Meet the Hospital Steward
His Role & Responsibilities Including His Relationship to Nursing
William T. Campbell, Ed.D., RN
Originally published in December 2013 in the Surgeon’s Call, Volume 18, No. 2
In any U.S. Army General Hospital during the Civil War, one would find an assortment of Medical Staff and support workers. Present would be the usual Surgeon, Assistant Surgeons, and Acting Surgeons (contract surgeons). Assisting them would be detailed male nurses, primarily convalescent or invalid soldiers, female nurses who were usually volunteers, and maybe a couple of Sisters from religious orders. In addition, there would be an assortment of orderlies, attendants, ward masters, cooks, laundresses, matrons, guards, and lastly the lonely sole Hospital Steward. Depending on the size of the hospital there might be a second Hospital Steward (more than 150 beds) or a third (more than 400 beds), but they were undermanned and overworked. The Steward was not only present in the hospital, but also found assisting the Surgeon with the regiment on the march, or in the camp, or on the battlefield, and on board naval ships. As the pharmacist of that era, these men were in great demand in both the military and civilian life. Their demand was so high that the Commonwealth of Virginia petitioned that a civilian druggist or chemist could not volunteer or be drafted as he was needed in the community. There were only 45 in the entire commonwealth and now they were needed not only to compound and distribute medicines, but with the blockade in place, they were also needed to manufacture medicines.
Any Civil War enthusiast who has read about the Hospital Steward would define this individual as a “workhorse.” While this position does not exist today as a single individual, at the time of the Civil War this man was commonly seen as the druggist/chemist (pharmacist today) and the hospital administrator. He was the druggist or chemist who worked in the dispensary (equivalent of the apothecary shop in civilian life then, or the drug store or pharmacy today). He compounded prescriptions rather than filled them. Pharmacy was not seen as a science until 1868, even though the Philadelphia College of Pharmacy had been educating these men in civilian life since 1821. The term Hospital Steward was replaced with Pharmacist in 1902. If assigned to a hospital he was also the Hospital Administrator. He functioned as the clerk, the COO, and the CFO.
Many of these men have interesting and unique stories to tell. Hospital Steward W. Moore Smith, 59th and 71st Pennsylvania Infantry, served at Gettysburg and faced the care of overwhelming casualties. Hospital Steward Perry W. Bahl, 16th Ohio Infantry, was wounded at Fort Gibson, MS. He was one of many hospital workers injured during the war. Pvt. Harlan Goodell, 7th Massachusetts Light Artillery, was discharged for disability, but stayed on and volunteered as a Hospital Steward/nurse/clerk at Higgins Hospital at Fort Monroe, VA. Hospital Steward William A. Bulkley at Satterlee Hospital in West Philadelphia found himself detailed as the Postmaster. Hospital Steward Theodore St. Clair, also at Satterlee Hospital, was ordered by I. I. Hayes, Surgeon in Charge, to be the Inspector of Police. Charles F. Beal, Acting Assistant Surgeon, at Dunbarton Street Hospital in Georgetown, tried to explain to his father in a letter dated July 1, 1863, that he had resigned his surgeon’s position and applied to be a Hospital Steward in the Regular Army. He said the position was very difficult to obtain and he had gathered recommendations from three surgeons in preparation for his application. Hospital Steward R. C. Underwood, born in Georgia, enlisted in the U.S. Regular Army and served at Fort Delaware in the post hospital. While safe from the battles he still did not survive the war. He died of consumption while on Pea Patch Island and is one of 135 Union soldiers buried at Finns Point in New Jersey. Hospital Steward M. B. Summer, 13th South Carolina Infantry, was captured near Gettysburg on July 5, 1863 at the Samuel Lohr Farm Hospital. He also did not survive his days of imprisonment on Pea Patch Island in the Delaware River. He died of smallpox on September 13, 1863 and is one of 2436 POW’s buried in a mass grave at Finns Point, Fort Mott, NJ.
To better understand the Hospital Steward it is best to read the first authoritative reference on this position written by J.J. Woodward. The Hospital Steward’s Manual: For the Instruction of Hospital Stewards, Ward Masters, and Attendants in their Several Duties was published by Lippincott & Co. in Philadelphia in 1862. Dr. Woodward was an Assistant Surgeon in the U.S. Army and was requested to write the instruction manual by the Surgeon General. In the manual Woodward (1862) states the medical qualifications of this applicant: “must have…sufficient knowledge of…pharmacy to take charge of the dispensary, acquainted with minor surgery, …application of bandages and dressings, extraction of teeth, application of cups and leeches, …knowledge of cooking.” One should note that the qualifications are much broader than pharmacy. The manual not only included the roles and responsibilities of the Hospital Steward, but also continued to include hospital attendants and nurses. Dorothea Dix had her own reference copy.
