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Confederate Medicine


During the American Civil War, the Union had the equivalent of 1,556,678 three-year enlistments, compared with roughly 1,083,000 for the Confederacy. Over 620,000 men perished, a figure that tops the total fatalities of all other wars in which Americans have fought. During the war, the average soldier could expect to become sick 5 or 6 times. This placed a tremendous burden on the medical departments of the North and the South.

The Confederate Medical Problem

The medical problem that confronted the doctors in uniform of the Confederate States Army and Navy was one of considerable magnitude throughout the war years. With little or no training and experience in military medicine or surgery and aside from the problem of preventive medicine the medical staff was faced with the grave responsibility of caring for more than three million cases of disease and wounds in an invaded and blockaded country. Joseph Jones, one of the most outstanding Confederate medical officers, estimated that the Confederate States mobilized more than 600,000 fighting men and believed that on the average each one of these fell victim to disease and wounds approximately six times during the war. Jones figured that 200,000 Southern soldiers were either killed outright or died as a result of illness or wounds. In addition to the responsibility of administering to the sick and wounded of its own military establishment, the medical staff was required to care for thousands of sick and wounded among Union prisoners that fell into the hands of Confederate military and naval forces. Joseph Jones believed that only one-fourth of the deaths in the Confederate military forces – some 50,000 – were probably attributable to the results of battle; it was disease, concluded Jones, that was the chief killer – taking the lives of 150,000 Southern soldiers.

The Confederate Medical Department came into being by an Act of the Confederate Congress dated February 26, 1861. President Jefferson Davis appointed Dr. Samuel Preston Moore of Charleston, SC, a 26-year veteran of the U.S. Army, as Surgeon General. As a nucleus for his Medical Corps, Moore could draw upon the experience of but twenty-four military surgeons, who resigned their commissions in the Union Army to join the Confederacy, and of two civilian surgeons (Dr. St. George Peachy and Dr. E.J. Eldridge) who had served in the Crimean War (1854-6).

The Medical Department of the Confederate States Army was organized to mirror that of the Union Army with three ranks: the Surgeon General had the rank, pay, and privileges of a Brigadier General; the Surgeons were the equivalent of Majors of Cavalry; and the Assistant Surgeons were ranked as Captains of Cavalry. Full Surgeons received $160 per month while the Assistant Surgeon received $110 per month. Additionally, provisions were made for Contract Surgeons, considered Acting Assistant Surgeons, with the rank and pay of a Second Lieutenant.

The Surgeon General's department was a mere skeleton of the Union's vast organization. Oh his job, Moore said, "the duties were arduous and exacting, the routine was killing, the emergencies to be met were legion, the responsibilities were overwhelming, all decidedly too much for one man."36 He had no staff of surgeons or nurses worthy of the name; there were in the South no good laboratories or chemical manufacturing establishments; the difficulty of importing drugs and medical supplies was bound to become very great, should the blockade already proclaimed by the North be successful. Undaunted by the task before him, Surgeon-General Moore proceeded with plans for an extensive medical department which would include, besides the head, who bore the rank of brigadier-general, one thousands surgeons with the rank and pay of majors of cavalry, two thousand assistants surgeons with the rank and pay of captains of cavalry, and an indeterminate number of acting assistant surgeons, to be enlisted as occasion might demand. Moore was able to obtain the services of 834 Surgeons and 1,668 Assistant Surgeons; in addition, 73 medical offers served in the Confederate Navy, also under Moore's direction. Seven hundred and seventy-five of these physicians were natives of Virginia. At the Nineteenth Annual Meeting of the Association of Medical Officers of the Army and Navy of the Confederacy in 1916, however, the "Committee on the Roster of the Medical Officers of the Confederate States" reported the following number of officers to have been nominated by the President and confirmed by the Senate for duty in the army medical service:

Surgeon General




Assistant Surgeons





The same committee found the following number of medical officers to have been nominated and confirmed for service in the navy:



Passed Assistant Surgeons


Assistant Surgeons


Assistant Surgeons for the War





All of these figures are exclusive of contract physicians. This number of medical personal was in sharp contrast to the almost 12,000 physicians who served in the Union forces during the Civil War period.

