H-Net: Interview Text {Part One}
NE: Guy, to start our conversation, you have already written a few books
on Civil War era medical topics, how did you decide to do this one on
the Confederate Army Medical Department?
GRH: Although I’m
interested in many aspects of Civil War medicine, I had become
especially intrigued by the Confederate Army Medical Department and how
it managed to keep itself going throughout the war. The central figure
in that organization was Surgeon General Samuel Preston Moore, but there
is little written about him other than mentions of his stern character
and organizational skill. Since Moore apparently left no diary or cache
of personal papers, my initial hope—primarily to satisfy my personal
curiosity—was to learn more about him by studying the operations of his
office in Richmond. I found some information about office personnel, but
it said little about how or why things were done. I then concluded that
the best course was to study the decisions emanating from the Surgeon
General’s Office.
The decisions themselves, and the
records pertaining to them, are difficult to appreciate without context.
How, for example, can communications about hospitals be understood
without knowing those facilities’ role and the influences upon them? As I
educated myself about various aspects of the department’s operations, I
came to realize that the information and insights I was accumulating
might be useful to others. The potential audience would include readers
looking not only into Confederate medicine but also into other aspects
of the Southern war effort. After all, an army’s effectiveness is
strongly linked to its health, and the Medical Department did not exist
in a vacuum. It interacted with the Quartermaster and Subsistence
Departments, for example, and had to deal with the interests of
politicians and military commanders.
Part of deciding to
write a book is examining what has already been published. The only
book-length work of relevance is H. H. Cunningham’s Doctors in Gray,
first published in 1958. Cunningham’s work is excellent but
wide-ranging, extending from government offices in Richmond to the
ailments of soldiers in the field. It would not overlap much with what I
had in mind, which was focused on departmental operations. Doctors in Gray
is based on Cunningham’s Ph.D. dissertation, whose source material is
nicely documented. The book itself, though, does not link statements
with specific reference sources and is thus of limited helpfulness to
researchers. Although Cunningham assembled an impressive bibliography,
he omitted many sources that I had found to be vital.
As a longtime researcher of Confederate medicine, I saw a place for Matchless Organization. It goes beyond Doctors in Gray
in detail, describes how the Medical Department reacted to
circumstances and interacted with other divisions of the War Department,
and serves as a solid reference source and foundation for further
research.
NE: What is your argument in Matchless Organization?
GRH:
Let me first say that, in general terms, my research mission was to
learn how the Medical Department functioned rather than to prove a point
or answer a specific question. Confederate archival material is far
from complete, and my experience had taught me to go where the
information led me. What emerged was a view of the Medical Department
that can be expressed in the following argument:
The
Confederate Medical Department, under the leadership of Surgeon General
Moore, did a creditable job of providing medical care in spite of
substantial challenges. Those challenges included personnel and materiel
shortages, worsening conditions in the South, interference from various
parties, a physician workforce primarily composed of men without
previous military service, and an overall lack of experience in
conflicts as large and intense as the American Civil War.
I
believe that the department’s accomplishments can be accounted for by
its robust organization and its ability to adjust to the changing
conditions.
NE: I want to get back to the resilience and
accomplishments in a moment, but first I want to chat a little about
your sources. When reading, you very quickly run into a passage where
you make a mention about a lack of sources and records. How difficult
was it to find source and thus tell this story?
GRH: Well,
first, the research was done and the manuscript submitted before the
COVID-19 pandemic struck, so that wasn’t an issue.
Many
records of the Surgeon General’s Office were destroyed in the Richmond
fire of April 1865. Thus, there are no complete sets of incoming or
outgoing correspondence, circulars, or orders. Also missing, I imagine,
are some reports that Surgeon General Moore wrote to the president or
secretary of war that might have gone a long way toward clarifying
various matters. Moore was especially sorry about the loss of compiled
statistics about illness, wounds, survival rates, and so forth. There
were, however, medical facilities in Richmond that didn’t burn, and
medical officers throughout the South usually kept their own copies of
official correspondence. Much of this material now resides at the
National Archives and Records Administration (NARA) facility in
Washington, DC.
There was plenty of archival material to
examine, but some of it was scattered in unfamiliar or unexpected files.
A big problem was that the records’ spottiness made them difficult to
interpret. That meant doing more background reading and consulting
multiple sources when a single, but nonexistent, explanatory report
might have clarified things upfront. My investigations often ended in
blind alleys and left questions unanswered.
I was, luckily, able to retrieve tons of information without leaving my computer. The army Official Records and the Medical and Surgical History of the War of the Rebellion are
available online or on DVD. The subscription service Fold3 has
Confederate compiled service records, some correspondence of the
Adjutant and Inspector General’s Office (AIGO), the Confederate citizens
file, and Confederate amnesty applications. The online NARA catalog
allows access to various AIGO records, including special orders. Old
newspapers can be examined via subscription services and though a free
Library of Congress site. Numerous books and articles that touch on
Confederate medicine are available online. First-hand accounts were
generally the most useful, but more recent works with complete
bibliographies often provided leads that warranted follow-up. A couple
of caveats about online sources: First, searching in printed material
can be frustrating because poor print quality, which is common in old
newspapers, can make optical character recognition inaccurate or
impossible. Second, the indexing of handwritten documents, when it
occurs, depends on staffers or volunteers reading names, which is
sometimes done incorrectly.
