A Q&A with Dr. Guy Hasegawa About His Latest Book on the Confederate Medical Department

In anticipation of Dr. Guy R. Hasegawa’s presentation at the National Museum of Civil War Medicine on August 14 at 2:30 PM on his new book Matchless Organization: The Confederate Army Medical Department, we asked him a series of questions about the Confederate Medical Department, the writing process, and what further questions he hopes to investigate. You can get an autographed copy of his book at the Museum the day of the presentation, or on our online store.

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How difficult was it to gather information on the Confederate Medical Department since so many of their records were lost in the Richmond fire of April 1865?

It is true that the fire destroyed the building that housed the Medical Department and many of its records. Keep in mind, though, that there were offices and hospitals in Richmond and elsewhere that did not burn and that medical officers generally kept their own copies of correspondence and other official documents. A lot of very useful documents survived the war, and many of them were published either in The War of the Rebellion: A Compilation of the Official Records of the Union and Confederate Armies or The Medical and Surgical History of the War of the Rebellion, both of which can be accessed online or via DVD. The National Archives and Records Administration (NARA) has a large collection of Confederate documents, many of which are available through the NARA catalog or the subscription service Fold3. NARA material that is not available online can be examined in person at the NARA facility in Washington, DC.

Although archival records probably accounted for the bulk of individual citations in my book, a glance at the notes and bibliography will show that most of the consulted sources were not Confederate records at all. Books and articles on the topic—especially period or first-hand accounts—were valuable, as were historical newspapers. Many such sources are available online.

Of course, not having complete Confederate records was frustrating, but there is ample information, archival and otherwise, to form a good idea of what occurred. Even if complete records were available, gathering and interpreting them would be a chore. Writing a thorough history of the US Army Medical Department during the Civil War, for example, would be a massive undertaking because of the mountains of available records.

What are a few of the more obscure sources that contributed important information for the book?

I think that obscurity is in the mind of the researcher. Many researchers seem not to look beyond published sources, so to them, any archival material might be obscure. For the type of work I’ve been doing, though, NARA has provided the bulk of information, so I’ll use NARA Confederate army records as a frame of reference and I’ll address, first, sources that are often underused among researchers and, second, those that I would call obscure.

Books and articles on Confederate medicine often confine the use of NARA documents—if they are consulted at all—to records labeled as arising from the Medical Department. An abundance of useful information, however, can be found in compiled service records, records of the Adjutant and Inspector General’s Office (AIGO), correspondence of the Secretary of War, the Confederate citizens files, and the Confederate amnesty files. For any of these, the researcher would need individual names to look up. The AIGO was the personnel division of the Confederate Army, so its files can show, for example, where soldiers and officers were assigned and when. Individuals might communicate with the Secretary of War because they desired a particular military appointment or had something to offer the government. The citizens file is supposed to contain correspondence and vouchers for civilians who had business dealings with the Confederate government, but military figures can sometimes be found because they dealt with the government as civilians or because some of their military records were misfiled there. Finally, the Confederate amnesty files, which are actually records of the U.S. Adjutant General’s Office, contain amnesty requests to the U.S. government from former Confederates; the applications typically summarize applicants’ Confederate service in their own words. I sometimes consult these sources when trying to find a specific bit of information. At other times, they are a routine part of a wide-ranging search. Many of the sources are online, so there’s little reason to neglect them.

Among my truly obscure NARA sources was “Communications from the Confederate War Department to the Confederate Congress” (entry UD 176A in Record Group 109). This file does not appear in the printed inventory of NARA’s Confederate records, but I stumbled over its listing while browsing the online NARA catalog. Although its title does not suggest medical content, I examined the file in person at NARA and found some vital documents, including the surgeon general’s proposal for a medical-evacuation system. Another obscure find was a staff roster of the Surgeon General’s Office, which resides in a huge compilation simply called “Manuscripts” (entry 183 in Record Group 109). The same manuscript number (3055, with no other details) appeared in the compiled service records of hospital stewards who worked for the surgeon general, so I made an educated guess about where to look and found manuscript 3055 to be the roster; several other useful documents were in the same compilation. I knew about the hospital stewards from a collection of letters I had on file from a previous project. To me, the lesson is that one can increase the likeliness of lucky finds by casting a wide net and following leads.

There were obscure sources outside of NARA. I was, for example, lucky to be aware of and obtain permission to use important materials from private collections, whose existence is generally unknown. I came to know the documents’ owners by meeting them at functions of the National Museum of Civil War Medicine and the Society of Civil War Surgeons.

What were the main differences in the operation of the Confederate Medical Department versus the US Army Medical Department?

