Confederate Navy medicine
Author: John S. Lynch, Msc.
Military
Medicine, Nov 1999 by Lynch, John S
http://findarticles.com/p/articles/mi_qa3912/is_199911/ai_n8855052?tag=content;col1
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
Disease:
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:
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.
References:
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.
Guarantor: John S. Lynch, MSc PA-C
Contributor: John S. Lynch, MSc PA-C
American Embassy-London, PSC 801 Box
35, FPO AE 09498-4035.
Civil War Federal Navy Bureau of Medicine and
Surgery