Much NARA material is not
online and must be examined in person. This involves knowing (or
guessing) where to look and then scrolling through microfilm or
requesting, waiting for, and finally leafing through paper records. The
process is tiring but gratifying when it yields a gem. Archival
repositories other than NARA were usually quite accommodating in sending
copies of requested materials.
It’s hard to say whether the research was more difficult for Matchless Organization than
for my previous projects. It certainly took more time because of the
range of topics covered and the need for additional background reading
and sleuthing. However, my general strategy of looking in many places
and following leads was the same. In some ways, researching Matchless Organization may
actually have been easier. First, I’ve been looking into Confederate
medicine on and off for more than 20 years, so I already had some source
material that ended up in the book. Second, that long involvement has
given me insights into the topic, so I was a bit better at interpreting
what I was finding and deciding how to follow up. Third, I’ve gained
some efficiencies over the years as a researcher, especially with NARA’s
Confederate collection. Fourth, it’s easier nowadays to access
published and archival materials online. None of this is to say that the
research was a piece of cake, because it wasn’t. Frankly, if the
research were easy, someone else probably would already have done it.
For me, the challenge of research is what makes it rewarding.
NE: I
also wondered about medicine and medical education at the time. How did
you become an M.D. and then a surgeon in the military? Were these
well-educated and qualified individuals?
GRH: At the time of
the Civil War, there was essentially no regulation of medical practice.
Educational requirements for becoming a physician, licensure, and
accreditation of medical schools did not exist, so anyone could claim to
have medical expertise and treat any patients willing to take their
chances with that practitioner. Most new physicians had probably served
an apprenticeship under a seasoned physician.
Medical
schools offered a single course of lectures per year. A course—we’d
probably call it a semester now—typically lasted several months and
consisted of lectures in several subjects, such as anatomy, surgery, and
pharmacy. Admission often required no more than the ability to pay
lecture fees. To receive an M.D. degree, a student had to attend two
courses of lectures, which did not have to be at the same school or in
consecutive years. If both courses were at the same school, then the
first and second courses were likely to be identical. Schools varied in
the amount of dissection or laboratory work and in the time devoted to
examining patients. There might be an exam to pass and a thesis to
write, but almost anyone with adequate funds who wanted an M.D. degree
could find a school to award it.
Many practitioners who
attended medical school took only a single course and never received a
degree, and many evidently did not consider medicine to be an
all-consuming career. It’s common to encounter physicians, with or
without a degree, who had other occupations or entered the army as
common soldiers. To be fair, some physicians devoted themselves to
medicine and went well beyond the minimum in attaining knowledge by, for
instance, traveling to Europe for additional training. Articles in the Confederate States Medical and Surgical Journal and
other periodicals by active or former Confederate surgeons reveal those
men to have been intellectual, keenly observant, and much more
well-informed than would be expected from completing just the typical
medical-school curriculum.
Early in the war, many
physicians were elected as surgeons by their regiment or appointed by
their governor. They then entered Confederate service as medical
officers when their state units were absorbed into the Confederate Army.
After it became clear that many such men were unqualified, they—and all
men applying to become medical officers—became subject to examination
by a medical board. Surgeons who failed the exam were asked to resign,
and those who did not were dropped from the ranks. The exams were
modeled after the fairly rigorous ones used by the U.S. Army but were
probably made easier to pass so as to fill open positions. It appears
that new applicants were required to have an M.D. degree from a
respectable school during the latter part of the war, but that
prerequisite may not have existed earlier. In any event, the exams were
credited with weeding out many incompetent surgeons and keeping
unqualified applicants from entering the medical corps.
The
physicians most competent to treat the Confederate sick and wounded
were probably those who had resigned from the U.S. Army, but there were
only about 25 of those among the thousands of men who served as
Confederate surgeons. Other very able physicians might include those who
had accumulated education and experience through years of practice. I
don’t think that age limitations were enforced rigidly by medical
boards, but many seasoned practitioners would probably have been judged
to be physically unsuited for the rigors of army life, although they
could serve as civilian contract surgeons. Physicians who had practiced
medicine for the past five years were exempt from conscription and felt
no need to join the medical corps to avoid being drafted as soldiers.
Thus,
most Civil War surgeons were fairly young and had been in civilian
practice or recently attended medical school. They had probably never
treated a gunshot wound, amputated a limb, or advised a commander (who
himself had recently been a civilian) about proper camp sanitation. One
young man reported passing the medical board examination and being
appointed assistant surgeon without ever having treated a sick person or
even lanced a boil.
Many soldiers were frightened at the
prospect of being treated by a Civil War surgeon, especially a young
one with whom they were unacquainted. However, given the state of
medical knowledge and education at the time, the need to provide care to
a huge army, and the available pool of civilian physicians, the
Confederate Medical Department probably did as well as could be expected
in selecting its medical officers.
To Be Continued in Part Two
Text Source: H-Net