In addition to the more than 3 million cases of wounds and disease cared for by the Medical Corps in the Confederate States during the war, 270,000 Union soldiers were held in the South as prisoners of war and whose medical needs had to be care for. The efficiency of the department is shown in part by the fact that the percentage of deaths of Union prisoner incarcerated in Confederate prisons was approximately 8%, while the percentage of deaths of Confederate prisoners in Northern prisons was approximately 12%.

Besides being sorely handicapped by the shortage of physicians, the Medical Department of the Confederacy "was faced also with the complete lack of drugs and pharmaceutical and chemical equipment, surgical instruments and supplies, and, worst of all, of textbooks upon the enigmatic medical problems that lay ahead. In antebellum years, drugs, instruments, and texts were all supplied by northern cities. Moore undertook to solve these problems.

To supply the medical and surgical needs of the military establishment during four years of war, supplies were purchased abroad and brought in as contraband through the blockage*, obtained through the lines, captured from the enemy, furnished by private and state agencies, and purchased or manufactured within the boundaries of the beleaguered Southern Confederacy.

The Confederacy maintained a number of purchasing agents in England, France, and Europe for both military and medical supplies. Caleb Huse, the War Department's first purchasing agent abroad, bought and shipped £13,432 10s.7. in medicines during the first two years of the war. The sum of $533,333,33 for the purchase of medical and hospital supplies was placed to the credit of Huse during 1863 and £30,000 of the Erlanger loan, marketed abroad that same year, was allotted to the Medical Department. That there was considerable activity on the part of the purchasing agents abroad late in the war may perhaps be shown by the fact that in August, 1864, the medical authorities requested £113,000 to meet their foreign obligations for the next six months. At the same time, the Surgeon General asked that $400,000 be made available to Medical Purveyor Hugh Stockdell at Wilmington, North Carolina, for the purchase of medical supplies arriving there through the blockade. Despite the fact that arms and clothing were given a priority over drugs in blockade running, drugs could be found on almost every ship entering a Conf ederate port… and in the opinion of one historian of the war "Lee's army, during the last two years of the conflict, was dependent for 'chloroform, morphine, quinine, blue mass, paragoric, laudanum, and digitalis almost entirely on the blockade runners.'"

Internal trade with the enemy went on throughout the war. A considerable amount of the internal trade centered around Memphis during the period of Federal occupation from 1862 to 1865. "Memphis," declared one Union general in May, 1864, "has been of more value to the Southern Confederacy since it fell into Federal hands than Nassau." Evidence to support this astonishing remark is not lacking for two months later it was estimated by the Union Congressional Committed on the Conduct of the War "that between $20,000,000 and $30,000,000 worth of supplies had passed through this city into the hands of the Confederacy." It is clear that a large amount of drugs was sent southward in exchange for cotton despite the fact that Union officers made a sustained effort to keep such trade under rigorous control.

Other means of obtaining medico-pharmaceutical products were through smuggling across the lines. Women were especially adept as purveyors of contraband inasmuch as soldiers were reluctant to search them, and accounts of their success in carrying quinine, morphine, and other items within the confines of hoop skirts and other clothing are legion. Greatly needed medical and hospital supplies were occasionally captured from the enemy. One of the most valuable captures of such supplies was made by General Nathan Bedford Forrest's cavalry during a raid into western Tennessee. Forrest appropriated all that was needed by his own command from three large wagon loads and shipped the rest to Atlanta. There a medical purveyor appraised the value of the shipment alone at $150,000 in gold. A large storehouse in Winchester, Virginia, filled with medicines, instruments, and other medical goods, was seized by Stonewall Jackson's men in May, 1862. Surgeons with invading armies did not hesitate to visit drug stores and doctor's offices for the purpose of appropriated needed supplies. Enemy surgical instruments were especially prized.

The most ambitious manner of providing the necessary articles was by determining whether substitutes for the scarce commercially prepared drugs might be found or cultivated. To such an end, Moore directed a letter to the various medical departments on April 2, 1862, enclosing a pamphlet describing the leading medicinal plants and ordered collection of such plants. The principal text in pharmacology was a war-time book prepared by Dr. Francis Peyre Porcher…entitled Resources of the Southern Fields and Forests, Medical, Economical, and Agricultural, Being Also a Medical Botany of the Southern States, with Practical Information on the Useful Properties of the Trees, Plants and Shrubs. It was first published in 1862.

A second textbook entitled A Manual of Military Surgery Prepared for Use of the Confederate States Army, published in 1863, was largely the work of Dr. Henry Fraser Campbell.

