Civil War Confederate Navy Office of Medicine and Surgery(The following are the personal edited research notes of Michael Echols, the source of which may or may not be completely documented. The complete article should be located and viewed in full. This is a contracted version of the original to preserve the link to the original.)
Confederate Navy medicine
Author: John S. Lynch, Msc.
Military Medicine, Nov 1999 by Lynch, John S
The Confederate Navy's Office of Medicine and Surgery was a small organization within the Confederate Navy Department. The physicians, surgeon's stewards, and nurses provided medical care to sick and injured sailors from both sides of the conflict. The provision of health care often took place under trying circumstances, including shortages of medicines, money, and food. Members of the medical department served in all major and many minor naval engagements and worked long hours treating the wounded after battle. Many of the physicians served in the U.S. Navy before the Civil War. Their sacrifices and achievements are lost in the maelstrom of the larger conflict on land. This article is an effort to call attention to their story.
One common misperception is that during the American Civil War the two combatant navies played only a subordinate role to the greater conflict on land. In fact, the Federal and Confederate navies greatly affected the war at the operational and strategic levels. General George McClellan's 1862 peninsular campaign and Benjamin Butler's Army of the James 1864 Virginian peninsula operations would have been impossible without the support of the U.S. Navy. The Union's Mississippi Squadron was key to denying the Mississippi River to the Confederacy and to the eventual capture of Vicksburg. The naval blockade of the southern coastline seriously hampered Confederate importation of war materiel and export of "king cotton," which, of course, affected the Confederacy both militarily and financially. The Confederate Navy also affected the operational and strategic course of the war. Confederate Navy ironclads, such as the Virginia and the Albemarle, kept Southern ports and rivers safe from capture and open for blockade runners. One major contribution to the war effort by the Confederate Navy was its handful of commerce raiders. These ships, the most famous being the CSS Alabama, destroyed the U.S. maritime industry by sinking merchant ships, driving up insurance costs to prohibitive levels, and finally forcing American cargoes into neutral ships. The U.S. merchant marine did not recover from Confederate Navy depredations until the 20th century, Historians primarily focus their attention on these raiders and the ironclads. As a result, few people today know anything about the Confederate Navy's Office of Medicine and Surgery. This article is designed to shed light on this overlooked chapter in the history of military medicine.
Organization, Staffing, and Budget of the Office of Medicine and Surgery:
The Confederate Navy's Office of Medicine and Surgery (OMS) was formally instituted on March 16, 1861, when Confederate President Jefferson Davis signed the Navy Bill into law. OMS was one of four naval bureaus. The other three were the Office of Orders and Details (the senior bureau and essentially an office of personnel with military judicial duties), the Office of Ordnance and Hydrography (which dealt with weapons, ammunition, and navigational equipment), and the Office of Provisions and Clothing (logistics).',' OMS was tasked with establishing and operating naval hospitals, acquiring and producing medicines, and obtaining or fabricating medical and surgical supplies It directed medical personnel and provided physicians for Confederate naval vessels and facilities. OMS was a small office that supported a small navy. (The Confederate Navy's highest personnel level was 753 commissioned officers and 4,450 enlisted men in 1864.1)
The early physician staff was mostly drawn from former U.S. Navy physicians. In 1860, there were 69 surgeons, 43 passed assistant surgeons, and 36 assistant surgeons in the U.S. Navy. Thirty-eight of these men resigned or were dismissed, representing a loss of 26% of the Federal Navy's physicians. At least 35 of these former U.S. Navy physicians eventually served in the Confederate Navy.' In contrast, in 1860 the U.S. Army had 30 surgeons and 83 assistant surgeons. Three surgeons and 21 assistant surgeons resigned from the Army for the Confederacy, representing a loss of 21% of the Army's medical officers.3 The OMS grew during the war in response to increasing demands for medical support. The original March 16, 1861, legislation authorized OMS to have 5 surgeons and 5 assistant surgeons. In December 1861, 30 "temporary" physicians were authorized. The demand for additional naval medical officers was such that the Confederate Congress passed legislation in April 1862 that increased OMS physician