Hello H-CivWar Readers:
Today we continue our conversation with Guy R. Hasegawa about his new book Matchless Organization: The Confederate Army Medical Department, published by Southern Illinois University Press in June 2021.
Your recounting of the examination to be an army surgeon was quite intriguing but it also seemed with the different structure and organizations of hospital levels, that the Confederate Medical Department ran into barriers just like the government, with army commanders wanting control over hospitals in the rear and the like. Was there any model that Moore could use to organize the medical efforts?
GRH: Here we face the problem of not knowing what Moore was thinking. He did, of course, have the model of the U.S. Army as he knew it before resigning. However, the situations that he encountered earlier in his career—in the Mexican War and on the frontier, for example—probably did not much resemble those he faced during the Civil War. He was aware of some aspects of European military medicine and certainly had a notion of how his Northern counterparts were handling their medical situation. Moore’s establishment of medical laboratories, for example, was probably influenced by his knowledge of the U.S. Army labs, which arose during the Civil War, and the U.S. Navy lab, which predated the war.
I suspect that the nature of the war, and the fact that things were always changing, would have made it hard to apply a model and then stick with it. The scope of the war forced tremendous growth in the number of medical officers and the capacity of general hospitals. At the same time, conditions worsened. The ability to import drugs and other medical goods diminished as the blockade tightened. Battles and Union advances into the South increased the number of casualties, diverted personnel into combat units from medically necessary positions, interfered with rail transportation, and forced medical facilities to move or close. Moore would have needed a pretty flexible model to accommodate all of that.
Furthermore, Moore did not have an entirely free hand in running his department. Some changes needed approval by the Confederate Congress, the president, or the secretary of war. As you mention, military commanders wanted to control general hospitals. General R. E. Lee wanted various hospitals closed so that the detailed soldiers working in them could be returned to the lines. Governors and congressmen wanted hospitals set aside exclusively for their states’ troops. How to handle such demands was usually not up to Moore. He had to deal with Congressional actions and with political decisions, made by his superiors, that affected the operation of his department.
To the extent that models existed and were applied, part of Moore’s administrative ability may have been that he recognized when he had to abandon them and improvise.
As somebody who studies the foreign elements in the war, I was intrigued by how much European military inspiration existed in the medical planning, such as the French ambulance-did they consider things like the Crimean War?
GRH: The French “flying ambulance,” which arose during the Napoleonic era, was indeed the inspiration for the medical evacuation system adopted by the Union Army. It was also the basis, as acknowledged by Surgeon General Moore, of his own grand scheme for battlefield care and the moving of wounded soldiers. Unfortunately, Moore lacked sufficient numbers of medical officers and ambulance wagons to make his plan work, so he had to settle for much less.
To American military surgeons, the Crimean War illustrated how not to run a medical system. Factors such as poor management and dismal sanitation resulted in frightful mortality rates. The war did inspire research into optimal hospital design, most notably by Florence Nightingale, whose advocacy of the pavilion design influenced the Union and Confederate decisions to adopt that type of construction and enforce rules for proper hygiene. Morbidity and mortality statistics from the Crimean War were used as benchmarks against which American Civil War medical treatment could be compared.
It was common for Union and Confederate surgeons to consider the experience of their overseas brethren. A textbook about surgery in the Crimean War was abridged and published in the South to assist new medical officers unfamiliar with military surgery. The same motive drove Confederate surgeon J. J. Chisolm to publish three editions of A Manual of Military Surgery during the war. That text contained information from German, French, and English works. The Confederate States Medical and Surgical Journal, published in 1864 and 1865 with the approval of Surgeon General Moore, contained numerous reprints of articles from European medical journals.
I’m not sure whether the Crimean War provided any positive models for Moore’s department to emulate. It and other overseas conflicts, though, did provide Confederate surgeons with information that might help them treat patients.
Something else you mention here is the impact of the blockade, how capable was the Confederacy to provide for its medical needs? What items were essential and in short supply?
GRH: The Confederate Army struggled to obtain adequate medical supplies, and evidence for this is apparent in the means employed to mitigate the problem. Those means included seizing goods from druggists, establishing labs to produce medicines, and trading with the enemy. Exactly how successful such actions were is hard to determine, but there were complaints from surgeons about the amounts and quality of goods they received.
In light of today’s medical knowledge, it’s easy to say that patients would have been better off without many of the medicines that the Medical Department tried to obtain. Some items, though, were truly essential and often hard to get. At the top of the list was quinine, which was effective in treating and preventing malaria, a disease that substantially compromised the army’s fighting strength. Adding to quinine’s scarcity and price was the fact that it was needed in both military and civilian practice. Quinine was produced in Europe and in the North from the bark of South American cinchona trees. Although bark imported through the blockade was cheaper than quinine, the South did not have the ability to convert it to quinine and vainly sought an effective substitute made from native plants. Chloroform and ether were widely used as anesthetics for major surgery or other painful procedures. Both were manufactured, at considerable effort, in Confederate Army labs. Opium and morphine were effective in treating pain, cough, and diarrhea. Although opium ordinarily came from Asia, an unknown amount and quality of opium was derived from poppies cultivated in the South.
