THE MEDICAL
DEPARTMENT
By MAJOR CHARLES
SMART, SURGEON U. S. A.
http://www.history.army.mil/index.html
( Note:
This article has been edited for relevance to the Civil War and
topics on this web site.)
The Medical
Department of the United States Army is as old as the United
States, starting in Colonial times.
In 1818 a bill
which organized the general staff gave to the Medical Department
for the first time in its history a permanent chief under the
title of "Surgeon-General." The "Director-General " of the
Revolutionary period and the "Physician and Surgeon-General" of
1813 were temporary appointments to meet the emergencies of the
times, but the surgeon-generalcy now authorized, and to which
Surgeon Joseph Lovell was promoted on account of his excellent
record, was a permanent position on the military staff of the
country. The same bill provided two assistant surgeons-general,
one for each of the divisions, but these, from the duties
prescribed for them, should rather have been called medical
inspectors. Hospital and garrison surgeons became consolidated
under the title of post surgeons, and as these took rank after
the surgeons of regiments, certain of the hospital surgeons who
had served in high positions on important occasions had reason
to be dissatisfied with the inferior status to which they were
consigned by this arrangement.
Surgeon Generals'
during the Civil War:
 |
 |
 |
 |
|
Thomas
Lawson
October
17, 1836–May 15, 1861 |
Clement
Finley
May 15,
1861–April 28, 1862 |
William
A. Hammond
April
28, 1862–August 18, 1864 |
Joseph
K. Barnes
August
18, 1864–1882 |
The Medical
Department was fortunate in having so able a man as Dr. Lovell
appointed as its chief. He defined the duties of his
subordinates, established an excellent system of accountability
for property, revised and improved the character of the medical
reports rendered, inspired his officers with the idea that as
sanitary officers they had greater responsibilities than mere
practicing physicians and surgeons, and labored earnestly to
have their pay increased and their official status raised in
proportion to his views of the importance of their duties. He
also established an equitable system of exchange of posts or
stations, so that one officer might not be retained unduly at an
undesirable station.
In 1821 the
finishing touches were given to the organization of the
department by doing away with the unnecessary positions of
assistant surgeons-general and apothecary-general, and
consolidating the regimental surgeons with the general staff, so
that the corps consisted simply of one surgeon-general, eight
surgeons with the compensation of regimental surgeons, and
forty-five assistant surgeons with the compensation of post
surgeons; but as this number was insufficient to provide one
medical officer to each of the military posts, the system of
employing civil physicians on contract was instituted.
Mexican War
During the
Mexican War the senior surgeons were assigned as medical
directors and in charge of general hospitals; certain of the
juniors were on duty at the hospitals and purveying depots and
the others in the field as regimental officers with the regular
troops; volunteer surgeons were on duty with their regiments
with occasional details for duty in the hospitals. The
surgeon-general left his office and took the field with General
Scott that he might better superintend the operations of his
department. General hospitals were established at New Orleans
and Baton Rouge, La., at Point Isabel, Matamoras, Camargo and
Monterey, at Vera Cruz, Plan del Rio, Jalapa and other points
en route to the City of Mexico, and lastly, in that city
itself. There was much sickness during the invasion. Diarrhoea,
dysentery and remittent fevers were the prominent diseases.
These were attributed to exposures on the plateaus immediately
after the march across the tierra caliente, where, on
account of the heat, the troops, many of them raw, had thrown
away their overcoats and blankets, and had not been able to
replace them. Moreover, many of the commands had become infected
with yellow fever while at Vera Cruz. Nevertheless the hospital
service was competent to the care of all cases, and every
official report that was rendered commented on the excellent
management of the Medical Department. "The Medical Staff," said
General Taylor after the battle of Buena Vista, "under the able
direction of Assistant Surgeon Hitchcock, were assiduous in
their attentions to the wounded upon the field and in their
careful removal to the rear.