levels to the following: I surgeon general, 20 surgeons, 15 passed assistant surgeons, and 30 assistant surgeons. Demand increased further, and in 1863 President Davis was authorized to appoint as many naval officers he deemed necessary.4 Fiftyone years after the Confederate surrender, the Association of Medical Officers of the Army and Navy of the Confederacy determined that there were 107 naval medical officers who served at one time or another during the war. The 107 physicians included 26 surgeons, 13 passed assistant surgeons, 63 assistant surgeons, and 5 assistant surgeons for the war.' In addition to physicians, OMS employed surgeon's stewards (a noncommissioned officer rank) who aided the physicians and were required to have a working knowledge of pharmacy and bandaging techniques and to be able to perform minor surgery.' Nurses were also employed or detailed as needed. Appropriations for the Confederate Navy were insignificant compared with that for the Confederate Army. Approximately $107,000,000 (Confederate) was appropriated for the Confederate Navy during the entire War. The Confederate War Department, in contrast, had a total appropriation of $2,180,700,000.4 Approximately $1,716,500 (2% of the naval appropriations) was budgeted for the Navy's Medical Department during the nearly 5 years of conflict. The Confederate Navy's medical appropriations were as follows: 1861, $20,000; 1862, $61,500; 1863, $250,000; 1864, $1,010,000; and 1865, $375,000. IA
The Chief of the Office of Medicine and Surgery for the entire war was Dr. William Augustine Washington Spotswood. 1,5 Spotswood, like many contemporary American physicians, did not have a formal medical degree. He did attend the University of Virginia's medical school but left in 1828 after completing the first year of its 2-year program. He was commissioned as an assistant surgeon in the U.S. Navy in December 1828. Spotswood resigned from the U.S. Navy on January 19, 1861, while assigned to the Pensacola Navy Yard.'-' Service Life for a Confederate Navy Medical Officer In general terms, the Confederate Navy physician faced less physical hardship than his Army counterpart. Many naval physicians lived in metropolitan areas, whereas Army physicians often slept under tents. Battle hazards were less for the naval physicians, because the ships were idled by blockade or, if in battle, they were protected by their duty stations being below the waterline or by ironclad bulwarks. The risk of contracting disease was high for the Navy physician. Poorly cooked or contaminated food could lead to diarrhea. Medical officers in ships anchored near marshland often contracted malaria. Only four physicians died while in service: David Llewellyn drowned in the immediate aftermath of battle; Joseph Grafton gave his life so another could five during a boating accident off the Brazilian coast; and George Blacknall and Daniel Green died from natural causes or disease.4,8-10 OMS physicians, as a result of their specialized training, were classed as limited duty officers by the Confederate Navy Department. I This meant that they could not be used in line officer positions. Naval medical officers were assigned to one of several general areas: land installations, riverine or harbor defense vessels, or cruisers.
Hospital duty was assigned to the older, seasoned surgeons because of their experience and to assistant surgeons so that they could gain experience. It was probably a sought-after assignment by these men, because it allowed them to live with their families, enjoy the local economy, and live in better conditions than their peers aboard ship. Confederate Navy hospitals were established in Norfolk, Virginia; Richmond, Virginia; Wilmington, North Carolina; Mobile, Alabama; Charleston, South Carolina; and Savannah, Georgia." Additionally, several infirmaries were scattered about the Confederacy. The largest and busiest naval hospital was the Richmond Naval Hospital. Surgeon James F. Harrison' commanded the facility for most of the war.' Another major facility, the Savannah hospital, was described in 1864 by a captured Federal Navy physician: "My patients were placed under my care at a hospital called the Savannah Naval Hospital, under the charge of Surgeon Jeffrey, CSN. This hospital was devoid of some of the luxuries which may be found in Northern hospitals, but was airy and comfortable, and the patients there received every care and comfort which the somewhat limited resources of the country permitted. I myself was treated with gentlemanly consideration by Dr. Jeffrey and the assistant surgeons, as well as by the numerous rebel officers who frequently called there. We were told by the guard, to console us, that this ration was the same as they got themselves, and I think it likely enough that they told the truth. I know that while at Savannah, I tabled with the rebel surgeons in the hospital, and that during all my stay there, nearly six weeks, we had coffee never, tea only about five or six times, butter about as often; and to the credit of the surgeons be it said that they denied themselves the luxuries of tea at $30 to $40 per pound, they had it furnished to our wounded, and generally fed them better than they fed themselves."' "Surgeon Jeffrey" was Richard W. Jeffrey, a Virginian and former U.S. Navy surgeon who had become a Confederate Navy surgeon by February 8, 1862. He was on "special service" between 1862 and 1863 and was assigned to the Savannah Naval Hospital in 1864. 