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The Civil War in 1864: The Beginning of the End

Books and Documents > The Army Medical Department 1818-1865

CHAPTER 11

The Civil War in 1864: The Beginning of the End

Under the direction of William Hammond, by 1864 an effective and more elaborate organization had replaced the simple structure characteristic of the Medical Department in the days of Lovell and Lawson. Able administrators ran the various functional and geographic divisions of the Department, and sick and wounded soldiers routinely moved in orderly stages from battlefield to general hospital, where a carefully organized staff, including civilian nurses and cooks, awaited them. The requisite medicines and supplies were usually available at every stage of the evacuation. Serious shortages or delays in the transportation of the wounded continued to occur but chiefly as the inevitable result of the unpredictable nature of battle, of the failure of commanding officers to cooperate in attempts to prevent disease, or of decisions made to enable an army to move swiftly. His very success, however, caused the brilliant and abrasive Hammond to become expendable and therefore vulnerable to the attacks of the many enemies he had made during the course of his short military career.

Hammond's Trial

Apparently never truly aware of his own vulnerability, Hammond was almost to the end convinced that a court-martial would find nothing of which it could convict him. He even pushed aside a final offer by Secretary of War Stanton to let bygones be bygones with an arrogant demand for an apology. Knowing that Hammond had both stepped on many toes and bent many rules, making enemies and providing them with the ammunition they needed to dislodge him from the position of surgeon general, not all of his friends shared his illusions as to the impregnability of his position.1

Increasingly determined to remove Hammond, Stanton named Hammond foes not only to the commission that investigated the surgeon general but also to the court that tried him. Although Stanton's responsibility for some of the problems Hammond encountered in planning his defense is not clear, papers needed by the defense apparently disappeared mysteriously, and some of Hammond's most distinguished supporters, after signing a petition in his behalf, later inexplicably denied having done so. The resultant implication of unscrupulous conduct on the part of Hammond or of someone acting in his behalf further blackened his name.2

1Strong, Diary, pp. 394, 476, quote from p. 394; Blustein, "Hammond," p. 105.
2Blustein, "Hammond," p. 105; Strong, Diary, pp. 394, 396; Ltr, Hill et al. to "Sir" (1 Jan 1864), Ms C19, NLM; "Statement of the Late Surgeon-General of the United States," Boston Medical and Surgical Journal 7 (1865):364.


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Hammond was arrested on 17 January 1864, shortly after his return to Washington from Tennessee, and his trial began two days later. The most serious and damaging charge against him maintained that he had exceeded his legal authority when he purchased blankets personally rather than through the medical purveyor and that the blankets were overpriced and of poor quality. Since Hammond was the purveyor's superior, the question of who actually accomplished the purchase might seem trivial, but the potential for graft when the department head purchased directly was not a new issue. During the American Revolution, accusations of impropriety in connection with supply led to the trial of William Shippen. Although in Hammond's case, evidence of personal profit was lacking and the questionable price and quality of the blankets he bought were easily explained by the existence of urgent requirements that could not otherwise be met, the hearts of his judges were not softened. In August he was found guilty on all charges. Sanitary Commission official George Templeton Strong maintained that the surgeon general was convicted of "little more than the technical sin of purchasing supplies too freely," but Hammond was dismissed from the Army and forbidden ever again to hold office in the U.S. government.3

Among those concerned with the trial and its verdict, some supported Hammond, but no one actively defended him during his ordeal. Strong proclaimed Stanton to be a man "whose hates are as unscrupulous as they are bitter and dangerous." Others, however, did not share Strong's indignation. One writer of a negative turn of mind accurately but rather unfairly pointed out that in two years Hammond had not succeeded in freeing the Medical Department from its reliance on millions of dollars of charitable donations or in establishing an Army-wide ambulance service, a concept opposed by General in Chief Halleck. At least one of Hammond's contemporaries concluded that it was "painfully certain that the evidence fully sustained the charges presented." When Hammond succeeded in having the conviction reversed in 1879, it was on the grounds that the court was prejudiced and that evidence that had not been admitted cast doubt upon the verdict. Although technically Hammond was guilty of at least one of the charges, it seems obvious that he was doing what was necessary under the circumstances to provide the best care possible for the sick and wounded and that an impartial secretary of war would not have placed formal charges against him. Nevertheless, the net in which Hammond was caught was partly of his own making, the result not of greed but of arrogance.4

Barnes'Administration

Since Hammond was arrested in mid-January, the work of the Medical Department for the entire year of 1864 was the responsibility of the man who in August would formally succeed him as surgeon general, Joseph K. Barnes. Barnes was a

3Strong, Diary, p. 433, quote from p. 476; Blustein, "Hammond," pp. 12, 106-07; Maxwell, Sanitary Commission, p. 240; Ltr, Henry to Bache (21 Aug 1864), Incoming Corresp, A. S. Bache Papers, Smithsonian, Washington, D.C.; H. C. Friend, "Abraham Lincoln and the Court-Martial of Surgeon-General William A. Hammond," Commercial Law Journal 62 (1957):74-75.
4 First quote, Strong, Diary, p. 476; second quote, "The Case of Surgeon-General Hammond," Boston Medical and Surgical Journal 71 (1865):125; Friend, "Lincoln," pp. 76-78; "United States Sanitary Commission," editorial in Chicago Medical Examiner 4 (1865):53-54; Blustein, "Hammond," pp. 109-10.


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veteran of the Mexican War who had joined the department in 1840. Although he was one of the medical officers passed over when Hammond became surgeon general, he was by no means the department's senior surgeon. Because of the way in which he came to office, there was little chance that Barnes could please Hammond's supporters, but with the strong backing of the secretary of war and with the guidelines established by his hapless predecessor, Barnes was able to lead the Medical Department successfully through the final year and a half of the war.

Under Barnes, most of those projects closely associated with Hammond, among them the Army Medical Museum, the history of the Medical Department during the Civil War, and, ironically, the Army-wide ambulance corps, went forward without further delay. At the museum, or, in Barnes' words, the "National Pathological Cabinet," specimens were coming in rapidly. The medical illustrators Barnes hired for the history worked in the museum and also went out into the hospitals, where they sketched and painted illustrations of wounds and the effects of hospital gangrene and similar complications. In the summer of 1864, the department added a "photographic bureau" to support the efforts of both the museum and history, and at least one surgeon contributed to the department's endeavor a set of photographs he had made on his own initiative. Late in 1864, experiments in photomicrography began at the museum, where Joseph Janvier Woodward was beginning his work with stains for microscopic specimens. As a result of these efforts, by 1864 the work of the museum was attracting increasing attention, more so, apparently, among foreign physicians than among Americans.5

JOSEPH J. WOODWARD. (Courtesy of National Library of Medicine.)

When Congress passed the bill creating an Army-wide ambulance service in March 1864, Barnes again reaped the benefits of the crop that Hammond, in this instance with Letterman's aid, had sown. Among the significant features of the new legislation was the prohibition of the use of ambulances for any purpose except the moving of patients and, in an emergency, medical supplies. An officer who used an ambulance for any other purpose was to be reprimanded and, if the offense was re-

5First quote, Ltr, Barnes to Thomas Longmore (29 Jan 1864), RG 112, entry 2, 37:32; Brinton, Memoirs, pp. 285-87, second quote, p. 284; Ltr, B. F. Palmer to Barnes (8 Sep 1864), RG 112, entry 12; Otis Report, in Lamb, "History," p. 284; "Army Medical Museum," American Medical Times 8 (1864):306; Robert S. Henry, The Armed Forces Institute of Pathology: Its First Century, 1862-1962 (Washington: Office of the Surgeon General, 1964), pp. 34-39.