The additions to
the numerical force of the Medical Department during and after
the Mexican War proved insufficient for the needs of our
scattered army; but although the surgeon-general repeatedly
called attention to his necessities, it was not until 1856 that
an increase of four surgeons and eight assistants was
authorized. The same bill provided for the enlistment of
hospital stewards with the rank, pay and emoluments of sergeants
of ordnance, and gave extra duty pay to the men detailed as
cooks and nurses in the post hospitals. Up to this time the
steward had been merely a detailed man, and it not infrequently
happened that after a medical officer had spent much time and
labor in educating one and instructing him in his special
duties, his work would be lost by the return of the man to his
company. Extra duty pay had been allowed to hospital attendants
from 1819, but a ruling of the Treasury Department had deprived
them of it and rendered necessary the clause relating to it in
this bill.
The Utah
expedition of 1857 found the Medical Department fully prepared
for any emergency, but no general hospital was established, as
the regimental hospitals sufficed for the care of the sick.
Civil War
Surgeon-General
Lawson died of apoplexy in 1861, after a service of forty years,
during thirty-four of which he had been chief of the department.
To his earnestness of purpose and untiring energy the medical
officers of the army owed much of the recognition which they had
obtained from Congress. He was succeeded by Dr. Clement A.
Finley, then the senior surgeon on the army list.
Just before the
death of Surgeon-General Lawson the Civil War had been opened by
the attack on Fort Sumter; and from the calls for large bodies
of troops issued by the President, and the feeling north and
south that a desperate struggle was before the country, it was
evident that without large reinforcements the Medical Department
would be incapable of carrying on successfully its share of the
work. At this time it consisted of one surgeon-general with the
rank of colonel, thirty surgeons with the rank of major, and
eighty-three assistants with the rank of lieutenant for the
first five years of their service and that of captain until
subsequent promotion. Three of these surgeons and twenty-one
assistants resigned "to go South," and three assistants were
dismissed for disloyalty. In August, 1861, ten additional
surgeons and twenty assistants were authorized, and a corps of
medical cadets was formed, not to exceed fifty in number, to be
employed under the direction of medical officers as dressers in
hospital. Some of the members of this corps did excellent
service, but as a whole it was numerically too small to make
itself felt as a power for good.
The medical staff
of the regular establishment was speedily assigned to duty in
connection with the preparations for the coming struggle. Some
took charge as medical directors of the corps and armies that
were formed, instructing the volunteer officers in the duties of
camp, and organizing them by brigades for hospital and
battle-field service; others acted as medical inspectors, aiding
the directors in their work of supervision and education; some
organized general hospitals for the sick that had to be provided
for on every move of the army, while others kept these hospitals
and the armies in the field supplied with medicines, hospital
stores, furniture, bedding, and surgical supplies; the remainder
were assigned to field service with the regular regiments and
batteries.
State Volunteer Surgeons
Each volunteer
regiment brought with it a surgeon and an assistant (afterwards
two assistants) appointed by the Governor of the State after
examination by a State medical board. The efficiency of this
service was further guarded by a central board for the
reexamination of any regimental medical officer whose
professional competency had been called in question. The senior
surgeon of each brigade became invested with authority as on the
staff of the brigade commander; but as seniority was determined
by a few days or weeks at furthest, it often happened that the
best man for the position was not rendered available by this
method. Congress therefore authorized a corps of brigade
surgeons who were examined for position by the board then in
session for officers of the regular corps. One hundred and ten
of these brigade surgeons were commissioned.
In April, 1862, a
bill was passed by Congress to meet the pressing needs of the
Medical Department. This gave the regular army an addition of
ten surgeons, ten assistants, twenty medical cadets and as many
hospital stewards as the surgeon-general might deem necessary;
and it provided for a temporary increase in the rank of those
officers who were holding positions of great responsibility. It
gave the surgeon-general the rank, pay and emoluments of a
brigadier-general; it provided for an assistant surgeon-general
and a medical inspector-general of hospitals, each with the
rank, etc., of a colonel of cavalry, and for eight medical
inspectors with the rank of lieutenant-colonel. These original
vacancies were filled by the President by selection from the
army medical officers and the brigade surgeons of the volunteer
forces, having regard to qualifications only instead of to
seniority or previous rank. At the termination of their service
in these positions medical officers of the regular force were to
revert to their former status in their own corps with such
promotion as they were properly entitled to. About the time of
this enactment Surgeon-General Finley was retired at his own
request after forty years service and Assistant Surgeon Wm. A.