The Confederate Medical Department suffered from a relative lack of personnel and material resources. Thus, Confederate regiments typically had one surgeon and one assistant surgeon, while Union regiments usually had a surgeon and two assistant surgeons. That staffing difference was largely behind the inability of the Confederates to implement an effective medical evacuation system. Because of the Union naval blockade and the weak Southern industrial base, Confederate surgeons often lacked sufficient supplies, such as medicines, surgical instruments, and ambulance wagons. That circumstance forced the department to devote attention to getting goods through the blockade or producing them locally, where manufacturing facilities and experts to run them were scarce. Supply shortages were much less problematic for Union surgeons. Most of the war was fought in the South, so the Confederates were forced to move various facilities, such as hospitals and medical purveying depots, out of the path of Union advances.

What were the main similarities?

The Confederate Medical Department was modeled after its Union counterpart. Regulations and procedures were quite similar, and many of the Confederate medical officers with the most responsibility had recently been U.S. medical officers. The prewar U.S. Army had a small medical department, so the huge scope of the Civil War and the need for large numbers of new medical officers meant that the vast majority of surgeons on both sides had recently been civilians. Union and Confederate medical officers probably had about the same quality of medical education, in part because many surgeons from both sides had attended the same medical schools.

Explain the roles of Medical Directors, Medical Inspectors and Medical Purveyors in the Confederate Army.

All of these titles were held by medical officers. Changes in how these officers operated reflected the surgeon general’s desire that their actions be controlled by him rather than by local military commanders.

Medical directors served on the staffs of commanders at the army or corps level. They helped coordinate medical activities and occupied the level of command below the surgeon general and above division, brigade, and regimental medical officers. Field hospitals fell under the purview of medical directors, as did general hospitals for about the first half of the war. During the second half of the war, medical directors of hospitals, who reported directly to the surgeon general, were responsible for general hospitals in defined geographic areas or for specific commands.

Medical inspectors were charged with examining facilities such as general and field hospitals, camps, and purveying depots to ensure that procedures and hygienic standards were maintained. Inspectors initially belonged to the same commands that they inspected, but this raised the awkward possibility of having to report adversely on colleagues. By the later part of the war, inspectors were assigned by and reported to the surgeon general, were not associated with the facilities they inspected, and had their assignments rotated from time to time to reduce the chance of bias.

Medical purveyors purchased and issued medical supplies. Field purveyors were attached to armies and received requests for supplies from their army’s corps, divisions, brigades, and regiments. The requisitions were then forwarded by the field purveyors to Richmond and subsequently to one of several depot purveyors to be filled. There were nine purveying districts, each with its own supply depot directed by a depot purveyor who reported to the surgeon general. Most purchasing of supplies was done by depot purveyors, but field purveyors and individual surgeons could buy supplies locally if necessary.

How important was the use of indigenous plants and the establishment of medical laboratories in the war effort?

Before the war, the South obtained almost all of its medicines, many of which were of foreign origin, from Northern wholesalers. The war dramatically reduced the inflow of goods from the North and the importation of supplies from overseas, so the South could not reliably obtain medicines in needed amounts or at an affordable price. The Medical Department thus established laboratories (usually associated with purveying depots) to carry out two efforts. The first was to manufacture standard medicines—that is, those that were supposed to be available to surgeons and were generally considered useful by mainstream physicians. Standard medicines prepared in the laboratories included chloroform, ether, mercurial formulations, and opium. The second effort was to make medicines from indigenous plants to substitute for unavailable standard agents. It should be noted that many standard medicines were plant-based, and some were made from species growing in North America. Most of the plants processed by the laboratories were recognized as having medicinal properties but were not considered first-choice treatments by most clinicians.

According to today’s medical knowledge, the number of truly useful standard Civil War medicines was quite limited. They included chloroform, ether, quinine, and opiates. The medical laboratories produced the anesthetics chloroform and ether but in unknown quantities and of unknown quality. It is possible that those two products of the laboratories were truly beneficial in allowing surgical operations and relieving pain. Great efforts were made by the laboratories to produce antimalarial substitutes for quinine, but there seems to have been general agreement at the time that none measured up to quinine. Opium and its derivatives were useful in treating pain, diarrhea, and cough, and laboratories gathered opium from poppies grown in the South. Again, it is unknown exactly how much opium was processed and how potent it was. The laboratories prepared many medicines that would today be considered ineffective or too dangerous to use. Thus, the overall importance of the laboratories and indigenous plants is hard to determine. Establishing the laboratories was a reasonable response to drug shortages, and some of their output may have reduced suffering. The laboratories produced some standard medicines at lower-than-market costs, but whether the savings exceeded the expense of labor and of equipping the facilities is unknown.