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peated, dismissed from the Army. Rather than giving each regiment a specific number of ambulances, Congress called for the ambulance allowance to vary with the size of the regiment. An infantry regiment of 500 or more men would have three ambulances, a regiment of fewer than 200 only one. In addition to the vehicles assigned to regiments, two ambulances were to accompany each corps headquarters and two army wagons each division ambulance train. Time proved the major flaw in this legislation to be the inadequate number of ambulances.6

The basic plan for the ambulance corps was unmistakably Letterman's. The medical director of each corps was, as he had intended, responsible for the ambulance service of that corps. A captain was in direct charge of the corps' ambulances, drivers, and attendants, and he reported to the medical director. A lieutenant commanded the ambulance corps of each division, a second lieutenant that of each brigade, and a sergeant that of each regiment. Three privates worked with each ambulance and one private with each wagon. All men detailed to the ambulance corps were to be examined by a board of medical officers to determine their fitness.7

The law of March 1864 strictly forbade line officers to appropriate ambulances for their own use, but no such understanding existed concerning hospital ships. The matter came to a head in September when Maj. Gen. Benjamin F. Butler, who demonstrated a generally high-handed attitude toward the Medical Department, matter-of-factly notified Barnes that he was temporarily taking over two hospital steamers, the only available vessels that would be safe for an oceangoing voyage, to return men from Confederate prisons in Savannah. Butler apparently thought he had Grant's approval of the move, but, upon learning of the takeover, Grant demanded that Butler explain his action. The secretary of war, unreservedly backing his new surgeon general, promptly informed Butler, "this proceeding is irregular, . . . you will please abstain from giving such orders," and added that no vessels were to be removed from Medical Department service without his prior consent.8

Other problems Barnes encountered in directing the Medical Department were also similar to those Hammond had faced. Medical officers continued to be frustrated in their efforts to preserve the soldier's health by improving his diet. Fresh vegetables remained scarce in the field and references to scurvy and scorbutic taint remained common in the records of the period despite a slight drop in the frequency with which actual scurvy was reported. Desiccated vegetables, some of which were high in vitamin A, were unpopular. Although, unlike vitamin C, vitamin A could be stored for a relatively long period in the body, by 1864 the vitamin A reserves of some of those who had joined the Army in the preceding three years were apparently seriously depleted, and the incidence of night blindness, the only reliable indicator of a vitamin A deficiency available from Civil War records, was increasing. The campaign to deliver more potatoes, high in vitamin C but relatively low in vitamin A, was apparently more successful than the ef-

6Letterman, Recollections, p. 178; WOR, ser. 3, 4:186-87.
7WOR, ser. 3, 4:186.
8Quote from WOR, ser. 1, 42, pt. 3:416; WOR, ser. 1, 42, pt. 1:1024, 1064 and pt. 3:416-17, 418, 432, 480; Ltrs, Butler to Stanton (26 Jan 1864) and McDougall to D. T. Van Buren (19 Apr 1864), both in RG 112, entry 12.


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fort to induce the men to eat other vegetables in desiccated form.9

The probable increase in the incidence of a vitamin A deficiency was not representative of the overall trend in disease under Barnes. In spite of the increase in the number of wounded, the sick and wounded together numbered less than 16 percent of the Army's total strength, and the death rate was declining. In June the report for the preceding twelve months revealed 300,000 fewer cases of disease among white troops than had been reported for the year ending June 1863, with the average soldier sick 2.2 times a year rather than the previous figure of 2.4. The year's only epidemic killed 278 soldiers when yellow fever struck at New Bern, North Carolina, but diseases associated with poor sanitation and hygiene, such as diarrhea and dysentery, were taking a lower toll. The decreasing incidence of typhoid fever suggests that many were immune to it by 1864.10

Adding to the complexities of the work of the Medical Department at this time were the wounds and diseases of an increasing number of black soldiers. During the year ending 30 June 1864, almost 190,000 such cases, less than 4 percent of whom were suffering from wounds or other injuries, came to the attention of Army physicians. The disease rate among black troops in 1864 was almost twice that of whites, and their mortality from disease was four times higher. These statistics also indicated that while the rate of disease directly associated with poor sanitation was similar in troops of both races, blacks suffered from scurvy four times as often as their white counterparts, suggesting that they may have received fewer potatoes than the white troops. They developed night blindness, however, only half as often as whites; as relatively new recruits, most probably still had adequate reserves of vitamin A.11

The Army was caring for large numbers of newly freed blacks, not only soldiers but civilians as well, especially in the areas of such cities as Vicksburg, Mississippi, and Memphis, Tennessee, where the General Hospital for Freedmen was established for black civilians under the supervision of the medical director of the XVI Corps. Late in 1863, the adjutant general had called for 10 percent of the wages of employed blacks to be paid into a freedman's fund to aid their less fortunate brothers. This order allowed the Army to detail hospital stewards to the freedmen's hospital, paying them $17 to $36 a month from the fund. Army surgeons also worked in these freedmen's institutions. With conditions in refugee camps poor, the death rate among blacks was high, and Barnes opposed burdening the Medical Department with the enormous expenses that involvement with the care of freedmen could entail. In the summer of 1864, the adjutant general rescinded the order that made Medical Department aid possible, a decision that resulted in confusion and a certain amount of despair among the Army surgeons affected by it. Barnes' objection to aiding blacks, however, was presumably based on the enormity of the challenge rather than any objection on principle to aiding civilians, since early in the year he had shown no reluctance in expanding one Army smallpox hospital in Washington and opening

9MSH 1, pt. 1:455; WOR, ser. 1, 36, pt. 1:221, 255 and ser. 2, 4:48 1; "A Word to Aid Societies" and John E. Summers, "Testimony of Lieut. Col. Summers, Medical Inspector, U.S.A.," both in Sanitary Commission Bulletin 3:673-74 and 683, respectively.
10MSH 1, pt. 1:297, 300-301, 453, 456-57; SGO, Annual Report, 1864, pp. 4-5, and 1865, p. 6.
11MSH 1, pt. 1:300-301, 456-57, 665, 669 and pt. 3:6; Grace, Manual, p. 171.


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another In Alexandria in order to take in civilian victims of that dread disease.12

By June 1864, the 190 general hospitals that sheltered most of the sick and wounded soldiers, both black and white, had more than 120,000 beds, a figure that again reflected an expansion of old facilities as well as the creation of new ones. Included among the latter were general hospitals established for the exclusive use of officers, one in each geographical department. The Medical Department still tended to return general hospital patients to institutions near their homes, sometimes apparently even to civil hospitals, especially when their period of disability would be long and the distance involved not too great. A desire to enable patients to vote in the upcoming presidential election reinforced this tendency in the summer and fall. The department also paid insane asylums for temporary housing for military patients, but in this instance, rather than sending patients to hospitals near their homes, it moved any whose illness was likely to be prolonged back to Washington and its government-run asylum.13

Although no buildings had to be constructed to create the new officers' hospitals, after July 1864 any new hospital construction that did occur had to follow the pavilion pattern originally favored by Hammond. Ventilation was an important consideration in new buildings, where each sixty-patient ward had to be separate from the others. Even so, the number of cases of hospital gangrene and similar infections was climbing and military surgeons still preferred to have their patients in small field hospitals where rates of infection were relatively low.14

Stanton's willingness to support the man he had chosen to be surgeon general led to the resolution of an old problem concerning the control of general hospitals. In December and at Barnes' urging, Stanton ruled that general hospitals were under the exclusive control of the surgeon general and that medical officers serving in these facilities, whether regulars or volunteers, were not subject to orders from local commanding officers. Within these institutions, medical officers had all the authority of commanding officers and were to be obeyed as such. Stanton did note, however, that although members of the Veterans Reserve Corps could still be used as guards and attendants, doctors were under no circumstances to retain able-bodied men in hospitals.15

In the fiscal year ending June 1864, the expense of hiring the contract doctors who formed most of the professional staff of general hospitals constituted roughly one ninth of the department's budget. The decline in the total number of patients for

12 Ltr, D. O. McCord to SG (with notes by Barnes and Eaton, 15 Sep 1864), SO (no. 94, 5 Nov 1863), and Ltr, Charles Lee to D. O. McCord (with note by McCord, 31 Oct 1864), all in RG 112, entry 12; Ltr, Barnes to Owen Lovejoy (13 Jan 1864), RG 112, entry 2, 36:535; George R. Bently, A History of the Freedmen's Bureau (Philadelphia: University of Pennsylvania, 1955), pp. 26-27.
13WOR, ser. 3, 4:207,791; Ltrs, William C. Spencer to W. P. Jones (5 Jan 1864) and Barnes to Lovejoy (13 Jan 1864), to W. G. Sellick (30 Jun 1864), and to J. P. Gery et al. (22 Nov 1864), all in RG 112, entry 2, 36:498, 535 and 38:9 and 576-77, respectively; Shumard to L. G. Burbridge (31 Jul 1864), Herrick to Provost Marshal General (21 Nov 1864), and McDougall to Barnes (25 and 27 Jun 1864), all in RG 112, entry 12; "Army Medical Intelligence: Circular Letter," American Medical Times 8 (1864):226-27.
14MSH 2, pt. 3:825; Grace, Manual, pp. 204-07; E Andrews, G. S. Hubbard, and R. H. Gilbert, "Repor of the Committee on Military Hygiene," Transaction of the American Medical Association 15 (1864):171; Armory Square Hospital Gazette (Washington: 24 De 1864), p. 4.
15Grace, Manual, p. 103; "Surgeons in Charge of Hospitals as Military Commanders," American Medical Times 8 (1864):175; Cir Ltr (31 Dec 1864) Ms C24, NLM.


