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