To increase and coordinate the amount of useful information which might be at the service of the medical staff at all times, Moore founded the Confederate Association of Army and Navy Surgeons in 1864 and in the same year began the publication of the Confederate States Medical and Surgical Journal51. This publication was edited by Dr. James B. McCaw, commandant of Chimborazo Hospital, and was issued for fourteen consecutive months.

The continuance of the War beyond a period which the more optimistic of both North and South though likely, made necessary a more permanent system of filing the staff with trained physicians. For this purpose, an examining board was set up in Richmond to test the qualifications of men applying for appointments as surgeons or assistant surgeons of the Army. The precise date of such a policy is uncertain, but it is certain that such antedated December 1861. Such boards were to “scrutinize rigidly the moral habits, professional acquirements, and physical qualifications of the candidates, and report favorably, either for appointment or promotion, in no case admitting of a reasonable doubt.”

Despite all of the limitations of supplies, personnel, etc. the Surgeon General and his busy staff tried to see to the needs of thousands of sick and wounded men. They administered a staff of more than 2500 duly enlisted surgeons and their assistants, with an uncertain number of contract surgeons, as well as other medical personnel and hospital attendants. They opened new hospitals, closed others, requisitioned supplies, purchased and shipped medicines, argued with the military men as to hospital personnel, fought with determined state officials for their many projects within the latter’s boundaries. In all they encountered ignorance, conservatism, prejudice, the personal jealousy of many and lack of comprehensive vision.

No better witness to the quality of the service of the Medical Corps can be found than the highest official of the Confederacy, President Jefferson Davis, when he stated, “It would be quite beyond my power to do justice to the skill and knowledge with which the Medical Corps performed their task.” Certainly it stands to reason that had not the general effectiveness of the staff been high, no such determined resistance as the South carried on for four years would have been possible.

Qualifications and Effectiveness of the Army Surgeons

Comparison of the abilities or skills of the Confederate physicians with their northern adversaries is manifestly impossible but it is of interest that Chief Surgeon Stout of the Confederate Army of Tennessee wrote, "No army ever entered the field with better educated medical officers although they were relatively few in number.” However, most of the Southern physicians’ training compared favorably with those of their Northern counterparts. Most students still continued to get their training in the offices of old practitioners who served as preceptors, but an increasing number were seeking enrollment in medical schools that were connected to some college. Most of the early ones were established in the Northern states, although a medical department was established by the trustees of Transylvania University in 1799 and Maryland had a college of medicine by 1807. Harvard’s medical school was highly regarded, and, at Philadelphia, the University of Pennsylvania, oldest medical institution in the United States, and Jefferson Medical College, established in 1825, attracted many Southern students… most medical students were receiving their education in the North by 1830. Medical dependence on the North was a marked as economic dependence. During the ante-bellum era medical colleges sprang up in the South partially as a result of the general cultural advance made throughout America at this time. For another, their establishment was urged in the South as one phase of the movement for Southern nationalism that got underway following the onset of the abolitionist agitation and sectional bickering. Furthermore, a constantly expanding population demanded more and more medical practitioners trained to combat diseases peculiar to the section. Southern medical institutions compared favorably with their Northern counterparts in every respect. The better schools in the North gave a four-or five-month course of lectures to doctoral candidates, and this standard was adopted in the South. Virginia, however, required a nine-month term, and in 1837 the dean and trustees of the Medical College of Georgia went on record as favoring continuation of their sessions of six month, begun in 1832 for the purpose of allowing more time for anatomical demonstrations and study. The medical faculties of Southern colleges also compared favorably with those in the North from both a quantitative and qualitative standpoint. Only two schools of medicine in America had as many as eight professors on their faculties in 1837, and one of these was the Medical College of Georgia. Southern medical college enrollments showed steady growth until 1861. The increase in the number of graduates fo the University of Louisiana from 35 in 1850 to 133 in 1861 reflects the general trend, but this promising development was arrested by the wartime course of events; the average doctoral graduate was ill-prepared by present standards to begin his practice. Many young doctors, North and South, began their medical careers without having had the opportunity to observe an operation closely. Some young practitioners themselves undoubtedly felt that the sick “would be better off if they trusted entirely to nature rather than to the haphazard empiricism of the doctors, with their blistering, bleeding, and monumental dosing.”

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