(The following are the personal edited research notes of Michael Echols, the source of which may or may not be completely documented)
An over-view discussion of the organization of the Army Medical Department and its subdivision, the Hospital Department. Identification of Hospital Department surgical sets is discussed as well as the relationship of Army surgeons and contract doctors. The following are various spellings and print forms of the departments:
U.S.A. HOSPITAL DEPARTMENT , USA HOSPL. DEPT, U.S.A. MEDICAL DEPARTMENT, U.S.A. MED. DEPT
By Dr. Michael Echols
Last Updated: Wednesday, September 21, 2016
Some general information: Obviously there is great interest in American Civil War medical items. Interest is especially high in surgical sets which were actually "used" during the war in the field. Unfortunately, identification of these sets is difficult unless specifically marked with "U. S. A., Hosp. Dept." or "U.S.A. Hospl Dept." or "U.S.A. / Medical Department" for the United States Army, Hospital Department.
The exact history of how and when surgical instruments and sets were marked “U.S.A. Hosp Dept” is not known to this writer. But, the Hospital Department was created within the Army Medical Department and references to it's existence ranges from before the Mexican War in 1840's well into the 1870's as a generalization. Specifics are few.
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. Army Hospital Department Bottle Colors
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
Following the Federal defeat at Manassas and the grim realization the war may last years and not months, the Army Medical Department, under the auspices of the Quartermaster Department, (the agency responsible for procuring supplies) began purchasing standardized sets and instruments from contract suppliers such as Hernstein, Tiemann, Kolbe, and Gemrig.1
Civil War surgical sets with the Hospital Department marking were purchased by the Federal government for use by regular Army and U. S. volunteer surgeons in the Union military system. The State Militia Volunteers could have brought their own surgical sets, but those would not have been marked for the U.S.A. Hosp. Dept.
There are surgical sets used during the Mexican War, (see an example) prior to the Civil War, which were marked with U. S. Army Hospital Department, so that marking is not exclusive to the Civil War. There are also books and other surgical items marked for the Hospital Department after the War, so it was an on-going entity over a long period of time. However, it reached it's most active point during the Civil War.
The Union government, through Surgeon Richard S. Satterlee as Medical Purveyor of the United States Army, contracted with various makers in the Northeast like George Tiemann of New York and Dietrich W. Kolbe' or J. H. Gemrig of Philadelphia to make specific types of instruments and field surgical sets. These sets were actually used in the War by the Union's field troops and rear area hospitals. These same instrument makers supplied the pre- and post-war medical community in all areas of the continental U.S. Therefore, it becomes important to "date" a given set or document its ownership.1
There were a large number of doctors who served on both sides during the war and they had to have access to instruments of the profession. The Union's troops were supplied during the War by some of the best known instrument makers in the United States, while the Confederate supplies were often from smaller makers in the South, earlier existing sets, or were imports from France, England, and other European makers. Only the Federal provisioners during the War are marked as 'U.S.A., Hosp. Dept.' and are "official" government sets or individual items.
Go here for a much more detailed discussion of contract surgeons
The fact the Confederate's instruments were perhaps from European or Southern or Northern origin is not to say they were inferior by any means. The European makers were in business long before the American makers and in many cases of better quality. It's just that the Union's medical supplies were organized and ordered to specification. The Southern states were much more wealthy than the Northern states when the War began and money to purchase supplies was not the problem.
Proving an amputation or surgical kit was used in the Civil War is difficult at best. Unless the name "U.S.A. Hospital Department" or "U. S. Army Medical Department", or the documented variation appears on the item, you need extensive information and documents to attribute a given set to the Civil War. Antique dealers are fond of calling anything old "Civil War Antiques", but the fact is few are authentic. The name and address of the manufacturer, or an inscribed doctor's name, is a key to dating the item. Many sets are labeled with the makers name and the dates they were in business can provide information as to the period of use. At the bottom of this page is a list of Civil War instrument makers.
U. S. Army Hospital Department and Medical Department inscriptions
In general, due to the time frame of 1860-1865 when actual Civil War material would have been made, most of the hand instruments like the surgical knives will have non-metal handles. Non-metal means: rubber, ivory, ebonized wood, bone, horn, gutta percha, etc.. All-metal handles were not used until the 1870's, so any wood cased or leather pouched minor surgical set with all metal handled instruments will not be from the Civil War era. All too often an antique dealer will label a small leather cased set with all metal handles as being from the Civil War and that is just not the case.
Obviously, if a given instrument maker didn't exist prior to the Civil War or the address on the instrument case of the maker dates post Civil War, then the instruments could not have been a part of the Civil War. Also, if the doctor didn't graduate until after the War, then...well you get the idea.
It is known that contract doctors and perhaps Union and Confederate surgeon's used their own pre-existing surgical instruments during the war, but unless there is actual documentation from the time, that would be very difficult to prove. This is why there are instruments which date prior to 1860 which may or may not have been used in the War.