Hammond was appointed the first surgeon-general with the rank of
brigadier-general. In December following eight more inspectors
were added. Their duties were to supervise all that related to
the sanitary condition of the army, whether in transports,
quarters or camps, as well as the hygiene, police, discipline
and efficiency of field and general hospitals; to see that all
regulations for protecting the health of the troops, and for the
careful treatment of the sick and wounded, were duly observed ;
to examine into the condition of supplies, and the accuracy of
medical, sanitary, statistical, military and property records
and accounts of the Medical Department; to investigate the
causes of disease and the methods of prevention; they were
required also to be familiar with the regulations of the
Subsistence Department in all that related to the hospitals, and
to see that the hospital fund was judiciously applied; finally,
they reported on the efficiency of medical officers, and were
authorized to discharge men from service on account of
disability.
Shortly after
this the corps of brigade surgeons was reorganized to give them
a position on the general staff similar to that of the army
medical officer, and render their services available to the
surgeon-general at any point where they might be most needed
irrespective of regimental or brigade organizations. They
henceforth became known as the "Corps of Surgeons and Assistant
Surgeons of Volunteers"; and the appointment of forty surgeons
and one hundred and twenty assistants was authorized.
(See
examples
of the written exam questions and answers for Union Navy
applicant, Dr. George Snow including his biography.)
(Another
example of a
Union Navy applicant.)
Promotion or
increased rank is the reward in the military service for duty
well performed; but little incentive of this kind was offered to
medical officers during the War of the Rebellion. Many who
entered as surgeons had no promotion to look forward to; and
they saw their comrades of the line, formerly their equals or
inferiors in rank, mount upwards step by step while there
remained to them nothing but the reward of a good conscience.
The sixteen lieutenant-colonelcies held by the medical
inspectors offered no chance of promotion to the vast number of
those who looked up to them. Surgeon-General Hammond made
several efforts to obtain increased rank for the medical
directors of armies. That a medical officer on duty as medical
director held only the rank of major, although responsible for
the work of five or six hundred officers, one-third of whom had
a rank equal to his own, seemed an oversight that required only
to be pointed out to be immediately remedied,-the more so that
the corresponding officers of the Adjutant General's, the
Quartermaster's and Subsistence Departments, were assigned to
their duties as colonels; yet the efforts of the surgeon-general
were met by a curt refusal on the ground that the skill and
efficiency of surgeons were not dependent upon rank and pay. The
reply was to the effect that surgical ability was not in
question; that the duties of a medical director were purely
administrative, and that for the proper performance of such
duties rank was essential; but no action was taken upon this
subject until towards the close of the war, when Congress
recognized the responsibilities of these officers by giving the
rank of lieutenant-colonel to the director of a corps and of
colonel to that of an army.
It is seen,
therefore, that during this great war the work of the Medical
Department was performed by the regular medical officers and the
corps of volunteer surgeons and assistant surgeons, both
commissioned by the President, and by the large body of
regimental medical officers commissioned by the Governors of
States. In addition to these, civil physicians, known as acting
assistant surgeons, were employed under contract, mostly in the
wards of the general hospitals established in the vicinity of
the national capitol and many of the large cities. Just before
the close of the war another class of medical officers was
authorized. Regimental surgeons whose regiments had been
mustered out on account of the expiration of their terms of
service were offered the position of acting staff surgeons as an
inducement for them to continue in service; and a few were thus
led to return, for assignment in the field or base hospitals.
The ambulance corps must also be mentioned as a part of the
machinery of the Medical Department. An ambulance service
consisting of men specially enlisted and under the command of
medical officers was urged by General Hammond, but no action was
taken at the time on his suggestion. Somewhat later, however, a
corps was organized from detailed men, with lieutenants as
brigade and division officers, and a captain on the staff of the
commanding general as chief of ambulances of the army corps.
