I had the fortune to spend some time (over the past couple of years, actually) with the new book by Guy Hasegawa, Matchless Organization: The Confederate Army Medical Department. Guy’s book is the latest in the Engaging the Civil War Series, published by Southern Illinois University Press in partnership with ECW.
Guy was kind enough to spend some time talking with me about the book.
Let me start with the title, because it invites some interesting consideration because a superlative like “matchless organization” doesn’t usually come to mind when one thinks of the Confederate government. What made the medical service such a stand-out?
I would credit the Medical Department’s chief, Surgeon General Samuel Preston Moore. His long experience in the U.S. Army gave him a solid background, so he sensed what needed to be done and took the necessary actions. He seemed to be a master of multitasking. He often faced obstacles or changing conditions and demonstrated a willingness to improvise. He was flexible enough to alter his views when presented with new information. Almost all of his medical officers had recently been civilians who were unaccustomed to being commanded and didn’t appreciate the rationale for army procedures. Moore nevertheless seemed to keep them in line, which helped maintain the department’s efficiency. I suspect that the surgeons chosen by Moore to assist in the Surgeon General’s Office were a tremendous help.
As in many other areas, the Confederacy had to build its medical department from scratch. That essentially gave the Federal army a head start when it came to medical services. How much of a difference did that make?
The Confederate Medical Department did not have to reinvent the wheel, because it modeled itself after its Union counterpart and started with a nucleus of former U.S. Army surgeons. The U.S. Army had only about 130 medical officers at the outset of the war, with a couple dozen resigning and becoming Confederate surgeons. Since both sides ended up with thousands of medical officers, neither had a huge advantage in the percentage with military experience. The U.S. Army was quite small and had not been engaged in a large conflict in the years leading up to the Civil War, so it and the Confederate Army were both unprepared, in organization and manpower, for the scope of what was to come. One could, in fact, argue that the Confederate Medical Department had one big advantage early in the war. Its very competent Surgeon General Moore was put in charge in late July 1861, whereas the also competent William Hammond did not become surgeon general of the U.S. Army until April 1862. Hammond’s wartime predecessors were not particularly effective. The medical response to the First Battle of Manassas was poor on both sides, so if the North had a medical edge, it wasn’t particularly apparent at the time.
I think that the Confederate Medical Department was hindered no so much because it got a late start but because the South itself was in a tough spot in terms of human and material resources. The South also had to deal with an inefficient rail system, inflation, the fact that most of the war was fought in its territory, and other factors familiar to readers.
How would you characterize the arrival of Samuel Preston Moore to the post of surgeon general?
Moore had two predecessors in the Surgeon General’s Office. Both had recently resigned from the U.S. Army. There’s not much known about the performance of the first, David Camden DeLeon, who was the most senior surgeon (in terms of U.S. service) available when he became the Confederate acting surgeon general in early May 1861. DeLeon was relieved and reassigned in mid-July, most likely to make room for Moore, who had outranked DeLeon in the U.S. Army and had recently agreed to serve the Confederacy. Moore took office in late July. During the short interval between the administrations of DeLeon and Moore, the position of acting or temporary surgeon general was filled by Surgeon Charles H. Smith.
There’s not enough information available to judge DeLeon, so comparing him with Moore is unfair. Smith simply occupied the space until Moore arrived. It’s impossible to say whether Moore was the best possible officer for the spot, but the postwar consensus by former medical officers was that the Confederacy was fortunate to have him. I agree with that assessment.
Luck, in fact, may have played a role in Moore’s appointment. He was originally invited to become a Confederate surgeon—whether the position of surgeon general was offered is unknown—in March 1861. Moore declined and opted for life as a civilian physician in Arkansas. Something changed his mind, but we’ll probably never know what. Also, a Confederate statute allowed officers formerly in the U.S. Army to maintain their seniority if they received a Confederate appointment by mid-September 1861. If Moore had become available after that, he might not have been appointed surgeon general.
You devote considerable space in the book to talk about efforts to improve and institutionalize standards of professionalism. We might take something like that for granted today, but why was that such an important initiative at the time?
The short answer is that it saved lives, but let me expand on that.
At the time of the Civil War, there was essentially no regulation of the practice of medicine in the United States. As a result, one could legally diagnose and treat patients without graduating from a medical school or passing a board exam. Medical schools were not subject to accreditation and tended to admit and graduate anyone able to pay the required fees. Thus, not only was there a tremendous range in skill and experience among people who called themselves physicians, there was also no minimum standard that all practitioners had to meet.
The U.S. military had a long tradition of administering a rigorous exam to men who applied to become medical officers. That made sense, because there was an obvious benefit in maintaining health in the ranks, and there was no desire to pay medical officers during prolonged careers if they couldn’t help achieve that goal.
In the early war, many regimental surgeons were appointed by their governor or elected by men in the ranks. They became Confederate surgeons when their state units were absorbed into Confederate service but did so without having passed an exam. Even the competent ones typically knew nothing about military medicine. Illness broke out in camps, and the medical response during early battles was disorganized. Some of the blame was rightly placed on the incompetence of surgeons.
Surgeon General Moore recognized the need to weed out poor surgeons and was supported by the president and secretary of war, so medical boards were established to examine all applicants and all surgeons who had not been in the U.S. Army.
Moore also stressed to new surgeons the importance of complying with standards of military medicine, such as maintaining sanitary conditions in camp and submitting detailed records. Those behaviors were necessary for the army’s health and for efficient operation of the department. Thus, the application of standards applied to both medical knowledge and procedure.
