Confederate Medical Department

       The organization of the Confederate Medical Department was identical with that of the United States army at the breaking out of hostilities, and the army regulations under which rank and discipline were maintained were those of the United States, the only copies which came under the writer's observation being those printed prior to the war. The medical staff of the armies of the Confederacy embraced only three grades of rank, viz.: one surgeon-general with rank, emoluments, and allowances of a brigadier-general of cavalry; about one thousand surgeons with rank, allowances, and emoluments of a major of cavalry; and about two thousand assistant surgeons, with the rank of a captain of cavalry; among the latter, or possibly in addition thereto, were a number of contract surgeons or acting assistant surgeons, with the pay of a second lieutenant of infantry, who were temporarily employed; nearly all of these, however, at some period subsequent to their employment as contract surgeons were examined by an army board of medical examiners and were commissioned as surgeons or assistant surgeons, or dropped from the army rolls.
       The following statement is quoted from an address by S. P. Moore, M.D., surgeon-general of the Confederate States army, delivered at Richmond, Virginia, October- 19, 1875:

" Congressional Legislation.-To make the corps still more effective, to hold out rewards to distinguished medical officers, to offer incentives (if needed) to faithful and efficient performance of duties, and to confer additional and commensurate authority on those in most important positions, a bill was prepared creating the offices of two assistant surgeon-generals, one to exercise authority west of the Mississippi, the other to be on duty in the surgeon-general's office; medical directors, medical inspectors, medical purveyors, all with rank of colonel. This bill passed both Houses of Congress (they appearing willing always to aid the department in its effort toward a more perfect organization), but was vetoed by the President. It seemed useless to make further efforts in this direction."

       To each regiment of infantry or cavalry was assigned a surgeon and an assistant surgeon; to a battalion of either, and sometimes to a company of artillery, an assistant surgeon. Whenever regiments and battalions were combined into brigades, the surgeon whose commission bore the oldest date became the senior surgeon of brigade, and although a member of the staff of the brigade commander, was not relieved of his regimental duties; sometimes, however, he was allowed an additional assistant surgeon, who was carried as a supernumerary on the brigade roster. To the senior surgeon of brigade, the regimental and battalion medical officers made their daily morning, weekly, monthly, and quarterly reports, and reports of killed and wounded after engagements, which by him were consolidated and forwarded to the chief surgeon of the division to which the brigade was attached; regiments and brigades acting in an independent capacity forwarded their reports to the medical director of the army or department, or to the surgeon general direct. Requisitions for regimental and battalion medical, surgical, and hospital supplies, as well as applications for furlough or leave of absence, discharge, resignation, or assignment to post duty, on account of disability, were first approved by the regimental or battalion medical officer, after giving his reasons for approval and the nature of the disability in the latter instances, and forwarded by him to the senior surgeon of brigade, and by him to the chief surgeon of division and the other ranking officers in the corps and army for their approval. Independent commands reported to the medical director of the department or army, or the surgeon-general direct. Medical purveyors nearest to the army, as promptly as possible, forwarded all needed medical, surgical and hospital supplies, on approved requisitions.
       Assignments to the position of chief surgeon of division were sometimes made in accordance with seniority of rank of the senior surgeons of brigades, in other instances on application of the general commanding the division. His duties, in addition to approving reports coining from the senior surgeons of brigades, were to advise with the division commander in all matters pertaining to the medical care and hygiene of his command, and to have personal care of the attaches of the division staff and headquarters, and to advise and consult with his medical subordinates.
       To each corps was assigned a medical director, a commissioned surgeon, his permanent assignment being made on personal application of the lieutenant-general commanding the corps; temporarily and when emergency demanded, his duties, which were similar to those of the chief surgeon of division as pertaining to the corps, devolved upon the chief surgeon of division whose commission bore priority of date; he, in turn, being succeeded by the ranking senior surgeon of brigade.
       A medical director was assigned to the staff of each general commanding a department, or an army in a department, his selection usually being in deference to the general on whose staff he served and to whom was submitted for approval all reports and papers, from the various army corps, independent divisions, brigades, or smaller detachments. He also bad charge of the staff and attaches of the department or army headquarters.