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whom the Medical Department was responsible apparently led Barnes to reduce the number of contract physicians in January. In June, however, the medical director of Baltimore's general hospitals informed Barnes that he had hired a "large increase of Contract Surgeons and Nurses" and that $15,000 would be needed each month to pay the former and another $5,000 for the latter. With new casualties resulting from the start of the campaign season, Barnes was finding it difficult to locate an adequate number of able private physicians willing to take the required examination. By the end of the year, the overall shortage of physicians had become sufficiently severe to cause the surgeon general to mount an aggressive campaign to persuade former volunteer surgeons to sign up again and to advertise for men to fill openings in the regular staff as well.16

Having concluded early in the year that the department had more stewards than necessary, by December Barnes had decided to reduce the department's expenses by limiting the hiring of stewards to those who would be serving black regiments, even though medical officers still experienced occasional difficulties in obtaining stewards when they needed them. Further economies were achieved by reducing the salaries of white female nurses to 40¢ a day, even when white male nurses and cooks were still being paid $24 a month. The salaries of these contract employees were not always paid promptly, for on at least one occasion Barnes was forced to complain that late payments had caused "very great distress and destitution amongst the Employees."17

Although because of the lowered disease rate, the overall number of patients admitted to Army hospitals was dwindling, the drive to crush Confederate resistance continued to produce many wounded. Managing supply and the network of hospitals involved was complex. In May the department moved the office of the assistant surgeon general, Robert C. Wood, to Louisville, Kentucky, where he could more effectively oversee the assignment of surgeons and patients and the distribution of supplies in that part of the country. Despite the demands of the war, however, Stanton had apparently concluded that the department's network of medical inspectors could handle their responsibilities without the aid of Sanitary Commission inspectors. He refused to continue allowing the commission to send its own men into the field, enraging Sanitary Commission leader Strong, who maintained that "the corps of government inspectors [had] notoriously proved a nullity."18

The refusal to continue the Sanitary Commission's right to inspect hospitals and camps at the end of 1864 represented a general deterioration in its relationship with the Medical Department after Hammond lost control of the Surgeon General's Office. In the spring the secretary of war for a time even refused to issue the passes

16Quote from Ltr, C. C. Cox to Barnes (15 Jun 1864), RG 112, entry 12; Ltrs, Charles Crane to Sargent (9 Jan 1864) and C. C. Lee to J. L. Thompson (8 Aug 1864) and Advertisements (21 Sep and 29 Nov 1864), all in RG 112, entry 2, 36:519 and 38:116, 275, and 556-59, respectively; Ltrs, McDougall to Barnes (18 and 23 Apr and 21 May 1864), all in RG 112, entry 12.
17Quote from Ltr, Barnes to George Harrington (23 Sep 1864), RG 112, entry 2, 38:283; WOR, ser. 3, 4:512; Grace, Manual, pp. 98-99, 198, 203-204; Stimson and Thompson, "Women Nurses," p. 230; Ltrs, McDougall to Barnes (7 Jul 1864) and McParlin to Barnes (20 Jun 1864), both in RG 112, entry 12; Ltr, Crane to T. P. Drew (13 Jan 1864), RG 112, entry 2, 36:536.
18Quote from Strong, Diary, p. 521; WOR, ser. 3, 4:287; Ltr, Crane to J. Foster Jenkins (21 Nov 1864), RG 112, entry 2, 38:523.


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commission representatives needed to move freely in the area where the Army of the Potomac was operating, making it impossible for them to deliver supplies during the battles of the Wilderness and Spotsylvania. Stanton also denied the Sanitary Commission the right to use the adjutant general's records in compiling its directory of Army patients and their locations. The Sanitary Commission, like Hammond, was no longer completely indispensable.19

The very fact that the Medical Department could now afford to be high-handed in its relationship with the Sanitary Commission suggests the strength of Barnes' position. Barnes' path had been well prepared by Hammond, who had created the department's administrative framework and had placed experienced men to function within it. Secretary of War Stanton was apparently quite willing to support Barnes against practically all comers. Because of the drop in the disease rate, the number of patients was dwindling, and the only real stress upon the department resulted from the demands of an aggressively waged campaign.

Medical Care of Forces in Virginia

In the spring of 1864, Union forces launched two major drives against the Confederacy, one in Virginia and the other in Georgia. Units in Virginia fought directly under Grant, now in command of the entire Union Army. Major General George G. Meade's Army of the Potomac and Maj. Gen. Ambrose E. Burnside's independent IX Corps formed a 120,000-man force aided in the East by Butler's 33,000-man Army of the James and by various other units. During this final year of the war, however, the medical care of the Union's principal army in northern Virginia was no longer the responsibility of Jonathan Letterman, who asked to be relieved early in the year. The preparation of the Medical Department in the Army of the Potomac for the forthcoming campaign was, beginning in early 1864, in the hands of Thomas McParlin.20

The health of the Army of the Potomac at its camp along the Rapidan River during the first months of 1864 was relatively good. With the weather unusually cold, most of those who were sick suffered from respiratory infections, although venereal disease took a heavy toll among veterans returning from furlough. McParlin had the army vaccinated when smallpox appeared, and when he detected signs of scurvy in the form of a scorbutic taint, he urged commissaries and medical officers to make sure that a proper diet was available. By 1 May he was convinced that the men were "well sheltered, well fed, and well clothed, refreshed by a long rest, and visits to home and friends, and full of confidence in their cause and in its leaders ... as nearly perfect in its health, strength, and morale as it is possible in so large a body of troops."21

Once the campaign was underway, however, malaria and digestive complaints began to haunt the Army of the Potomac. More patients suffered from these problems than from gunshot wounds. It is likely that many of those with other diseases had malaria as well-McParlin commented that he had observed a periodicity, or reg-

19Maxwell, Sanitary Commission, pp. 263, 266, 311-13.
20Letterman, Recollections, p. 185. Unless otherwise indicated, material on the Army of the Potomac is based on WOR, ser. 1, 36, pt. 1:210-75, and MSH 1, pt. 1, app.: 148-211.
21Quote from WOR, ser. 1, 36, pt. 1:213; Letterman, Recollections, pp. 183-84; Perry, Letters, pp. 155-56; "Army of the Potomac," American Medical Times 8 (1864):189.


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ularly repeating pattern, of fever in most of his sick during the campaign. The quinine doled out at sick call was undoubtedly vitally important to the fighting ability of Union forces in Virginia.

Caring for the sick and wounded under McParlin at any one time were from 500 to 800 medical officers, among them an assistant medical director, two inspectors, and a medical purveyor and his assistant. McParlin assigned an assistant surgeon, John S. Billings, the principal responsibility for the collection of statistics, a challenge made more difficult by the fact that the medical staff was not large enough to guarantee the keeping of adequate records during those periods when battle was raging. Billings nevertheless took to his new assignment with enthusiasm. On 30 April he wrote to his wife that he was being sent "a barrel of whiskey ... with which to preserve surgical specimens and immediately after the next battle, I expect to send enough pickled arms and legs to the surgeon general to make a museum of themselves."22

In April Meade named the specific surgeons who were to serve as surgeons in chief at the brigade and division levels, a move that lessened the influence of commanding officers who would otherwise have appointed their own chief surgeons. An average of from forty to sixty nonmedical officers served in the ambulance corps for the Army of the Potomac, supervising the work of 1,300 or more enlisted soldiers manning approximately 600 ambulances. Forty or more stewards worked in the corps hospitals.23

JOHN SHAW BILLINGS. (Courtesy of National Library of Medicine.)

When McParlin first took over from Letterman, he relied upon regimental hospitals to care for those who fell ill, but in February he also organized division hospitals for the sickest of his patients. The organization of the division hospital in the Army of the Potomac varied, but a surgeon in chief was routinely in charge, while a recorder, three operating surgeons, each with two assistants, and a medical officer responsible for food and shelter worked under him. The surgeon in chief, as one of the most experienced physicians on the staff, was usually a member of the operating team at the division hospital, where almost all surgery was performed. With division hospitals grouped together by corps, this system made it easier for the corps medical director to contact his immediate

22Quote from Garrison, Billings, p. 76; Duncan, "The Battle of the Wilderness," in Medical Department, pt. 9, p. 18.
23Duncan, Medical Department, pt. 9, p. 18.