These officers were practically acting quartermasters for the
Medical Department so far as related to the transportation of
the sick and wounded.
In 1864
Surgeon-General Hammond was tried by court-martial and dismissed
from the service on account of disorders and neglects in
relation to the purchase of blankets, medicines and medical
stores of inferior quality. General Hammond contended that the
law authorized him not only to indicate to medical purveyors
what and where they should purchase, but even to send the order
himself, particularly under the emergency calls of a great war,
and that in none of the specified instances had he been actuated
by any motive other than that of performing the important duties
of his office with credit to himself and benefit to the invalids
who depended on his department for their care and comfort.
Nevertheless, the proceedings were approved August 18, 1864, and
Medical Inspector-General J. K. Barnes, who had been acting
surgeon-general pending the trial, was appointed to the vacancy.
It is scarcely needful, so far as General Hammond is concerned,
to say that this sentence has been annulled and set aside.
Fourteen years after it was promulgated he came before Congress
for relief. The Senate Military Committee in its report reviewed
the case and the history of the times, showing how there came to
be a want of cordiality between the Secretary of War and the
surgeon-general, and that, in consequence, the weaker went to
the wall. The bill which replaced his name on the Army Register
was approved March 18, 1878.
In the early
period of the war the unit of organization for field work was
the regimental hospital, but the advantages of consolidation
became speedily manifest. When the sick exceeded the capacity of
the regimental accommodation, brigade hospitals were established
to receive the overflow and obviate the necessity for sending
temporarily disabled soldiers to distant general hospitals.
After a battle the coöperative work of the surgeons of a brigade
was found to give infinitely better results than could be
obtained by preserving the individuality of the regimental
hospitals. A larger experience of these advantages led to the
consolidation of the brigade hospitals of a division for
administrative purposes into a field hospital for the division.
These worked so well in the Western Army, and in the Army of the
Potomac during the battle of Antietam, that thereafter orders
were published calling for their establishment as soon as an
engagement was imminent. A medical officer was assigned to the
command of the division hospitals; assistants were detailed to
provide food and shelter and keep the records, and the best
surgeons of each brigade were assigned to duty at the operating
tables. Those officers who were not required for special service
in the hospital accompanied their commands into action and
established dressing stations at convenient points in rear of
the line of battle where the wounded were prepared for
transportation by the ambulances of the hospital. At the
beginning of a campaign a standing order was promulgated by the
medical director detailing his medical officers to their various
duties in case of an engagement. The chief of the hospital and
his assistants were permanent details, sometimes staff instead
of regimental surgeons. They remained at all times with the
ambulances on the march and in camp. When a line of battle was
formed, a suitable site was selected to which the ambulance
train brought up the tents and supplies for the establishment of
the hospital, and the ambulance officers proceeded to the
dressing stations to bring in the wounded. The success of this
field hospital system was such that in many commands its
existence was continued during the period of inactivity in
winter quarters, only trivial ailments being treated in camp by
the regimental medical officers, whose medical knapsacks were
replenished from time to time from the supplies of the hospital.
When established on the battle-field the objects of the division
hospital were to give shelter and surgical care, with time and
facilities for the performance of all needful primary
operations. As soon as this work was accomplished the wounded
were sent to the base of supplies in ambulance or other
available wagons of the Quartermaster, Subsistence or Ordnance
Department, and from this they were shipped by rail or steamboat
to northern cities where ample accommodation and comforts were
provided in the magnificent system of general hospitals which
had been established.