       The non-commissioned medical staff consisted of a hospital steward for each regiment or battalion, with the rank and emoluments of an orderly sergeant, his selection as a rule being made by the ranking medical officer of the command, usually a graduate or undergraduate in medicine, or one having had previous experience in handling drugs; and his duties were to have charge of the medical, surgical, and hospital supplies under direction of the regimental or battalion medical officer, caring for and dispensing the same, seeing that the directions of his superior as to diet and medicines were carried out, or reporting their neglect or failure. The regimental band constituted the infirmary detail to aid in caring for the sick in camp and to carry the wounded from the field of battle, and when so occupied were under the surgeon or assistant surgeon. When necessary, additional detail was made from the enlisted men to serve temporarily or permanently on the infirmary corps. In some instances, an enlisted man was detailed as hospital clerk, and with the hospital steward was required to be present at sick-call each morning; these soldiers, with the infirmary detail, were relieved from all other regimental duty, such as guard duty and police detail.
       The duties of the assistant surgeon were to assist or relieve the surgeon in caring for the sick and wounded in camp or on the march. On the field of battle he was expected to be close up in the immediate rear of the center of his regiment, accompanied by the infirmary detail, and to give primary attention, first aid to the wounded-this consisting in temporary control of hemorrhage by ligature, tourniquet, or bandage and compress, adjusting and temporarily fixing fractured limbs, administering water, anodynes, or stimulants, if needed, and seeing that the wounded were promptly carried to the field-hospital in the rear by the infirmary detail or ambulance.
       The duties of the surgeons, in addition to caring for the sick in camp and on the march, were to establish a field-hospital, as soon as they could learn that the command to which they were attached was going under fire, at some convenient and, if possible, sheltered spot behind a bill or in a ravine, about one-half to one mile in rear of the line of battle, which was done under direction of a brigade or division surgeon. Here the combined medical staff of a brigade or division aided one another in the performance of such operations as were deemed necessary, as the wounded were brought from the front by the infirmary detail on stretchers or in the ambulance. Amputations, resections of bone, ligatures of arteries, removals of foreign bodies, adjusting and permanently fixing fractures, and all minor and major operations and dressings were made when deemed best for the comfort and welfare of the wounded men. As soon as possible after the permanent dressings were made at the field-hospital, and even in some instances while the troops were still engaged, the wounded were carried to the railroad and transported to the more permanent hospitals in the villages, towns, and cities, some miles distant.
       The uniform worn by the medical corps was similar to that of the rank and file with only a slight difference. While the cloth and cut were the same, the facings of the coat collar and cuffs and the stripe down the sides of the trousers were black, while those of the infantry were light blue, the artillery, scarlet, and cavalry, buff; on the front of the cap or hat were the letters " M. S." embroidered in gold, embraced in two olive branches. On the coat sleeve of the assistant surgeon were two rows of gold braid, with three gold bars on the ends of the coat collar extending back about one and a half inches; while the surgeon had three rows of braid on the coat sleeves, and a single star on each side of the coat collar about an inch and a half from the end. The chevrons on the coat sleeves and the stripe down the trousers of the hospital steward were similar to those worn by an orderly or first sergeant, but were black in color.
       The statement is sometimes made that many Confederate surgeons were inefficient, and in support of this contention a statement attributed to President Davis, in Surgeon Craven's "Prison Life of Jefferson Davis " is produced, in which he is reported to have said in conversation with the author, that " they had been obliged to accept as surgeons in the Southern army many lads who had only half finished their education in Northern colleges."
       This statement would seem to indicate a scarcity of capable medical men who were willing to serve as such in the Confederate army, while the facts are that many of the infantry and cavalry battalions and regiments, as well as artillery companies, in addition to their usual complement of medical officers, bore on their rolls, either in field and staff, the commissioned officers of the line, or even in rank and file, capable and eminently well qualified medical men, many of whom were subsequently transferred to the medical corps. The reports from Northern prisons where line officers or enlisted men often assisted the Federal surgeons in the care of the sick, confirm this statement.
       It can be said, in all sincerity and confidence in the statement, that the students of the South who graduated from Northern and Southern medical colleges prior to the war between the States, were superior in scholastic attainments and mental qualifications to those of subsequent years. Not only is this the personal observation of the writer, but corroborative thereof are the following quotations from an address by Samuel H. Stout, M.D., late medical director of hospitals of the Department and Army of Tennessee.