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subordinates. The absence of the division's chief surgeon from the battlefield was keenly felt, however, since he was needed to enforce discipline and order among the surgeons there.

In some division hospitals during battle, musicians managed the pitching and striking of tents, loading and unloading of the wounded, carrying of water and wood, burying of the dead, and policing of the hospital area. In one such facility, the 350 men and boys of the drum corps were organized into five companies, each led by a sergeant, and the whole commanded by a lieutenant. A provost's guard usually enforced discipline.

Although McParlin had thoroughly prepared for patient care, hospitalization, and evacuation, he made no attempt to provide cavalry units with ambulances. He believed that mounted men moved too fast and covered distances too great for hospital and ambulance trains to accompany them. After a cavalry engagement, surgeons appropriated nearby buildings and attempted to supply their patients by raids upon local resources.

McParlin was not initially responsible for the condition of the Medical Department in Burnside's IX Corps, which had left Annapolis at the end of April in great haste with inadequate transport and little room for medical supplies. The requisite number of ambulances moved with Burnside, but many needed repairs. The ambulance organization required by the legislation of March, furthermore, had not been fully implemented in Burnside's force. Most of the required stretchers were missing, and the civilians hired to drive the ambulances deserted in droves early in the campaign. When Grant ordered Burnside's corps officially added to the Army of the Potomac on 25 May, McParlin found that it was not only still badly in need of transport, but "badly supplied and organized" as well.24

Despite his careful planning, factors beyond McParlin's control threw continual challenges his way. Recognizing that the army must move swiftly, he sent all his sick and wounded as well as all property he considered unnecessary to the rear before the campaign started, but on 4 May Grant allowed only half the remaining ambulances to cross the Rapidan River with the troops Since the number of these vehicles permitted to accompany the army still exceeded the legally required minimum, Grant apparently did not anticipate the difficulties that resulted from his order. McParlin was not profligate in his use of ambulances and was careful not to take chances with those that accompanied him, allowing only a limited number to be exposed to fire at any one time, but events proved that the number of ambulances allowed by Congress was far too small for the aggressive campaign Grant waged.

During the battle of the Wilderness that followed the crossing of the Rapidan, the removal of the disabled to ambulances proved unusually difficult. Dense scrub hid the injured, and fires raged in the dry brush and pine, burning or suffocating men too badly hurt to escape unaided, while the enemy inhibited rescue attempts by firing at every movement. Despite their bravery, stretcher-bearers were unable to remove all of the almost 9,000 wounded from the field. As many as 200 died from the effects of the flames alone. Grant could not wait for these casualties to be brought back to safety, nor for them to be removed back along the chain of evacuation in the usual, rather leisurely manner. On 7 May, Meade ordered all his wounded sent back to Wash-

24Quote from Ltr, McParlin to Barnes (30 May 1864), RG 112, entry 12.


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ington at once. More than 300 army wagons had to join almost 500 ambulances in attempting to execute the command, and more than 1,000 men were unavoidably left behind. The next day, fearing that guerrillas might capture them if they went directly to Washington, Meade ordered that casualties be taken instead to Fredericksburg. Because of the change of plans the wounded spent thirty hours on the road, and evacuation vehicles were late returning to pick up the casualties from the battle that started at Spotsylvania on 8 May.25

The ambulance corps took two weeks to remove all who had been left behind at the Wilderness. A large number died while waiting. Their wounds were severe, and the supplies left for them proved inadequate after stragglers came out of the woods to share them. Casualties returned from captivity by the Confederates were also suffering from the same shortages that afflicted Lee's forces as the result of a successful Union cavalry raid that destroyed most of their medical supplies.26

Although they had not completed their count of the casualties from the Wilderness when Union and Confederate forces met again at Spotsylvania, after yet another day of battle, surgeons were struggling to care for over 9,000 more wounded. Few physicians remained in the field by this time, however, and McParlin's plans had been based on the assumption that patients would be evacuated from field hospital to general hospital before many had accumulated. But large numbers were held at depot facilities at Fredericksburg because Confederate guerrillas had cut the rail line to Aquia and were suspected of having mined the Rappahannock River. Because many of the surgeons accompanying the wounded to Fredericksburg had to stay there to care for them, medical officers remaining in the field were overworked and exhausted.27

Both confusion and delay characterized the evacuation of the Spotsylvania casualties because ambulances were still busy removing the wounded from the Wilderness. In addition, the wounded on the battlef ield were too numerous for the available stretcher-bearers to handle. Two to four healthy soldiers could often be seen escorting a severely wounded comrade to safety. Meade again ordered all available vehicles, regardless of type, made ready to remove the wounded. On 10 May the ambulances finally returned from Fredericksburg, but both horses and attendants were worn out. Since renewed action was expected, Meade had ambulances and spring wagons (highly regarded as substitutes for ambulances) retained at the front and those of the wounded not yet removed to Fredericksburg sent off in returning supply wagons.28

The night of 11 May was dark and wet, but despite the exhaustion of men and beasts and the poor condition of the roads, the evacuation twelve miles back to Fredericksburg continued. Medical inspectors supervised the move of another 3,500 casualties on 12 May alone. The proportion of severely wounded among them was so high that fewer than a quarter of the injured could move themselves. Once again the lack of transportation prevented the prompt removal of many, and it was not until the 15th that 600 who had been left

25"Fredericksburg Correspondence," Sanitary Reporter 2 (1864):18; Ulysses S. Grant, Personal Memoirs, ed. E. B. Long, 2 (New York: Charles L. Webster & Co., 1866):290; USSC, Documents 2, no. 76:1-2.
26Grant, Memoirs 2:227; Duncan, Medical Department, pt. 9, pp. 19-20.
27Ltr, McParlin to Barnes (10 May 1864), RG 112, entry 12.
28Grant, Memoirs 2:290.


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behind earlier were picked up for the trip to Fredericksburg. The next day McParlin estimated that 18,500 patients had already gone through his field hospitals.29

On 19 May, McParlin had to order vehicles collected from other units for the use of newly arrived artillery regiments that had brought with them neither medicines and supplies nor transportation for their wounded. His surgeons assisted the artillery's medical officers in chosing men for their ambulance corps and advised them concerning the Medical Department's routine in caring for the sick and wounded, both on the march and during battle.

The sick and wounded were not McParlin's only concern in the early weeks of the campaign. Malingerers by the thousands became a problem for him as they had been for Tripler and Letterman. Some appeared to have inflicted their own wounds. According to McParlin, they tended to present themselves not to military surgeons but to Sanitary Commission doctors, who could be more easily impressed by "bloody bandages and judicious limping." Malingerers added to the confusion at Fredericksburg, where the establishment of a large depot hospital system on short notice left McParlin with no chance to stockpile supplies for the 26,000 casualties who would eventually pass through that city.30

Initially supplies could come into Fredericksburg and patients could leave only through Belle Plain, on the Potomac River. The harbor there was shallow and, until the engineers intervened, had no wharf. The road from Fredericksburg to Belle Plain, furthermore, could be attacked by guerrillas. As a result, supplies did not reach Fredericksburg until 10 May. The first twenty ambulances sent in to supplement those already with Meade's army arrived at Belle Plain on the 11th, when Sanitary and Christian Commission supplies also began coming in. To expedite food delivery to the hospitals, Meade assigned a lieutenant to each division facility to assume responsibility for hospital subsistence.31

In Fredericksburg enlisted patients occupied the usual churches and public buildings, although medical officers tried to locate the hospitals of each corps near one another. Wounded officers initially stayed in private homes where the owners cared for them. Facilities in Fredericksburg soon became crowded and infection took a heavy toll despite generally adequate ventilation and a good water supply. Near the end of the month, however, tents began to arrive, and doctors could move their patients out of doors, where infection spread less rapidly. At this time, the Medical Department also established an officers' hospital at Fredericksburg.32

Because medical officers were required both at the front and in Fredericksburg, too few surgeons were available to meet the need at either place. On 9 May, for example, only thirty physicians were caring for 7,000 patients in Fredericksburg. On 8 May, therefore, Barnes put out a call to the surgeons general of Pennsylvania, New York, and Massachusetts for ten surgeons each for ten days' service, broadening the call three days later to include other states in a request for five more physicians each.