11 Confederate Navy hospitals admitted a total of 1,990 patients, discharged 1,410 patients, and reported the deaths of 69 patients (a death rate of 3.5%) between October 1, 1863, and October 1, 1864 11
Assignment to the riverine or harbor defense vessels was probably the least sought-after duty. Often, the young assistant surgeons were sent to these vessels, although surgeons were assigned to the larger vessels and as fleet surgeons for the various squadrons. The crews were berthed aboard ship, and this duty was extremely tedious because there was little activity against the enemy. It could also be very uncomfortable if the officer was assigned to one of the ironclads, because these vessels were extremely hot in the summer and cold and damp in the winter. A berth in a cruiser was the most active duty against the enemy to which a medical officer was assigned. Passed assistant surgeons were often detailed to these vessels. A report dated November 30, 1863, to the Secretary of the Navy noted that 7 of the 11 passed assistant surgeons were assigned to cruisers." The long voyages meant separation from family, but at least there was a sense of accomplishment each time an enemy merchant ship was taken. Service aboard a cruiser was probably very tedious for the medical officers, because they had only medical duties. This may have caused occasional resentment on the line officers' parts, because they were busy with the ship's functions while the medical officer idled about. The ship's captain could assign ad hoe duties to the physician. On one ship, the medical officers were assigned to inspect the ship's coal after problems were encountered with it. 14
Navy physicians were also assigned to Army support. (Naval medical officers, like naval line officers, concurrently held Army rank.) The Chief of OMS was a brigadier general, fleet surgeons were considered colonels, surgeons were majors, and assistant surgeons were captains.15 Assistant Surgeon Marcellus P. Christian, CSN, was on such duty in 1861 when he was assigned to an Army general hospital in Culpeper, Virginia."
Pay scales for the naval medical officers varied with rank and sea-duty status. Fleet surgeons earned $3,300 (Confederate) annually, surgeons between $2,200 and $3,000 depending on seniority and sea duty, and passed assistant surgeons received $1,500 for shore duty and $1,700 for sea duty. Assistant surgeons received between $1,050 and $1,250 depending on seaduty status.4. ' Navy physicians earned less than their Army counterparts (which undoubtedly caused some friction between the two groups).
Confederate Navy Physician Uniform:
The basic regulation uniform for the medical officer was a gray frock coat and gray trousers. The coat had a black silk lining and two nine-button rows of Navy buttons. The coat's shoulder straps were made of one-and-three-eighth-inch-wide black cloth with rank-dependent devices enclosed by a one-quarterinch-wide gold border. The uniform hat was a gray kepi-like cap with a one-and-one-quarter-inch-wide gold hat band. It had rank insignia placed on its front, above the band. Rank was indicated by sleeve lace, shoulder straps, and cap insignia. The Confederate Navy recognized three physician ranks: surgeon, passed assistant surgeon, and assistant surgeon. Surgeons with more than 12 years of experience (service in the U.S. Navy was recognized) had two one-half-inch strips of gold lace around the coat sleeve cuff. The shoulder strap device was two crossed gold-embroidered olive leaf sprigs centered and running the length of the strap. The hat insignia was three four-tenth-inch-diameter gold-embroidered stars enclosed by a gold wreath of olive leaves.
Surgeons with less than 12,years of experience wore one strip of one-half-inch lace around the coat sleeve cuff. The shoulder strap device was one gold-embroidered olive leaf sprig versus the two authorized for more than 12 years of service. The hat insignia was two four-tenth-inch-diameter gold-embroidered stars enclosed by a gold-embroidered wreath of olive leaves. Passed assistant surgeons wore a strip of one-quarter-inch lace around their coat cuffs. The passed assistant surgeon's shoulder strap had a single gold-embroidered olive leaf at each end of the shoulder strap. The cap device consisted of one gold-embroidered star enclosed by a gold-embroidered olive wreath.