At first the
Medical Department labored under considerable disadvantage on
account of its dependence on the Quartermaster Department for
its transportation in the field, and by sea and rail, as well as
for its hospital buildings; but in progress of time these
difficulties became smoothed over by the organization of the
ambulance corps for the field transportation of the wounded, and
the building of special hospitals and hospital steamers which
were placed under the orders of the Medical Department. The
extent of the provision for the care and treatment of the sick
and wounded may be appreciated when it is observed that in
December, 1864, there were in the general hospital of the North
118,057 beds, 34,648 of which were unoccupied and ready for the
accommodation of those who might be disabled at any time in the
progress of events on the theatre of war. During the war there
were reported on the monthly reports of medical officers
6,454,834 cases of sickness and injury, 195,627 of which were
fatal. Of the diseases, diarrhoea and dysentery, fevers of a
typhoid character and pneumonia were the most prevalent and
fatal.
Purveying
Depot
Medical and
hospital supplies for all these cases were provided mainly from
the purveying depot in New York City in charge of Surgeon R. S.
Satterlee, whose honorable record extended from the Florida and
Mexican wars to this important duty during the Civil War.
Supplies were also purchased in Philadelphia and to some extent
in Chicago, St. Louis, Cincinnati, etc. The expenditures on
behalf of the Medical Department in 1861-1866 amounted to 48
million dollars.
The museum and
library of the Surgeon-General's Office, both of which have now
a world-wide reputation, had their beginnings during the war.
Surgeon-General Hammond, in a circular in May, 1862, announced
the intention of establishing an Army Medical Museum, and
requested medical officers to collect specimens of morbid
anatomy, medical and surgical, which might be regarded as
valuable, together with projectiles or foreign bodies removed,
and such other matters as might prove of interest in the study
of military medicine and surgery. Later circulars gave more
specific instructions regarding the collections to be made. For
a number of years the museum was installed in the old theatre
building in which President Lincoln was assassinated, but
recently a handsome and commodious building has been erected in
the Smithsonian grounds at Washington, D. C., where are now
aggregated over 31,000 specimens, two-thirds of which are
anatomical and pathological and the remainder microscopical,
with, in the library, nearly 107,000 bound volumes and 166,000
unbound theses and pamphlets. Congress has provided for the
publication of an index catalogue of the library, thirteen
volumes of which have been published, bringing the work nearly
to the end of the letter S. This catalogue, the work of Major
John S. Billings, has given a marvellous impetus to medical
literature and education in this country, as it places the
valuable stores of the library within easy reach of those who
are qualified to make use of them. The original intention was to
have the library and museum connected with a hospital and
medical school for the special training of those intended for
the medical service of the army, but since the war the military
force of the country has been too small to warrant the support
of an institution of this kind. The library and museum have,
however, taken a higher position than that originally intended,
for they are now regarded as belonging to the medical profession
of the country and not to any special school, hospital or
section. Another of the notable results of the war is the
"Medical and Surgical History of the War of the Rebellion." The
six large quarto volumes of this work were published at various
times from 1870 to 1888, when the last was issued. These volumes
show that while the work of the Medical Department, in field and
hospital, was carefully performed as regards the individual
case, the necessary reports and papers were fortunately not
forgotten. Some volunteer surgeons who took pride in considering
themselves practical men, because they gave but little care to
what they were pleased to term the red-tapeism of the department
in calling for reports, have since then learned to appreciate
the importance of these reports in their connection with the
immense business of the Bureau of Pensions.
Secretary Stanton
has put on record his testimony to the efficiency of the Medical
Department during the war, not only as regards the care and
comfort of the sick and wounded, but as to the accomplishment of
its important duties without in any instance impeding or
delaying the movements of the army. Its casualty list affords
proof of the courage and zeal of its members and of their
devotion to duty, for 32 were killed in battle or by guerrillas,
and 83 were wounded, of whom 10 died in consequence; 9 were
killed by accident; 4 died in rebel prisons, 7 of yellow fever,
and 271 of disease incidental to camp life and resulting from
exposure.