29Grant, Memoirs 2:237; Ltrs, McParlin to Barnes (13 and 16 May 1864), RG 112, entry 12.
30Quote from WOR, ser. 1, 36, pt. 1:235.
31Brinton, Memoirs, pp. 268-70; Maxwell, Sanitary Commission, p. 251; William Howell Reed, Hospital Life in the Army of the Potomac (Boston: William V. Spencer, 1866), pp. 13-14; Ltrs, Brinton to Barnes (two of 10 May, one each of 11 and 12 May 1864) and SO (16 May 1864), all in RG 112, entry 12.
32Ltr, McParlin to Barnes (22 May 1864), RG 112, entry 12.


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Among the professional men to come to Fredericksburg was dentist William T. G. Morton, one of the developers of ether anesthesia, who, according to Joseph Janvier Woodward, anesthetized as many as 100 patients a day. Although the help of these civilians was invaluable, they also contributed to the confusion because of their unfamiliarity with Army routine.33

The road from Fredericksburg to Belle Plain was rough, the weather wet, and the confusion at the depot great. No facilities for the injured existed at Belle Plain. Since the wounded suffered greatly when moved any distance in ambulances and wagons, McParlin decided to keep the seriously wounded in Fredericksburg until the rail line to Aquia had been repaired and gunboats had cleared the Rappahannock. By 14 May the situation at Belle Plain had improved, and supply was "profuse," but 8,000 wounded remained at Fredericksburg. With the river and railroad clear, McParlin had all those whose condition would keep them out of action for more than a month evacuated to Washington. By 22 May fewer than 6,000 remained in Fredericksburg facilities.34

Days before the last of the wounded left Fredericksburg on 28 May, Meade had ordered the next depot for the advancing army established downstream at Port Royal. On 25 May he had the sick and wounded still with the army sent there, once again using wagons to the extent possible to spare ambulances for work nearer the battlefield. The Medical Department, however, had not had time to prepare for the arrival of patients at Port Royal, and although it was raining when the first ones arrived, doctors had to leave them in their vehicles until the next day. Within a few days the army had advanced too far beyond Port Royal to use it as a base. On 30 May, even while boats were still removing patients from Port Royal, the Medical Department was beginning to set up tents at White House.35

From 23 to 31 May the Army of the Potomac moved south toward Richmond and then east around that city toward Petersburg. Early engagements resulted in fewer than 2,800 injured, but in early June the battle of Cold Harbor accounted for almost 7,000 wounded. In addition, many who were sick rather than injured also had to be evacuated. For more than a month, the men's rations had included no vegetables. Scurvy was appearing among soldiers already suffering from malaria and, with sanitation in the trenches poor, bowel complaints as well. Only after mid-June did shipments of the new crops of vegetables begin to arrive for Grant's men, including a large supply for the depot at White House. By then, however, thousands of the seriously ill and wounded had left White House for general hospitals to the north.36

Although surgeons returning from their duties at Fredericksburg eventually relieved the shortage of physicians with the Army of the Potomac, transportation for the wounded remained inadequate, even after the arrival of forty-eight new ambulances and eight medicine wagons that

33Woodward, Outlines, pp. 151-52; Ltrs, Barnes to various SGs (8, 11, and 12 May 1864), all in RG 112, entry 2, 37:403, 419, and 420, respectively.
34Quote from Cuyler to Crane (14 May 1864), RG 112, entry 12; Reed, Hospital Life, pp. 15-16, 41; Ltrs, Cuyler to Barnes (13 May 1864) and McParlin to Barnes (20 and 24 May 1864), all in RG 112, entry 12.
35Reed, Hospital Life, pp. 47-48; Ltrs, McParlin to Dalton (27 May 1864), in Edward Barry Dalton, Correspondence, Documents, and Certificates Pertaining to Dalton's Medical Career, 1861-72, Ms fB29, NLM; Ltr, McParlin to Barnes (24 May 1864), RG 112, entry 12.
36Grant, Memoirs 2:290; WOR, ser. 1, 36, pt. 1:188.


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JOHN BRINTON (center, seated) AND HOSPITAL ATTENDANTS at Petersburg. (Courtesy of Library of Congress.)

could also be used to move the sick and wounded. A corps from Butler's Army of the James joining the Army of the Potomac in time for Cold Harbor caused further difficulties by bringing with it only eighteen ambulances and no tents. Surgeons from another unit had to aid the doctors with Butler's men during the battle. Once again after Cold Harbor, because of the shortage of transportation, two or three able-bodied men could be seen escorting a single wounded companion from the front to the hospital.37

At the White House depot, surgeons attempted to load the patients from Cold Harbor onto hospital boats for evacuation as soon as they had received emergency care and had been screened to eliminate malingerers. The Quartermaster's Department worked closely with the Medical Department in this endeavor, but casualties were soon coming in as fast as they could be sent off. Medical officers shipped almost 1,300 patients north on 2 June alone, but on 4 June, when they sent off a similar number, 1,460 still remained at the White House depot, and McParlin was forced to turn to the Sanitary Commission to supplement his nursing force.

In mid-June, the Army of the Potomac resumed its movement to the south, and once again the ambulances following it

37Reed, Hospital Life, pp. 54-55.


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GENERAL HOSPITAL FOR ARMY OF THE POTOMAC at City Point, Virginia. (Courtesy of Massachusetts Commandery Military Order of the Loyal Legion and the U.S. Army Military History Institute.)

were soon filled with the sick, many suffering from heat stroke. By 17 June field hospitals sheltered almost 1,900 sick and wounded. By the next day, however, surgeons had established a new depot facility at City Point, on the south bank of the James northeast of Petersburg, and four days later White House stood abandoned.38

Although the siege of Petersburg eased the difficulties caused by the rapid movement of Grant's army, the wounded continued to come in, especially after the battle of the Crater on 30 June. Problems resulting from poor sanitation and disease increased. In the heat of July the disease rate was twice the May average of 2.3 percent. Swarms of flies led McParlin to order mosquito nets for his patients. When the weather was dry, dust filled the tents where the sick and wounded lay, but when it rained, stagnant pools became so numerous that McParlin urged greater attention to drainage. Approximately 40,000 new recruits unfamiliar with the necessity for sanitation reinforced Grant's force in the course of the campaign of 1864, a fact that may explain why soldiers were once again relieving themselves wherever they were, ignoring latrines. Typhoid fever as well as diarrhea and malaria, diseases that together caused more than half of the hospitalizations in the last six months of the year, became a greater danger to the Army

38Order (McParlin's copy, 15 Jun 1864), RG 112, entry 12.


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of the Potomac than the Confederate soldiers besieged in Petersburg.39

The length of the siege required modifications in the way in which hospitalization was managed. When Grant's force took up its position outside the city, regimental surgeons established themselves within several hundred yards of the trenches, near ambulance stations, and McParlin kept division hospitals in tents. As winter approached, however, he had fifty- by twenty- foot log structures erected to shelter his patients from the cold. Most of the sick remained in these division hospitals, but when they became overcrowded, medical officers sent some of their patients back by train to the depot at City Point.40

The City Point depot covered an area of several hundred acres and contained five corps hospitals. A hospital at Point of Rocks, six miles up the Appomattox River, apparently sheltered Butler's remaining sick and wounded, but one of the City Point facilities was set aside for the black troops from Butler's command. Although not all reports agree, in the summer these institutions may have been able to house as many as 10,000 patients, but in the colder months, when pavilions replaced many of the tents, their population was probably less than 6,000. Despite much initial confusion, the huge facility was soon operating smoothly, with a steam laundry and two steam engines keeping a 6,000-gallon tank filled with river water for bathing and washing, while dug wells provided drinking water. A rail line went through the center of the depot so that patients could be taken from the cars directly to their beds, without the use of ambulances. Although opponents of the practice pointed out that the use of convalescents as hospital attendants was harmful to their health, these men handled many of the duties at the City Point hospitals, including nursing and police. They apparently worked with great goodwill, since accounts of the period mention decorations put up by nurses and wardmasters to make hospital rooms more cheerful. Blacks within the lines were ordered to duty as laundresses and cooks, while stragglers and suspected malingerers might also be put to work.. Special-diet kitchens were often run by women who, in McParlin's opinion, "were of much more use [there] than when employed as nurses in wards."41

Once again sending patients out and bringing supplies in was at first difficult. Piers were crowded, but temporary ponton wharves, including one for the Medical Department's exclusive use, were soon in place. Shallow draft vessels could come directly to these wharves, leaving only deep draft boats to be unloaded by lighter. Severely wounded patients could then be quickly evacuated north. McParlin stored medical supplies that were temporarily unneeded in barges so as to free wagons for other uses. Although wagon traffic kept the area dusty in dry weather, as soon as an adequate pumping system had been installed, water was available for spraying on the dust to lay it. During periods of rain, however, the entire area still became a quagmire. When rain fell during an attempt to move a hospital that had proved to be both inadequate and badly located,

39Grant, Memoirs 2:239-89.
40Reed, Hospital Life, p. 94.
41Quote from MSH 1, pt. 1, app.: 165; Reed, Hospital Life, pp. 94-95; Huston, Sinews, pp. 227, 230; Adelaide W. Smith, Reminiscences of an Army Nurse During the Civil War (New York: Greaves Publishing Co., 1911), pp. 80-8 1; "City Point: From Dr. McDonald," USSC, Sanitary Bulletin 2:812; GO, Butler (no. 161, USSC Bull, 6 Dec 1864), RG 112, entry 12.