Assistant surgeons' coats lacked cuff lace; instead, they wore three buttons along the cuff. They wore the unadorned shoulder strap described above. The cap device was a gold-embroidered olive leaf wreath. The quality of the uniform probably varied with time and place. Those physicians serving overseas were probably better dressed than their comrades in shore billets in the Confederacy. There was some variation, but in general naval medical officers kept to regulations. 17
Navy surgeons treated a wide range of afflictions: colds, yellow fever, malaria, pneumonia, chilblains, diarrhea, contusions, fractures, lacerations, heat exhaustion, sunburns, and venereal disease. 18 Malaria was the most common illness encountered by Confederate Navy personnel."," The disease rate was high. Confederate Navy medical reports indicated that there were 6,122 patients treated during a 9-month period in 1863; this is a significant number considering the highest level of personnel the Confederate Navy had was 5,203 men in 1864 .2
The Confederacy's James River Squadron provides an illuminating glimpse of how disease affected the Confederate Navy. The squadron (in 1864) was composed of seven vessels and was commanded by Commodore John K. Mitchell, CSN. On August 10, 1864, Mitchell reported that one-third of his men on each of the squadron's ironclads were on the sick list, which also included half of his medical officers., The high disease rate forced Mitchell to move the squadron away from its anchorage, curtail its Army support operations, and request replacement medical officers (which meant the loss of these men from their normal duties). 19 Mitchell reported on August 22, 1864, that 226 of his men were on the sick list (with 157 of them at the Richmond Naval Hospital). One ship alone reported 61 men ill.' Many of these James River Squadron men suffered from malaria, for the squadron was anchored next to a marsh containing plasmodially infected mosquitoes.
Battle injuries treated by Confederate Navy medical personnel included gunshot wounds, cutlass wounds, shrapnel wounds, and bums. Confederate naval casualties for four engagements were analyzed.' Although the casualty returns varied considerably in detail and some were incomplete, they provide a general idea of the combat casualties faced by the medical personnel. During the four engagements, there were 47 Confederate naval personnel killed, 83 wounded, and 2 missing in action (see Table 111). Among the wounds noted were 22 patients with lacerations, 7 with contusions, 4 with gunshot wounds, 4 with bums, 2 with puncture wounds, I with a fracture, and I with an eye injury. The anatomical distribution of the wounds was as follows: 24% head and neck, 7% truncal, 38% lower extremities, and 31% upper extremities. The lower percentage of chest and abdominal wounds may be attributed to the fact that gun crews were probably crouched down while working their guns and exposing only their heads, arms, and legs to shells exploding on the opposite side of the gun. Mechanisms of injury included 39% from shell explosion, 27% from blunt trauma (e.g., being blown down a hatch or against a bulwark by a shell blast), 21 % from shell fragmentation or wooden splinters, and 12% from bullets.20-13
The interior of an ironclad during battle was noisy and, in some instances, messy. Fleet Surgeon Daniel B. Conrad described his perspective of the battle of Mobile Bay: "You could only hear voices when spoken close to the ear, and the reverberation was so great that bleeding at the nose was not infrequent." He also noted the result of the transfer of force from a large naval shell striking the exterior of the ironclad to human flesh in contact with the ship's interior: ". .suddenly there was a dull sounding impact, and at the same instant the men whose backs were against the shield were split to pieces. I saw their limbs and chests, severed and mangled, scattered about the deck, their hearts lying near their bodies. All of the gun's crew and the Admiral were covered from head to toe with blood, flesh, viscera.... The fragments and members of the dead men were shoveled up, put in buckets and hammocks, and struck below. 1114 The results of steamship boiler explosions (whether from mechanical failure or cannon shot) were a concern to medical officers. The CSS Chattahoochee's boilers exploded as a result of mechanical failure in December 1863. The boiler exploded during a shift change, and escaping steam scalded two entire shifts of the engineering staff and put the Chattahoochee out of commission.25 A shell striking a boiler could be catastrophic to both ship and crew. A graphic example of this occurred during the battle of Albemarle Sound on May 5, 1864. The USS Sassacus suffered a single strike to a boiler, which caused 20 casualties, 14 of whom were scalded by boiler steam. One man was instantly killed by the steam, and another five died by the next day as a result of their burns .26
OMS established a medical laboratory and a pharmaceutical manufacturing facility in Richmond, Virginia. Despite the pharmaceutical manufacturing plant, OMS relied heavily on medicines run through the blockade.