We can get some idea of the numbers of contract and 'regular' military doctors during the War and assume that many of contract doctors would have provided their own surgical sets. The following information is from: A History of the Army Medical Department: Civil War Medicine 1861-1865 by Mary C. Gilletty
"The quality of the Army's contract physicians was important, since during the course of the war more than 5,500 civilian doctors assisted the Medical Department. Many routinely staffed general hospitals while others provided help only in emergencies when it was necessary to locate more physicians quickly. In the last group were some of the nation's most prominent doctors. When a battle resulted in overwhelming numbers of casualties, those who flocked to the scene might include quacks, cultists, and practitioners of questionable ethics, men who were not under military discipline and who could, therefore, come and go as they liked, taking assignments that pleased them and rejecting all others. They often performed unnecessary operations or wrought havoc as they dug about for bullets. As a result of the problems experienced with doctors so casually assembled, the Medical Department decided to call only upon members of a reserve surgeons corps formed by the governors of various states. These gentlemen were paid the salary of contract surgeons and came in if called. They served under Medical Department orders and were required to remain at their assigned posts at least fifteen days, unless officially released sooner."
"The Medical Department had intended that its detailed and copious records concerning the Union's sick and wounded guarantee the emergence of something of value to medical science as well as to the Army from the most frightful conflict that the nation had ever faced. During the struggle and the months immediately following it, more than 12,000 medical officers- regulars, volunteers, and contract- examined over 250,000 wounds and treated more than 7 million cases of disease. In the course of their duties, more than 300 Army surgeons died from wounds, disease, or accidents.
Almost 6,000 regimental medical officers, whose qualifications were initially ascertained at the state level, also served at one time or another in the Union Army. An equivalent number of civilian doctors unwilling or unable to join the Army worked as contract surgeons, either for short periods when necessity dictated or in general hospitals in the cities where they lived."1
Civil War Surgery: The truth about what surgeons did and did not do during the War
How often amputation was performed can be determined from the following account by Gilletty:
"Although occasional reports of excessive enthusiasm for amputations did surface during the Civil War, this form of surgery was apparently often undertaken only after careful consideration of the alternatives. Excision was generally viewed as the least desirable choice, however, in cases where there was damage to the upper leg, and damage to a joint was often regarded as necessitating amputation. The records concerning the number of amputations performed are not complete, but the figure was at least 30,000. The most common amputation was that of the hand or fingers, while the highest fatality rate, of 83.3 percent, occurred after amputation at the hip joint. Surgeons discovered that amputation at the knee took a surprisingly high toll of 57.2 percent, and even amputation of the lower arm was followed by the deaths of 20.7 percent of those operated on. Considerable difference of opinion existed as to how the amputation was to be performed in any event, with many favoring a flap procedure that could be quickly done on the field and involved less danger from bleeding than the circular form of the operation. Some surgeons favored immediate operation, others a very brief wait until the first shock had worn off. The surgery itself was apparently a rapid procedure even though anesthesia was generally used. A hip amputation reportedly took two minutes, including the time needed to tie off the femoral artery."1
1. The Army Medical Department 1818-1865 by Mary C. Gillett, Center of Military History, Washington, D.C., 1987
Occasionally, personally owned surgical sets were engraved with the doctor's name on the top of the wood surgical instrument case and that would be especially helpful in tracking down the actual user and time frame. There are extensive documents on almost all the doctors who served in the War, so it is possible for an expert or historical researcher to determine authenticity should that be desirable. Before you pay extra for provenance, do the research. (Note: I personally try not to collect sets just for provenance. It's too dangerous to the pocket.)
After the War, many doctors moved out West and purchased surgical sets to take with them. Just because a given doctor served on either side during the War doesn't mean he used a given set in the War. The same goes for the later "Indian Wars" era. However, it may be a case of a given set was owned by a Civil War doctor, but the use of that set in the war will be questionable unless the set is marked as having been produced for the U. S. Army. Is this getting any clearer?
The point I'm trying to make is that authentic, documented Civil War sets are rare and the odds of one turning up at a weekend local auction are slim and none. Just because a set was made by one of the listed Civil War contract makers is no guarantee it was used in the Civil War.
If you are going to claim a set was used in the Civil War, you better have some extensive documentation and even if you have a marked set, you have to make dead sure the engraving is not faked. Fakes are being made because Civil War sets bring a premium. See the photos below.
The other problem with many of the "Civil War" sets is missing instruments and substitutions in the set. Often parts are missing from any set, but war-time issue is particularly subject to loss. Fortunately or unfortunately, depending on your perspective, the instruments were more standardized for the contracted sets and the odds of finding a replacement part is better than for finding one for an individually handcrafted set. As is the case with most velvet lined wood cased surgical sets, the wood cases were made specifically for a given instrument and the fit of the given instrument to the case is generally perfect. If someone tries to substitute an instrument, then it is usually obvious or not consistent with the time-frame of the set.