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the effort became an ordeal of mired ambulances and exhausted men and horses.42

The management of the wounded was more than ordinarily difficult for units that for one reason or another temporarily left the immediate Petersburg area, usually in attempts to cut enemy supply lines. In one such instance, the II Corps moved to the north of the James River, sending its sick on to City Point before the move. Twenty ambulances followed each division of the corps as it marched to pick up the many men who became too exhausted in the July heat to continue on their own. Surgeons established a temporary hospital on the north bank near the ponton bridge by which the troops had crossed and a regular field hospital on the south bank, from which patients were taken to City Point. During a similar but longer-lived operation, malaria became such a problem that surgeons had ditches dug around hospital sites to improve drainage and issued whiskey and quinine prophylactically for a brief period. Whenever possible they took over houses for use as hospitals and sent the sick back to City Point each time a move was necessary.

As the weather turned cold, medical officers with these expeditions found themselves confronting the effects of cold weather and exposure upon men who had impatiently discarded heavier clothing and blankets during a warm spell. When rain and sleet accompanied the arrival of very cold weather, the rate of respiratory disease climbed among those who were forced to use temporary and inadequate shelter. To meet the needs of units leaving the immediate vicinity of Petersburg, medical officers in one corps set up what they called a flying hospital, which consisted of a medicine wagon, a hospital wagon, and half the number of ambulances allowed each brigade involved.

Grant's 1864 campaign took a heavy toll among members of the Medical Department of the Army of the Potomac, especially among the men -of the ambulance corps. From 1 May through 31 July alone, one medical officer and ten men from the ambulance corps were killed in action. Five surgeons, three hospital stewards, and sixty-five members of the ambulance corps were wounded in the first three months of the campaign in eastern Virginia.

In striking contrast to Grant's energetic campaign was that of Butler and his Army of the James, which never got farther than the junction of the James and Appomattox rivers despite the fact that Lee was at first totally unprepared to meet an attack from this source. Like the Army of the Potomac, Butler's army moved initially with a bare minimum of medical supplies, ambulances, and the like, leaving its sick behind in hospitals in the Hampton-Portsmouth-Fort Monroe area. A steamer served as a storeship and as a shelter for the wounded. Several other smaller vessels took casualties back to Fort Monroe as soon as they could be moved. One corps soon established a permanent hospital at Point of Rocks, and the others followed its example soon thereafter. Because Butler got no further than Bermuda Hundred, however, his medical officers never faced the problems with evacuation and hospitalization that plagued their counterparts with Grant in May and June.43

Units fighting in western Virginia and Maryland experienced little success until they were consolidated under Maj. Gen.

42Ltr, McParlin to Barnes (24 Jun 1864), RG 112, entry 12.
43Ltrs, McCormick to Barnes (3, 5, 11, 18, and 20 May 1864) and McClellan to Barnes (14 May 1864), all in RG 112, entry 12.


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GENERAL HOSPITAL AT POINT OF ROCKS, VIRGINIA. (Courtesy of Library of Congress.)

Philip H. Sheridan's command. Their setbacks resulted in the capture of many of their wounded. Sheridan's medical director, James Ghiselin, was forced to put together a medical organization more or less from scratch, but using Letterman's plan as his guide, he successfully created both a medical team and a network of hospitals. The surgeon general cooperated promptly with requests for supplies and more surgeons to man facilities established in Winchester. In so doing, Barnes made it possible for Ghiselin to avoid the difficulties McParlin experienced during the battle for Spotsylvania, when his surgeons were spread thin trying to care for patients both in Fredericksburg and near the battlefield at the same time.

Although the pattern of care and evacuation was generally similar to that of the forces facing Lee in eastern Virginia, the shortage of ambulances here was less serious. It led to delays in retrieving the 4,000 wounded after the battle for Winchester, but the use of army wagons to supplement ambulances enabled the latter to remain with the army as it advanced. Most of the more than 10,000 wounded from 20 August to 31 October moved smoothly and quickly from field hospitals to depot facilities and thence by hospital train to general hospitals in Philadelphia, York, Wilmington, and Baltimore. In the course of caring for them, however, one surgeon was killed and three more died of their wounds, while two others were hurt but survived. The only major crisis, a temporary lack of food for hospitalized patients caused by Con-


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federate guerrilla activity, was quickly resolved by the commanding general's decisive action in ordering rations intended for troops in the field diverted to hospitals.44

JAMES T. GHISELIN. (Courtesy of National Library of Medicine.)

Medical officers serving in Virginia in 1864 faced a variety of challenges, most of which arose from the fast-paced nature of Grant's campaign. His rapid moves against Lee in the spring and early summer complicated evacuation and hospitalization and emphasized the need for a larger ambulance allowance for aggressively waged campaigns. The siege of Petersburg, on the other hand, brought with it all of the difficulties involved in keeping standards of sanitation high among troops camped long in one area. In western Virginia, the medical director of Sheridan's new army grappled with the problems that arose from the hasty creation of an army from a hodge-podge of units with varying standards of medical care. Surgeons could not meet all of these challenges with complete success, yet even in the face of partial or temporary failure, they managed to function in a rational, disciplined manner to limit the suffering of the sick and wounded.

Sherman's Campaign in Georgia

The second major campaign of 1864 was that led by Maj. Gen. William Tecumseh Sherman, under whose command three armies that had been fighting west of the Appalachians were consolidated to take Atlanta and then to push on to the coast. Sherman, like Grant, launched his campaign on 4 May, but the distance to be covered was great and, unlike Grant, he made slow progress during the summer, needing seventy-four days to move the first 100 miles. The path Sherman took lay for the most part along a railroad, and his medical officers were able to make extensive use of hospital trains during the first half of the campaign, but transportation became increasingly uncertain because of enemy raids upon lengthening supply lines. Although his men had become skilled in the art of rebuilding track and bridges rapidly, in leaving Atlanta Sherman finally decided to end his reliance upon support from the rear. His men would live off the land as he moved east, and he would keep with him those who fell ill or were wounded after his departure.45

44Brinton, Memoirs, pp. 293-301; WOR, ser. 1, 43, pt. 2:163; Maxwell, Sanitary Commission, pp. 269-70; MSH 1, app.:223-26; Ltr, Campbell to Barnes (17 Oct 1864), RG 112, entry 12.
45Unless otherwise indicated, all material on Sherman's campaign is based on MSH 1, pt. 1, app.:297-327, and Matloff, American Military History, pp. 270-74.


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GEORGE COOPER. (Courtesy of National Library of Medicine.)

