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