How did the hospital system change over time?

We’re referring here to general hospitals rather than field hospitals. General hospitals were located away from the fighting, were in more or less permanent structures, and had their own staff. In contrast, field hospitals were not far from the front lines, were established hastily in convenient structures or tents, could be disbanded and moved quickly, and were staffed by regimental surgeons and men from the ranks. Field hospitals were temporary and handled the ill from camp and the wounded from battles. Men needing a higher level of or extended care were transferred to general hospitals.

Early in the war, general hospitals were established in existing structures, such as public buildings, factories, or warehouses. As the war progressed, the Medical Department favored the building of pavilion-style hospitals, which were quickly constructed facilities consisting of large numbers of identical single-story wooden buildings. The individual structures were designed to ensure ample ventilation and space for each patient (considered vital for health and recovery) and were usually made to accommodate two rows of beds or cots (a total of 40–60 patients). If a highly contagious disease appeared in pavilion-style hospital, the affected building could be easily evacuated and fumigated if necessary. In contrast, the same circumstance might necessitate the evacuation and disinfection of an entire warehouse hospital. Furthermore, hospitals in preexisting buildings were often in the midst of a city or town and presented the danger that disease might spread from the hospital to the populace. Pavilion hospitals, on the other hand, tended to be located on the outskirts of population centers. In a pavilion hospital, specific buildings could be devoted to patients with similar diagnoses.

A related development involved the control of hospitals. Early in the war, some hospitals were established by private groups (charitable organizations, for example) and individual states. Although the Medical Department gained overall control of these hospitals, the surgeon general preferred to do away with the interference posed by the other parties. The construction of large pavilion-style hospitals allowed him to close many small private hospitals. Governors and legislators wanted individual hospitals to be devoted to soldiers from their state, which could pose logistical problems if hospitals consisted of single large structures. Because they were composed of multiple buildings, sections of pavilion hospitals could be devoted to the various states.

What new questions arose while researching this book?

Although we have a general picture of what happened, I’d like to know more about the behind-the-scenes drama and maneuvering.

Samuel Preston Moore was surgeon general for most of the war, but he was preceded by David Camden DeLeon as acting surgeon general. DeLeon was probably replaced because Moore, who entered Confederate service after DeLeon, had seniority when they both served in the U.S. Army, but there was an allegation that DeLeon had failed in some important duty. DeLeon then served briefly as medical director of the Army of Northern Virginia, but he was disabled by a fall, resigned from the army, and pretty much disappeared from the scene. So what was the real story about DeLeon?

Moore is the central figure in the book, yet how he interacted with other key personalities is largely unknown. I’d like to know, for example, what he thought of Adjutant and Inspector General Samuel Cooper, who directed the AIGO. The AIGO, on paper, was a coequal member—with the Medical, Quartermaster, and Commissary Departments—of the army’s general staff. However, Cooper was a crony of President Jefferson Davis, was the army’s highest ranking general, and tended to throw his weight around. He and Moore had at least one disagreement regarding authority, so it would be enlightening to learn how Moore handled that relationship.

Moore’s relationship with Surgeon Edward W. Johns, medical purveyor at Richmond, is also intriguing. Johns may have sought additional power as the head of a new Purveyor General’s Office, separate from Moore’s Medical Department and on par with the rest of the army general staff. Moore would probably have opposed such a development, and the Purveyor General’s Office was never formed. It would be fascinating to know what transpired and why.

Unless someone finds a long-lost wartime diary, journal, or cache of personal letters written by Moore or one of his close associates, such questions may never be answered. I hope that my book raises other questions and serves as a baseline for further research.

Click here to order the book

About the Author

Guy R. Hasegawa received a B.A. in zoology from the University of California, Los Angeles, and a Doctor of Pharmacy degree from the University of California, San Francisco. He worked as a clinical pharmacist in Ann Arbor, Michigan, where he also served as Assistant Clinical Professor at the University of Michigan College of Pharmacy. He recently retired after a 31-year career as an editor for the American Journal of Health-System Pharmacy. His pharmacy-related publications date back to 1978.

Dr. Hasegawa’s research in Civil War medicine has dealt with diverse topics, including pharmacy, medical purveying, medical cadets, chemical weapons, and artificial limbs. He has published numerous historical articles in scholarly journals and contributed chapters to books on Civil War medicine. His latest book is Matchless Organization: The Confederate Army Medical Department (2021). His previous books include Mending Broken Soldiers: The Union and Confederate Programs to Supply Artificial Limbs (2012) and Villainous Compounds: Chemical Weapons and the American Civil War (2015)