When the campaign began, Sherman's medical officers had not had time to activate Letterman's system in its entirety. Field hospitals were for the most part still organized by brigade rather than division. The medical officers who were to perform surgical operations for the Army of the Cumberland, one of Sherman's three armies, were initially named by brigade, but in June George Cooper, the newly arrived medical director, adopted the division method of organization, thus making it a simple matter for each division's physicians to assist one another regardless of the units to which they were attached. The medical director of the Army of the Ohio, Henry Hewit, initially appointed a committee of surgeons at the army level to perform surgery, but he, too, eventually turned control over this aspect of the care of the wounded to his division chiefs.46

The system of Union Army hospitals that evolved during the summer of 1864 in Georgia varied to some degree from army to army and from place to place. As a rule, however, ambulances and, when necessary, army wagons initially evacuated patients to field division hospitals. If these units had to move on with the army before depot facilities could take in all their patients, surgeons sent the sick and wounded to mobile general field hospitals, and then finally to the depot for the train trip back to Chattanooga, 136 miles from Atlanta. Casualties were often sent beyond that city, with one train going 151 miles to Nashville, another the 185 miles from Nashville to Louisville. Hewit pointed out that his patients had to continue immediately on to Knoxville, which could be very hard on the wounded, especially if they had to change trains. It was desirable, however, to keep the Nashville and Chattanooga hospitals available for the newly wounded, and thus those who had been treated were usually moved on, further from the battlefield. The casualties of the small Army of the Tennessee were for a time sent to a hospital in Rome, Georgia, rather than to Chattanooga. Cavalry units with Sherman, like those with Grant, had neither hospitals nor ambulance service, and their wounded had to enter infantry facilities or houses along the route of march where private families could be paid to care for them.47

At least one of the problems of evacuation was caused by Sherman's commanding officers who, following the time-

46Ltr, Perin to Barnes (6 Jan 1864), RG 112, entry 12.
47Ltrs, Hewit to SG (9 Mar 1864) and to Edward E. Potter (copy, 13 Mar 1864), both in RG 112, entry 12; MSH 2, pt. 3:970-71.


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honored custom of trying to appoint the weakest men to ambulance duty, ignored the strenuous nature of this assignment. Ambulances were also in a poor state of repair as the campaign got under way, but the necessary work was completed during the season. The animals that pulled the ambulances, however, were chosen from among those that had almost starved to death at Chattanooga the previous fall and winter. Many had not recovered from that ordeal and were unfit for arduous work.

Since forage was not easily found as supply lines lengthened, and since a campaign many had expected to be short continued month after month, a substantial amount of supplies and equipment was left behind to reduce the number of animals that had to be fed. Nevertheless, Sherman allowed the Medical Department to bring an adequate supply of medicines and hospital needs. He also assigned an acting commissary of subsistence to the field hospital organization. Between Sherman's effort and those of the various volunteer commissions, the diet of the sick and wounded in the field was reportly as good as that of their counterparts hospitalized in the rear, and this even when able-bodied soldiers were suffering from scurvy.

Many of the men in the field with Sherman were veterans who, with the scent of victory in the air, had reenlisted. At the start of the campaign, they were reported to be in good health, but the condition of men who were new to the army was, as usual, poor. Once again, many had been accepted without adequate medical screening. A diet low in vitamin C and an arduous campaign caused scurvy to appear early and by June men were breaking down. At least one surgeon blamed the lack of vegetables for the difficulty that many men had withstanding the rigors of the campaign. By July definite signs of scurvy had appeared in an average of 20 percent of those in one division of the Army of the Ohio and what was described as a scorbutic taint was sufficiently pronounced to be identified in more than half of the men. The problem began to diminish in importance only when green corn became edible in the fields. Blackberries and many vegetables ripened at the same time as corn and were probably responsible for the improved health ascribed by many to corn.

As Sherman's force moved slowly toward Atlanta, surgeons caring for his sick and wounded showed flexibility in their approach to the problems they encountered. On at least two occasions in the campaign, when a division hospital of the Army of the Cumberland needed help, surgeons from other divisions came swiftly to its aid. When the rail line was cut or a bridge destroyed, surgeons established temporary hospitals to shelter patients until the route back to Chattanooga had been restored. One such facility was located in an abandoned Confederate hospital at Kingston in Tennessee, a second at Acworth in Georgia after the enemy had cut a railroad bridge. After the bridge had been rebuilt, surgeons at Acworth did not wait for the arrival of hospital trains but shipped their patients west on returning freight cars.

In late June, medical officers faced a particularly unpleasant situation when ordered to move the casualties resulting from the battle of Kenesaw Mountain within twenty-four hours. Division hospitals were six to nine miles from the nearest depot, and surgeons had to use every kind of transport they could find, including baggage wagons, to move the 2,000 wounded along roads rendered virtually impassable by days of rain. Scurvy was by this time almost rampant among Sherman's men and proper food was apparently not yet available for the casualties who boarded


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the trains after the battle. The situation became all the more difficult when the trip took three times longer than had been anticipated, but Cooper asked the Sanitary Commission to aid the wounded by setting up rest stops at Kingston, Tennessee, and at Resaca and Dalton, Georgia. Not all attendants on board the train were conscientious about their duties, but physicians could not walk from car to car to check on their work while the train was moving. Given the hasty nature of the evacuation, however, the Medical Department probably could not have done better.48

As Sherman's troops drew nearer Atlanta, field hospitals followed, moving finally from Marietta to Vinings Station, where they remained until Atlanta fell and they moved into the city itself. Even within Atlanta, however, these facilities never became fixed. When the initial location of one of these hospitals was needed for new fortifications, medical officers moved it from its original site to a less desirable one. Almost 6,000 were wounded in action near Atlanta, and at least half that number remained in Atlanta hospitals in October, when Confederate attacks upon the railroad leading back to Tennessee virtually cut Atlanta off from supplies for several weeks. Until the rail line could be repaired, food supplies were supplemented by items brought in by foraging parties.49

On 29 October, with the railroad finally repaired, Sherman sent the division field hospitals of his three armies back to Resaca in boxcars, no hospital trains being available. Since medicines could not be found in the countryside and Sherman planned to destroy the rail line behind him to prevent the enemy from using it, surgeons would from that point onward have to manage with what they could carry with them. Sherman took with him, therefore, only his fittest men, hoping to minimize the depletion of medical supplies by sending the weak, whose the health might fail under the rigors of the march, back west with the sick and wounded.50

Before leaving Atlanta, Sherman and his medical officers determined carefully what they should take with them. They allowed each division of 6,000 men approximately thirty ambulances, a medicine wagon carrying sixteen tent flies, a month's allowance of the most useful medical supplies, and several army wagons that could be used to move the packs of men who became too weak to carry them. Their plans proved entirely adequate, since relatively few fell ill on the march, and the rate of sick and wounded averaged only 19 per 1,000. The clear air and food gathered from the countryside, including berries and sweet potatoes, actually brought about an improvement in health. Medical officers examined the few who did fall ill each morning before breakfast and loaded those unable to march into ambulances. Each unit had its own foraging party to bring in food for the sick, including fresh meats, vegetables, fruits, and honey. Cows accompanying the march provided milk. One soldier wrote his wife that the men had "not lived so well before in the army." John Moore, medical director for Sherman's command in the fall of 1864, was concerned that the medical supplies taken

48Duncan, Medical Department, pt. 10, p. 12; "Extracts From the Report of Mrs. J. T. Horner, State Agent for Iowa," Sanitary Reporter 2:13 1.
49Maxwell, Sanitary Commission, pp. 268-69; Duncan, Medical Department, pt. 10, p. 14; "Letter From Mr. Tone," "Report of Dr. Read," and "Letters From Mr. Hoblit," all in Sanitary Reporter 2 (1864):95, 99, and 100-101, respectively.
50"Letters From Mr. Hoblit," Sanitary Reporter 2 (1864):100-101; E. Andrews and J. M. Woodworth, The Primary Surgery of Gen. Sherman's Campaigns (Chicago: George H. Fergus, 1866), pp. 2-3.


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along would not be sufficient and had arranged for a new supply to be kept ready for shipment to Savannah or any other site along the coast should it be needed. His concern proved unnecessary, but when Savannah surrendered on 21 December, four ocean-going hospital transports met Sherman's army with supplies for 5,000 patients.51

Sherman's preparations for his march to the sea included sending Maj. Gen. George H. Thomas with part of the Army of the Cumberland back to Tennessee to protect Nashville, a vital supply center, from Confederate forces under General John B. Hood. Although in late November Thomas still did not consider himself ready to commit his main forces against the enemy, two corps saw heavy action outside Nashville as they attempted to gain time for him. While Union forces dropped back first to Franklin and then to Nashville itself, ambulances and wagons evacuated as many as possible of the sick and wounded either to a train depot or directly to Nashville.

JOHN MOORE. (Courtesy of Library of Congress.)