Prison hospitals seemed to be a special case, posing specific, unique challenges with a lot of dynamics at work. What forces came into play that interfered with the Medical Department’s ability to do better work in those instances?
I think the problem boiled down to the Medical Department’s inability to properly care for prisoners who were in awful condition because of malnutrition, exposure, unsanitary living conditions, and a lack of good drinking water.
A medical officer could help minimize illness by encouraging his military commander to enforce sanitary standards and by making efforts to ensure that men were getting enough nutritious food and clean water. Confederate leadership, however, kept sending POWs to already overcrowded camps without making provisions to supply adequate shelter and nutrition. Even if a camp commander agreed with his surgeon’s recommendations for making improvements, the resources were not forthcoming from the Quartermaster and Subsistence Departments. The medical result was that the POWs suffered from severe malnutrition and scurvy. Filthy living conditions and contaminated water caused debilitating diarrhea and dysentery. Minor injuries, such as scratches and insect bites, could develop into serious infections because starvation and scurvy interfered with the body’s ability to fight microbes and heal.
Although the camps had shortages of medical personnel and supplies, treatment usually does not work well in a starving patient. Medicines to cure the infections causing diarrhea and dysentery did not exist, and even if a patient did improve in the prison hospital—from being sheltered and receiving better nutrition—he was bound to relapse once returned to the main prison compound.
Other researchers have explored the factors that led to the decisions that doomed POWs. They included food and supply shortages in the South, incompetence, callousness, and the failure to agree with Union officials on a lasting system for prisoner exchange.
How do you think you work expands on what we already know about Confederate medicine?
The book adds new knowledge—for example, about the evolution of the Confederate system for medical evacuation, and about the people who worked in the Surgeon General’s Office. It also adds depth and context, which will help readers understand why things happened as they did. Although some of the book’s information is already known, in that it has been published elsewhere, some of the sources are obscure. I have attempted to bring those scattered pieces together to form a coherent picture. Readers who want to learn more will benefit from the book’s complete documentation, which will allow them to consult the exact sources that I did.
How did you get interested in this topic?
I’ve been researching Civil War medicine for over 20 years now, and my investigations of the Confederate side always led to Surgeon General Moore. I wanted to learn more about him, his office, and other key medical figures in Richmond, such as Surgeon Edward W. Johns, the city’s medical purveyor. (My interest in medicine, and in medical purveying in particular, relates to my background in pharmacy.) Because the various operations of the Medical Department tended to interrelate, that research eventually morphed into an exploration of the entire department. I couldn’t, after all, appreciate Moore as an administrator without some knowledge of everything he had to manage.
And here are a few short-answer questions:
What was your favorite source you worked with while writing the book?
I had many favorites, but I’ll mention one here. It was a file from the National Archives and Records Administration (NARA) called “Communications from the Confederate War Department to the Confederate Congress.” I had been unaware of its existence until stumbling upon it while trying to navigate NARA’s quirky online catalog. The file’s description mentioned the Surgeon General’s Office, so I examined it when I next visited NARA. It contains some vital correspondence involving Moore, secretaries of war, and important legislators.
I especially liked this file for a number of reasons. First, I believe it is unknown to most researchers, and it’s always exciting to examine a useful source that few eyes have seen.
Second, the content of the file is important and unlike that of other sources that I used for the book. Third, the documents are originals or copies of originals on well-preserved paper with readable ink. It was a pleasure to examine clean, easily read documents at NARA, because I was so used to blurry microfilm images, stiff laminated pages, or letterpress copies with faded or blotched ink.
Who, among the book’s cast of characters, did you come to appreciate better?
Surgeon General Moore might be the expected answer, but my research pretty much reinforced what I already knew about him.
I was particularly impressed with Surgeons Lafayette Guild and William A. Carrington, in part because a fair amount of their correspondence survived the war and offers glimpses into their ability and personality. Guild, formerly of the U.S. Army, was Medical Director of the Army of Northern Virginia. His letters reveal him to have been thoughtful, observant, and unafraid to offer his candid opinion. Carrington, a civilian before the war, held numerous important positions, including that of Medical Director of Hospitals for Virginia. He seems to have fit into his army role well and was straightforward in his letters to Moore. His concern about the treatment of POWs was especially interesting.
What’s a favorite sentence or passage you wrote?
For this type of work, I want readers’ attention focused on the topic and not distracted by the writing itself. Thus, during editing, I reworded passages that were unclear or made it look like I was trying too hard to be clever. It’s hard to identity favorite passages in the finished book. In general, I’m most pleased with are those that, within the context of the surrounding material, gracefully explain complex concepts. Viewed in isolation, they would probably not seem to be anything special.
What modern location do you like to visit that is associated with events in the book?
I like Richmond, especially the area around Capitol Square. Unfortunately, the building that housed the War Department (and the Surgeon General’s Office) was destroyed in the fire of April 1865. However, part of the current Court of Appeals building, which housed the War Department for about a month, still stands. Also present are the capitol itself and various other structures in the square, such as the bell tower and George Washington Monument, all of which are clearly seen in wartime images of Richmond. Other wartime landmarks in the vicinity, such as churches, are still there.
What’s a question people haven’t asked you about this project that you wish they would?
I think I’ve already said about everything I’d want people to know about the project. It would be nice, though, if someone asked whether the book would make a good gift. My answer would be “Yes! Buy several, and do it now before the Christmas rush!” Maybe the royalties will help me pay for my next batch of printer ink.