Regular Army Medical Department

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.

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.

Surgeon-General (Brigadier General - after April 19, 1862, as per General Order No. 48)

Assistant Surgeon-General (Colonel)

Medical Inspector-General (Colonel)

Medical Inspector (Lieutenant Colonel)

Surgeon (Major)

Those medical officers holding the posts as Medical Directors of Armies, Corps and Divisions. Also, Brigade Surgeons as well as U.S. Regular, U.S. Volunteer and State Regimental Surgeons

Assistant Surgeon (Captain)

Assistant Surgeon (1st Lieutenant)

Hospital Stewards and Orderlies (male nurses)

The hospital steward is a non-commissioned officer, he ranks with Ordnance Sergeants, and next above the first sergeant of a company. He is therefore entitled by his rank to obedience from all enlisted men who may be in the hospital, whether patients, ward-masters, nurses, or employees, who must cheerfully and promptly comply with all his reasonable and lawful commands.

Hospital stewards may be appointed from the enlisted men of the army, or may be specially enlisted. The appointment is, in every case, made by the Secretary of War. Non-commissioned officers or soldiers may be appointed hospital stewards, on the recommendation of the senior medical officer of the hospital, post, or command. This recommendation must be endorsed by the company commander, and the commanding officer of the post or detachment, and forwarded by the latter to the Adjutant-General of the army.

"As the object of these more permanent appointments is to procure the services of a more competent body of hospital stewards, no soldier, nor citizen, must henceforth be recommended for appointment, who is not known to be temperate, honest, and in every way reliable, as well as sufficiently intelligent, and skilled in pharmacy, for the proper discharge of the responsible duties likely to be devolved upon him."

- Hospital stewards may also be enlisted, as such, from civil life. Applications, in the hand writing of the candidate, should be addressed to the Surgeon-General, accompanied by testimonials as to character and competency. The enlistment is for the term of three years.

The candidate for enlistment or appointment as hospital steward should be not less than eighteen nor more than thirty-five years of age. He must be able-bodied and free from disease. Previous to his enlistment he is inspected by a medical officer, in the same manner as any other recruit, and will be rejected if found laboring under any disease or disability which would reject a recruit. He should be of honest and upright character, of temperate habits, and good general intelligence. He must have a competent knowledge of the English language, and be able to write legibly and spell correctly. This point must be satisfactorily ascertained before he can be enlisted, as without this qualification it will be impossible for him to keep the books and records, or to attend to the general business of the hospital. In addition, he must have sufficient practical knowledge of pharmacy to enable him to take exclusive charge of the dispensary, must be practically acquainted with such points of minor surgery as the application of bandages and dressings, the extraction of teeth, and the application of cups and leeches, and must have such knowledge of cooking as will enable him to superintend efficiently this important branch of hospital service.

He should be industrious, temperate, patient, and good-tempered, and actuated by an honor able desire to minister to the extent. of his ability to the necessities and comforts of the sick and wounded soldiers who are placed under his charge.

There were a number of "other" members that made up the staff within the medical corps. Some of these would be: Nurses (male and female), Orderlies, Cooks, etc. Nurses and Orderlies were usually Privates, or low ranking NCO's, from the Regiment, assigned to the medical department.

Hospital Steward