The latter part
of the year 1865 was devoted to the breaking up of the depots
and general hospitals, and next year the Medical Department was
again placed on a peace footing with a personnel consisting of a
surgeon-general; an assistant surgeon-general with the rank of
colonel; a chief medical purveyor and four assistants,
lieutenant-colonels; sixty surgeon-majors, and one hundred and
fifty assistants, captains and lieutenants. In 1872 provision
was made for a chief medical purveyor with the rank of colonel;
but in the meantime all promotions and appointments had been
interdicted, so that the reports of the surgeon-general speak in
urgent terms of the crippled condition of his department. In
1873 there were 59 vacancies, and in the following year, to meet
the demands of the service, no less than 187 surgeons had to be
employed on contract. At this time Congress authorized the
appointment of assistants surgeons, but cut off two of the
assistant medical purveyorships and ten of the sixty surgeons,
prohibiting promotion until the number became thus reduced; and
in 1876 the number of assistant surgeons was cut down to 125.
From the close of
the War of the Rebellion the want of higher rank and
corresponding increase of pay for the older officers of the
corps had received a good deal of attention, and several efforts
were made to give these officers a status similar to that
provided for the seniors of the other staff corps. These were at
last successful in 1876, when, in addition to the existing
grades there were authorized four surgeons, colonels, and eight
lieutenant-colonels, giving the members of the corps their
present rank, viz., 1 brigadier-general, 6 colonels, 10
lieutenant-colonels, fifty majors and 125 captains and
lieutenants.
For some time
after this the department was crippled by the retention on the
active list of members who were wholly incapacitated by reason
of advanced age. Officers of the other staff corps and of the
line were placed on the retired list and their places taken by
younger men, but the seniors of the Medical Department were
permitted to remain on nominal active service until removed by
death. At last the compulsory retirement law of 1882 gave a
recognizable and gratifying impetus to what had hitherto been
the stagnation of promotion. Among the first removed by this law
was Surgeon Jno. M. Cuyler, who had held his position on the
active list for forty-eight years. Surgeon-General Joseph K.
Barnes was also removed; he did not long survive his retirement,
nor did his successor, General Charles H. Crane, continue long
in office after him. Both these officers were for nearly twenty
years associated in the management of the department, and their
deaths occurred within a few months of each other. General
Barnes possessed the full confidence of Secretary Stanton in all
matters pertaining to the administration of the department, and
to this was due the independent status of general hospitals in
time of war, together with the removal of hospital
transportation, both by sea and land, from any interference by
other than medical authority,two important decisions which
tended much to the efficiency of the medical service during the
War of the Rebellion.
In reviewing the
history of the Medical Department, it seems to the writer that
its officers, and those of the army as a whole, have reason to
feel gratified. Having had its beginning as we have seen in the
patriotism of the individual medical man, which led him to pack
his saddle-bags with needful supplies for the care of his
friends and neighbors who might come to grief on the road
between Boston and Concord, it has evolved through the medium of
experience in the Revolutionary War, in that of 1812, in the
Mexican War, in campaigns innumerable against hostile Indians,
and in the terrible trials of the War of the Rebellion, into a
corps of officers whose members are tied down to no specific
duties, but are available for assignment in an emergency to the
duty which each is best qualified to undertake, and whose rank,
pay and emoluments increase with their age and experience.
Extensive
information about the surgical sets produced for the Medical and
Hospital Department during the Civil War:
Army Medical and Hospital Departments Budgets
Extensive
history of the Medical Department
Instrument sets specified by U.S. Army Medical
Department during the Civil War
Display of instruments normally found in a Civil War
hospital set 1861-65
Hernstein & Son, U. S. Army Hosp. Dept. issue field
surgery set
Hernstein Civil War U. S. Army Hospital Dept. Staff
Surgeon's set
Tiemann Civil War U. S. Army Hospital Dept. Field
Surgeon's set
Snowden & Brother U. S. Army Medical Dept. field
surgery set
U.S.A. Hosp. Dept. trepanning set by Hernstein
U. S. A. Hosp. Dept. medium size ivory surgical set,
1861
U. S. A. Hosp. Dept. 9 in. bottle, 1861-65
Regulations for the Medical Department of the Army,
1861
Notes on
Army
Medical Department 1866, multi-topical
U.S. Army Hosp. Dept. Wood's Medicine, Vol. I & 2
Snowden and Brother field size U.S.A. Med. Dept military
amputation set, 1861