1. Luraghi R: A History of the Confederate Navy. Annapolis, MD, Naval Institute Press, 1996.
2. Coski JM: Capitol Navy: The Men, Ships and Operations of the James River Squadron. Campbell, CA, Savas Publishing, 1996.
3. Adams GW: Doctors in Blue. New York, Henry Schuman. 1952.
4. Cunningham HH: Doctors in Gray: The Confederate Medical Service, Ed 2. Baton Rouge, Louisiana State University Press, 1960.
5. Scharf JT: History of the Confederate States Navy. New York, Gramercy Books, 1996.
6. W.A.W. Spotswood card. Confederate Navy Index, Library of Virginia, Richmond. 7. Chitwood WR: Doctor Spotswood and the Confederate Navy. VA Med Mon 1976; 728-33.
8. Report of LT Maffit. In Official Records of the Union and Confederate Navies in the War of the Rebellion [hereafter cited as ORNI, Series 1, Vol 2, p 657. Washington, DC, Government Printing Office, 1894 -1921.
9. Report of Commodore Buchanan. In ORN. Series 1, Vol 7, pp 43-9. Washington, DC, Government Printing Office, 1894 -1921.
10. Report on the Office of Medicine and Surgery, April 28, 1864. In ORN, Series 11, Vol 2, p 647. Washington, DC, Government Printing Office, 1894-1921.
11. Richard W. Jeffrey card. Confederate Navy Index, Library of Virginia, Richmond. 12. Report on the Office of Medicine and Surgery, I November, 1864. In ORN, Series 11, Vol 2, pp 758 - 61. Washington, DC, Government Printing Office, 1894 -1921.
13. Report on the Office of Medicine and Surgery, 30 November 1863. In ORN, Series 11, Vol 2, pp 559-61. Washington, DC, Government Printing Office, 1894-1921.
14. Memo to LT Maffit concerning brown coal. In ORN, Series 1. Vol 2, p 640. Washington, DC, Government Printing Office, 1894-1921.
15. Bill for the Reorganization of the Medical Corps of the Confederate States Navy. In ORN, Series 11, Vol 2, pp 247-8. Washington, DC, Government Printing Office, 1894-1921.
16. Military records for MP Christian. National Archives and Records Administration, Washington, DC.
17. Lord FA, Wise A: Uniforms of the Civil War. New York, Thomas Yoseloff, 1970. 18. Langley H: A History of Medicine in the Early U.S. Navy. Baltimore, MD, John Hopkins University Press, 1995.
19. Report of Commodore Mitchell. In ORN, Series 1, Vol 10. pp 730-1. Washington, DC, Government Printing Office, 1894 -1921.
20. Report of Surgeon D. B. Phillips. In ORN, Series 1, Vol 7, p 42. Washington, DC,
Government Printing Office, 1894-1921.
21. Campbell RT: Gray Thunder: Exploits of the Confederate States Navy. Shippensburg, PA, Burd Street Press, 1996.
22. Report of Fleet Surgeon D. B. Conrad. In ORN, Series 1, Vol 21, pp 578-9. Washington, DC, Government Printing Office, 1894-1921.
23. Report of Fleet Surgeon W. D. Harrison. In ORN, Series I, Vol 11, pp 688 -9. Washington, DC, Government Printing Office, 1894-1921.
24. Campbell RT: Southern Thunder: Exploits of the Confederate Navy: Shippensburg, PA, Burd Street Press, 1996.
25. Report of LTA. McLaughlin, CSN. In ORN, Series I,Vol 17, pp 871-2. Washington, DC, Government Printing Office, 1894-1921.
26. Report of Acting Surgeon Edgar Holden, USN. In ORN, Series 1, Vol 9, pp 742-3. Washington, DC, Government Printing Office, 1894-1921.
27. Phillips DB: The career of the Merrimac. Southern Bivouac 1887; March: 598608,
28. Report of Surgeon John A Browne, USN. In ORN, Series I, Vol 3, pp 69-71. Washington, DC, Government Printing Office, 1894-1921.
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Contributor: John S. Lynch, MSc PA-C
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