I’ll mention a couple of drug categories that were mainstays of therapy but would be considered therapeutically useless or excessively dangerous today. The first was drinkable alcohol—the preferred medicinal form was usually brandy—which was widely used as a stimulant and in combination with chloroform or ether for general anesthesia. The army contracted with distillers and established a number of its own distilleries to make whiskey, which I suppose was the most easily produced alcoholic beverage of sufficient potency. The effort was hampered by state governors who thought that grain should instead be used to feed soldiers and citizens. The second was mercury-containing medicines. We think of these drugs as being used to treat venereal diseases, which was the case, but they were probably more frequently prescribed, among their many uses, as laxatives. Physicians put great value in cleansing the bowels to free the body of toxins. Thus, mercury compounds were frequently given to patients with diarrhea or dysentery to first flush harmful substances from the system. Probably the most common mercury formulation was “blue mass” or “blue pills,” which numbered among the medicines made in Confederate labs.
Among the nondrug items in short supply were ambulance wagons and surgical instruments. Wagons were probably not imported in great numbers, if at all, and the South did not have enough local manufactories turning out such vehicles. The best surgical instruments were made in Europe or in the North. Many Confederate surgeons had recently been in civilian practice and might not own instruments for major operations such as amputation. Those who did have such instruments might not risk their being lost or damaged, so they left them at home and depended on the government to issue them a set. Some Southern craftsmen started making instruments, but the only assessment I’ve seen is that they were of poor quality.
The previous question sort of leads to my next question about PoW camps and medical care. I resided in close proximity to the Andersonville prison site and I remember that the staff there was reluctant to blame shortage for the death and suffering. You do not agree with that assessment.
GRH: Well, I don’t know exactly what the staff said or meant, so I hope my response answers the question.
The death and suffering at Andersonville and other POW camps occurred because Confederate officials gave low priority to the treatment of POWs. The camps were overcrowded and often provided inadequate shelter. The prisoners did not receive enough food, and what they did get did not constitute a balanced diet. Sanitation of the camps was poor or nonexistent, and drinking water was often contaminated.
I’ve seen arguments that sufficient rations were available in the South and that a caring and efficient Subsistence Department could have fed POWs and Confederate soldiers at the same time. Having more food, in the form of typical rations (hardtack and salt pork), would have helped the POWs, but it would not have prevented scurvy, which was a huge problem. Soldiers could forage and supplement their rations with fruits and vegetables, but getting enough vitamin C was more difficult for POWs. Despite the possible availability of rations, it is generally acknowledged that food shortages existed in the South. It seems reasonable to suppose that an ample supply of food would have made the ineptitude of the Subsistence Department less consequential.
The shortage of medicines affected POW camps, but I don’t think having an adequate supply would have made much difference. The medical purveyor did send small amounts of orange juice to Andersonville, but it was not enough to prevent scurvy in the general prison population. Quinine would have been desirable, but malaria was not a big problem at Andersonville. Diarrhea and dysentery, which were huge killers, were infectious and caused or worsened by awful sanitation, poor food, and filthy water. Those diseases would not have been cured by any available drugs, since antimicrobials had not yet appeared on the scene. Opiates might have lessened diarrhea temporarily, but continued exposure to pathogens would have made the relief only temporary. Malnutrition made it difficult for any prisoner to recover from illness.
I suppose that your question relates to the difference between true difficulty in providing for POWs—because of real shortages of food and other articles—and actions or decisions (or lack thereof) that contributed to the suffering. I think the former could contribute to the latter. The general food shortage, for instance, probably engendered the sentiment that Confederate soldiers and citizens should be fed before POWs were. Inefficiencies in distributing supplies were more likely to cause harm if those goods were scarce rather than abundant. There were other factors in play on the part of Confederate leaders and prison officials—such as ignorance, incompetence, callousness, and the inability to sustain a robust prisoner-exchange system—that seem less connected to shortages. I think that shortages contributed to but were not the only reason for the horrid conditions in POW camps.
Drawing to the close, I wondered if you could give us a small glimpse at Richmond’s medical/hospital scene, such as the military hospitals run by the government and state governments.
GRH: The total number of army hospitals in Richmond was in the dozens, although not all existed at the same time. In the early war, most hospitals were established in preexisting structures, such as warehouses and public buildings, and even in private residences. Many were operated or supported by states or charitable organizations. Later in the war, smaller hospitals were closed, and most patients were cared for in large, newly built, pavilion-style hospitals controlled by the Medical Department. In mid-1864, the capacity of Richmond hospitals was close to 11,000 patients.
The War Department, including the Surgeon General’s Office, was housed in a building near the Virginia State Capitol. Nearby were the Richmond medical purveying depot and offices of the local medical director, medical inspector, and medical examining board.
Also nearby was the Medical College of Virginia (MCV), one of the few medical schools that stayed open during the war and educated prospective army and navy surgeons. MCV had a hospital that cared for soldiers and hosted meetings of the Association of Army and Navy Surgeons, an organization dedicated to sharing knowledge among medical officers.
The Navy Department, including its medical bureau, occupied the same building as the War Department and was fairly close to the Richmond Naval Hospital.
I think it’s safe to characterize Richmond as the center of Confederate military medicine.
To close, I like to ask if you have any plans for your next book? I know this is your third book on Civil War Medicine, you think there is more to be said for you?
GRH: I have two book projects relating to Civil War medicine that are on hold. I can’t finish researching the first while various manuscript collections remain inaccessible because of the pandemic. The second might be covering too small a niche in the already specialized field of Civil War medicine, so I need to devise a way to make it appealing to a large enough audience and thus attractive to a publisher. Things are too much in the air for both projects, so it’s probably best that I don’t say any more about their exact topics.
Thanks, Niels, for the chance to discuss Matchless Organization! I hope that our conversation encourages readers to take a look at the book and learn more about a most interesting subject.
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