It is especially important that historically significant sets attributed to a given owner, with provenance, should not have any part of the set replaced or substituted. If a set is attributed to a documented doctor, then nothing in that set should be replaced.
The Civil War manufactures, in many cases, were contracted by the Union government to supply the Army with specified surgical sets and may or may not be marked "U.S.A. Hospl Dept." or "USA Hospital Department". For example, in a war specified set one would expect a "bullet" extractor would be a part of that specification and would be found in the set. On the other hand, not many general amputation sets have a bullet extractor. By deduction, if you find an amputation set with a bullet extractor of a certain type, you may expect it was used during a time when bullets were flying, but that doesn't mean it was used in the Civil War. (Do you get the drift?)
The Civil War Army contract sets are very utilitarian and usually not the fancy ivory handled sets or presentation sets sold to "famous" doctors in a professionally competitive place like New York. The list of makers listed below are not the only providers, but some of the more notable. Some of these manufacturers existed prior to and after the War. The trick is to figure out which ones were suppliers to both sides during the War.
The wood cases for real" Civil War" commercially made sets will be in military type wood boxes with cast brass corners. The wood boxes usually, have double lateral sliding locks on the front of the case, not central keyed locks. Central keyed locked sets are generally civilian issue. (Finding the 'key' during a battlefield experience would have presented some difficulty.) Some military sets with a single sliding lock or with both a sliding and keyed lock have surfaced.
The military sets generally have a brass cartouche on the top of the box which will be inscribed with the United States Army Hospital or Medical Department insignia of some sort. Some of the instruments will also be marked with the insignia of the Department. The military sets are in general similar in lay-out of the instruments and all will have a velvet type of lining. The urethral instruments will be the longer type for use on males.
One point of confusion about military sets is the marking on the top of the sets. It can be "USA Medical Department" or "USA Hosp. Dept." To the best of my knowledge, the sets marked "Medical Department" can be pre- or post- Civil War as they were made for and owned by the military. The original Medical Department existed after the Revolutionary War until well after the Civil War. They owned surgical sets which were in existence before and after the Civil War.
Those sets made during the Civil War and marked " U.S.A. Hosp. Dept." are strictly Civil War issue by and for the Union Army.
It is not uncommon for Civil War medical items to be found in a general Civil War collection. Therefore, those collectors may be major preservers of "real" sets. Since there are far more general Civil War collections, the likelihood of a large number of medical sets being in those collections is important. To date, the only public catalog of American surgical sets has been accumulated by Dr. Edmonson and presented in his book on American Surgical Instruments. This is an area where the Civil War collectors could help with the knowledge base by contributing detailed photos of their sets for publication of these important artifacts. I am currently making plans to collect this data for general use via this site. Anyone wishing to contribute photos may contact me via this site.
Buying an 'authentic' Civil War item at auction is a study in foolishness. You better know a lot to do it and get a guarantee with written return privileges from the seller or auctioneer.
A word of warning: there are reproduction amputation kits out there. Some of the best were made by E.G. Archer & Son, Surgical Instrument Co., Knoxville, Tenn. These are fine for "Civil War reenactors", but not for collectors.
As previously mentioned, all too often, antique dealers will attribute a medical item as being "Civil War" . This is very difficult to ascertain without extensive documentation. The fact that an item existed at the time of the Civil War is not necessarily reason to say it was used in the Civil War. Remember, many of the manufacturers existed prior to and after the war. Often the address of manufacture printed on an item will tell you the date range during which that item was made. Name and address changes are a way to narrow the time and usage of a given instrument or case. This is where Edmonson's American Surgical Instruments book is so helpful as it painstakingly charts the addresses and dates of all American manufacturers of the time.
A few statistics from Edmonson's book...to give you an idea of the number of sets ordered for the war by the United States Army and to help figure the odds of one showing up now as well as rarity:
4,900 amputating and general operating cases
1,150 trephining, exsecting, post mortem, and personal instruments
12,700 minor surgery and pocket cases
Additional information about the Union medical staff organization and materia chircugica
Listed are some (not all) of the known Civil War instrument makers as reported by James M. Edmonson, Ph.D., in his book: American Surgical Instruments, a directory of makers to 1900. See the books and references page for the publisher of this essential book.
Known U. S. Army contract makers of Civil War instruments and kits
Ferdinand G. Otto
Jacob H. Gemrig
Horatio G. Kern
Snowden & Bro.
Dietrich W. Kolbe
Louis V. Helmold
Frederick c. Leypoldt
Jacob J. Teufel
Codman and Shurtleff
William Z. Rees
Wade & Ford
Max Wocher (not & Son)
Civil War related Hospital Department books currently in this collection
Contact Dr. Arbittier or Dr. Echols
Last update: Monday, December 12, 2016