       "When I attended lectures in Philadelphia more than half a century ago, the number of students in the two schools there (the University, and the Jefferson) was a little more than one thousand, more than half of whom were from the Southern States. Of these latter, a majority were bachelors of arts, or had received a classical education. The Southern States in the slaveholding sections were, therefore, prior to the war well supplied with educated and chivalrously honorable surgeons and physicians. Such were the men who served at the bedside and in responsible positions in the medical corps of the armies and navy of the Confederacy."
       Finally, Samuel P. Moore, M.D., in an address delivered at Richmond, Virginia, October 19, 1865, published in the city papers of the following day, said, "The Confederate medical officers were inferior to none in any army"; and in another paragraph: "Although there were many capital medical men in the medical corps, yet, from the easy manner by which commissions were obtained for medical officers appointed to regiments, many were supposed not to be properly qualified. It was therefore deemed advisable to establish army medical boards for the examination of medical officers already in service, as well as applicants for commission into the medical corps. These boards were to hold plain, practical examinations. The result was highly satisfactory."
       In Tennessee, more than one instance can be mentioned where a good and well-qualified practitioner, on application to Governor Harris for a position in the medical corps, was by him urgently and earnestly advised and entreated to remain at home, as be would be needed there, because, as quite a number of his colleagues were to be found in the rank and file of the assembling soldiery, in addition to a full complement in the medical corps, the old men, the women and children, and the slaves at home must be cared for as well as the "boys" in the army. This measure prevailed in other States, and in only a few instances of rare emergency, that could not by any means have been avoided, and then only for a brief period, was there any dearth or scarcity of medical officers in the Confederate army, in the field or hospital.
       Some States began organizing their troops before affiliating with the Confederacy, as in Tennessee. The medical officers received their commissions from the secretary of state, after examinations, both oral and written, by an army medical examining board appointed by the governor of the State. The medical examining board at Nashville was headed by Dr. Paul F. Eve, a teacher of surgery of wide experience, and a surgeon of both national and international reputation. His colleagues were Dr. Joseph Newman, who bad served with the Tennessee troops in the war with Mexico, and enjoyed the confidence and esteem of a large clientele in Nashville during the intervening years, and Dr. J. D. Winston, also one of the leading practitioners of the capital city of the State. Boards of like character were serving the western division of the State at Memphis, and at Knoxville, in the eastern. When the State troops, then organized, were transferred to the Confederate States, they were recommissioned by the Secretary of War of the Confederacy, on recommendation of the surgeon-general, after examination and approval by the army medical examining boards of the Confederate army. As other troops were subsequently organized, they were supplied with medical officers who. had passed a satisfactory examination before a Confederate army medical examining board and commissioned in like manner; the same measure was followed in the hospital service.
       The examinations before State and Confederate army boards were thorough, complete, and eminently practical. Each applicant was required in a given number of hours to fill out the answers to a number of written questions, under supervision of the secretary of the board; and this being done, he was invited into an adjoining room and submitted to an oral examination to the satisfaction of the assembled board. The Confederate board of examiners serving with the Department and Army of Tennessee, as I remember, consisted of Dr. D. W. Yandell, of Louisville; Dr. J. F. Heustis, of Mobile, and Dr. Stanford E. Chaille, of New Orleans, all being well-known teachers of medicine and surgery in their respective States, and at that time, or subsequently, of national reputation. Other medical examining boards were of like character.
       The late Doctor Chaille, the dean of the medical department of Tulane University, in a private letter, speaks of the work of the examining boards appointed in 1862 to report on the competency of the medical staff. The Confederate soldiers were almost exclusively volunteers who had elected their medical as well as other officers. Doctor Chaille reported that his board caused the dismissal of a number of the surgeons and assistant surgeons, sometimes incurring the hostility of the officers and men in consequence, " because of the gross incompetence of laymen then as well as now to judge of the incompetence of medical men." He goes on to say that the incompetent were " exceptions to the superior merit of the vast majority of the members of the Confederate medical staff." This statement goes far to explain any apparent contradictions in the testimony regarding the competence of Confederate surgeons, and must be generally accepted.
Source: "The Photographic History of the Civil War" Volume IV, article by Deering J. Roberts, M.D., Surgeon, Confederate States Army

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