Within the city, preparations for defense went forward, but considerable confusion prevailed because of the manpower shortage. Thomas gathered all available men into an "extemporized" unit and called in all surgeons in the area on leave or otherwise unassigned to serve as its medical staff. His medical officers scoured the city for ambulances. Only one corps' medical department was effectively organized. As the time for decisive action approached, its surgeons methodically broke up their facilities, moved their sick to general hospitals, and placed their ambulances and wagons by the side of the road, ready to move out. The director of the general hospitals in Nashville took over every building that could be used to house casualties until he had 4,000 vacant beds awaiting them. Just as his new patients began to arrive, however, so did reinforcements in the form of troops from Missouri, and these units added to the problems facing medical officers because they were "deficient in almost everything belonging to the hospital department."52

On 15 December Thomas attacked Confederate forces besieging Nashville and drove them beyond the Tennessee River in

51Quote from Ltr, J. R. Zearing to his wife (15 Dec 1864), in Lue1ja Zearing Gross, "A Sketch of the Life of Major James Roberts Zearing, M.D. (1828-1911)," Transactions of the Illinois Historical Society 2 (1921):191; "Report of Dr. Read" and "Letter From Rev. J. C. Hoblit," both in Sanitary Reporter 2 (1864):130-31; War Department, SGO, Annual Report, 1865, p. 3; Ltr, Huntington to Barnes (7 Jan 1865), Ms C130, NLM.
52Quote from MSH 1, pt. 1, app.:323; Brinton, Memoirs, p. 327.


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great confusion. By this time the weather was exceedingly cold, and the incidence of fevers, respiratory problems, rheumatism, and diarrhea increased among his troops. The wounded suffered greatly, but medical officers cared for them promptly in the field and quickly moved almost 8,000 back to the city. Since the railroad had been cut, the wounded had to use ambulances for the entire trip. As Thomas pursued the enemy, surgeons collected growing numbers of casualties in hospitals in towns along the way, including Franklin, where they discovered 185 survivors from the more than 200 Union casualties of the battle of Franklin. They also found approximately 1,500 Confederate wounded abandoned there, "in a lamentable condition," a state of affairs a Sanitary Commission representative attributed in part to "bad nourishment." Trains evacuated all the wounded from Franklin and other communities back to Nashville as soon as they were in a condition to be moved and the track had been repaired.53

Although as many as 3,600 beds were available at Chattanooga and over 800 at Murfreesboro and Tullahoma- among the cities to which Army of the Cumberland patients were taken- Nashville held more than any other. In June general hospitals there sheltered 6,000, of which more than 2,000 were in tents, but by November a pavilion hospital for 2,000 was nearing completion. Among other hospitals in that city were an Army-run facility for smallpox victims and another for blacks, both soldiers and civilians.54

Many Army of the Cumberland patients sent to Chattanooga during Sherman's drive on Atlanta eventually arrived in Nashville, since Chattanooga facilities, including a convalescent camp, were crowded during the summer despite the use of tents taken from the enemy. When Nashville began to receive patients directly from the battlefield, however, the medical director there could not relieve the resultant crowding of his hospitals by sending casualties back to Chattanooga, presumably because the enemy was between the two cities. Chattanooga facilities were by then far from crowded, however, since they received no patients from Sherman after he left Atlanta. The city's military hospitals ended the year with fewer patients than usual, many of whom were well on their way to recovery. Army of the Ohio patients continued to go through Chattanooga. Although 2,000 remained at Knoxville at year's end, almost 10,000 filled general hospitals in Louisville, Kentucky, or the nearby communities of New Albany and Jeffersonville, Indiana.55

Trans-Mississippi Campaign

The least fortunate part of the Union Army's plans for 1864 involved an ill-conceived expedition led by Maj. Gen. Nathaniel Banks designed to take Shreveport, Louisiana, and to free the Red River from Confederate control. The campaign was a

53Quotes from "Report of Dr. Read," Sanitary Reporter 2 (1864):124; "Letter from Mr. Ruggles," and "The Wounded at Franklin-Report of Mr. C. B. Ruggles," both in Sanitary Reporter 2 (1864):123 and 133, respectively; Ltr, Cooper to Barnes (19 Dec 1864), RG 112, entry 12.
54Brinton, Memoirs, p. 340; "Report of Dr. Read," "Report of Rev. Mr. Ingraham," and "Report of Mr. Ruggles," all in Sanitary Reporter 1 (1863):166 and 2 (1864):30 and 98-99, respectively; R. Wallace, "United States Hospitals at Nashville," Cincinnati Lancet and Observer 7 (1864):587, 590, 598.
55Duncan, "When Sherman Marched Down to the Sea," pt. 10 of Medical Department, p. 3; "Report of Rev. F. H. Bushnell," "Report of Rev. H. B. Hosford," "Report of Dr. Read," "Report of Mr. M. C. Read," and "Letters From Rev. H. B. Hosford," all in Sanitary Reporter 1 (1863):170 and 2 (1864):29, 99, 124, and 126, respectively.


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failure from the outset, and its failure inevitably complicated the work of medical officers. The 15,000-man force led by Maj. Gen. Frederick Steele that should have left Arkansas to meet the main part of the force under Banks at Shreveport had to turn back. Banks' drive north toward that city in early April also fell short of its goal, and left more than 1,600 of his men injured. The enemy captured almost 500 Union wounded, 9 medical officers, and 70 ambulances, evacuation having been seriously retarded by a "stampeded mass of wagons, artillery, infantry and cavalry." Four more medical officers voluntarily remained behind to help care for the captured Union wounded. Although surgeons had to abandon division hospitals with little food or "ordinary comforts" for their occupants, Confederate authorities allowed Union doctors to bring several loads of medical supplies to the casualties, whom the enemy commanding general agreed to parole as soon as they could be moved. Medical officers sent Banks' wounded on to general hospitals in New Orleans and Baton Rouge.56

The medical director who would normally have kept the records for Steele's force was in the East for Surgeon General Hammond's trial from late January to early May, and the records of the medical care for this half of the Red River force during April are missing. Some of the wounded were arriving at hospitals in Arkansas by the time of the medical director's return, however, a few at Pine Bluff and the rest at Little Rock. Medical officers had taken over private homes to house their patients in Little Rock but, sharing the belief of so many of his colleagues that such buildings were too poorly ventilated to serve adequately as hospitals, the medical director ordered tents set up around the general hospital for the use of the wounded. Erysipelas had already appeared among them, however, and convalescence took unusually long. Surgeons eventually had many of the wounded moved to northern hospitals, either accompanied by a medical officer or, if convalescent, in small unattended groups on passenger vessels.

Although the Army dropped its Red River campaign, Arkansas saw further action when a Union force of 6,500 men came through in pursuit of Confederate guerrillas in September. The Union general sent his sick, numbering more than 600, to the hospital at Duvals Bluff and his convalescents to a camp established for them in Arkansas. These new patients added to the strain placed upon the hospital system by the sick and wounded of units normally in the area, where the disease rates were high and the proportion of medical officers to men was low.

Conclusion

The campaign west of the Mississippi was not a failure as far as the Medical Department was concerned, despite military defeats, the capture of many of the wounded and a number of medical officers, the loss of ambulances, and the absence of one of the leaders of the department in Arkansas during the first five months of the year. Surgeons were also plagued by temporary shortages of vegetables and supplies caused by low water in the Arkansas River, unexpectedly low temperatures, and the destruction in a fire of quinine reserves. But experience with the demands of war had by now taught the leaders of the Medical Department in both the West and the East the nature of the challenges they could

56Quotes from MSH 1, pt. 1, app.:336. Unless otherwise indicated, material on the Red River expedition and action in Arkansas is based on MSH 1, pt. 1, app.:336, 345, and on Smith, Ms C126, NLM.


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expect to meet, and many of their subordinates the nature of military medicine. Despite adversities, therefore, the Department was able to keep the situation in the West under control and to handle the difficulties encountered in the course of the year as well as circumstance permitted.

The armies that would bring about the final defeat of the Confederacy, however, were fighting in the East. It was in Virginia and Georgia that medical officers were experiencing unfamiliar challenges. Grant's constantly moving army made a shambles of an evacuation system that had under other circumstances been adequate. The long and vulnerable supply lines in the wake of Sherman's force as it penetrated deep into enemy territory called for the exercise of more than ordinary ingenuity in anticipating and meeting medical and hospital needs. Because they had the active support of both the surgeon general and the secretary of war, medical directors of the armies of Sherman and Grant could concentrate upon meeting these new challenges, and the members of the Medical Department as a whole could function effectively as a team in the final months of the Civil War.