical officers in the Union army. The Army Medical Board required all surgeons to pass an oral and written test to determine their competence in the medical sciences as well as history, geography, literature, philosophy and languages. Many failed these examinations and at the instruction of the Secretary of War, the requirements were significantly lowered. Thus, the number of competent surgeons rivaled the incompetent, and those that did serve had an alarmingly disparate base of knowledge: Army surgeons lacking in the latest knowledge of medical theory and technology, and civilian volunteers lacking surgical experience. Charges of needless operations performed to perfect surgical skills, surgeons abandoning patients whose wounds proved uninteresting, and surgeons operating while intoxicated were rampant. Equally as prevalent were accusations of indignity and contempt in the treatment of civilian surgeons by regular army surgeons. In response to these conditions, Surgeon General Hammond created a “civilian-auxiliary” system in cooperation with the State’s governors. So effective was this auxiliary that following Grant’s spring campaign of 1864, not a single story of scandal surfaced.   Source of above: “Civil War Surgery: A Historical Approach”; Submitted to the Des Moines University Surgical Foundation, August 2000, Scott S. Carpenter, DO 2003 Of the amount of labor performed by the Medical Staff during the war some idea may be obtained when it is stated that 5,825,480 cases of wounds and disease occurred among the white troops and 629,354 cases among the colored troops.(1) "The cost of maintaining the Medical Department formed no small portion of the total expenses of the war, and it is a matter of just pride that it can be said that the medical disbursing officers performed their duties faithfully and honestly, and that the immense quantities of medical supplies distributed all over the country were almost without exception properly accounted for. The expenditures on behalf of the Medical Department to the close of each fiscal year, on the 30th of June, from 1861 to 1866, were as follows: 1861     $194,126.77 1862     $2,371,113.19 1863     $11,594,650.35 1864     $11,025,791.33 1865     $19,328,499.23 1866     $2,837,801.37 Making a total of $47,351,982.24 expended during the war (exclusive of salaries of commissioned officers) for the benefit of the sick and wounded soldiers of the nation." Source:  "The Medical and Surgical History of the War of the Rebellion. (1861-65.)  Part III, Volume II, Chapter XIV.--The Medical Staff and Materia Chirugica"  Be sure to read:  Civil War Surgery: The truth about what surgeons did and did not do during the War