The Hospital Steward was selected and appointed to his position and title. In contrast, the male nurse was usually temporarily detailed without change in rank or title from inexperienced enlisted men. The Steward had to apply for his position using an application process. Woodward’s (1862) qualifications included “18-35 years old, able-bodied, free of disease, honest and upright,” of “good intelligence, having a knowledge of English, able to spell and write correctly,” and “industrious, patient, and good tempered.” There was a competitive exam to take. He was screened for previous experience and having worked as a druggist or chemist or apothecary clerk in civilian life was a huge plus. Previous experience even as a medical student was greatly beneficial. After the exam, interviews, and references, the appointment had to be confirmed by the Secretary of War. Once the process was successfully completed the Hospital Steward received the rank of NCO (Non-Commissioned Officer). He was “equal to Ordnance Sergeant” and “next above First Sergeant.” The appointment was permanent for the duration of the war and he could not be returned to regular duty. He was the only able bodied man who could not be returned to active duty.
Woodward’s manual (1862) also dictates the dress uniform and symbols of position and rank. The dress sword shall be the NCO sword, not the MS sword. The dress sash shall be red worsted wool, not green silk. The insignia shall be the half chevron of caduceus and snakes worn on the upper sleeves. The dress hat can be adorned with a feather or plume, an eagle pin on the right side, a gold Laurel wreath on the front with a silver US (not MS), and a green and buff hat cord. The undress uniform for fatigue purposes or hospital work clothes includes the blouse or sack coat with the same very distinctive half chevron on the upper sleeves. The pants are to be the sky blue enlisted foot soldier’s trousers with a 1 ½ inch wide crimson stripe down the outer seams. The red/ crimson stripe and sash does not mean artillery as a branch of service but rather means NCO. The cap is the enlisted man’s regulation forage cap. The uniform, color code, and insignia certainly distinguished this position from the rest of the medical staff.
The roles and responsibilities of the Hospital Steward were numerous and varied depending on his duty location. In the hospital and acting as the pharmacist, he compounded (measured and mixed) prescriptions written in the prescription book by the surgeons, rather than just filling them from a bulk supply. He also verified that the medication was actually administered although he was usually not the person who gave it. As Hospital Administrator, he was responsible for inventory and ordering of medical supplies, hospital supplies, record keeping, and overall hospital administration. His inventory of records was never ending. It included the Steward’s Weekly Report, an enormous spread sheet manually recorded. On it were recorded weekly the number of beds, linen, clothes, dishes, and even spittoons. In the field and on the march his dispensary had to be mobile and he learned to quickly assemble and disassemble it. Much of his time was spend in packing precious glass bottles of medications. Dr. Jonathan Letterman even assigned the Hospital Steward to carry the hospital knapsack for the surgeon when on the march.
In addition to the roles and responsibilities previously mentioned, Woodward listed one other responsibility. The Hospital Steward was to be the nursing supervisor for the male detailed nurses (enlisted men), but not for the female nurses. Woodward (1862) stated: “enlisted men are under the orders of the surgeon…look up to as their commanding officer…are also under the orders of the hospital steward, to all whose lawful commands they must yield prompt obedience.” Gillett (1987) in The Army Medical Dept 1818-1865 also mentioned the tie with nurses when she said “…the Hospital Steward, who before the [Civil] war often added the role of nurse to his other duties…”. The supervisory role was echoed in the South where the Regulations for the Army of the Confederate States, Medical Department (1862) stated “the cooks and nurses are under the orders of the stewards.” In contrast, regarding the female nurses, Woodward stated “she should heartily co-operate with the steward, and strictly obey the orders of the medical officers.” While all female nurses were under the orders of the Surgeon and for some also the supervision of Dorothea Dix, they were not under the orders of the Hospital Steward.
Want more? Read Seven Hospital Stewards.
Learn more in this interview with Dr. William Campbell, the article’s author
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Roper, John (Ed.). (2001). Repairing the March of Mars: The Civil War Diaries of John Samuel Apperson, Hospital Steward of the Stonewall Brigade, 1861-1865. (Jason Clayman, Peter Gretz, and John Herbert Roper, Trans.). Macon, GA: Mercer University Press. (Original letters 1861-65).
West, Alan I. (2010). Remember Me: Civil War Letters Home from a Hospital Steward 1862-1864 Daniel McKinley Martin. Chicora, PA: Mechling Bookbindery.
Woodward, J. J. (1991). The Hospital Steward’s Manual: For the Instruction of Hospital Stewards, Ward Masters, and Attendants in their Several Duties. (New introduction by Ira M. Rutkow.) San Francisco: Norman Publishing. (Original work published 1862, Philadelphia: Lippincott).
About the Author
Dr. Campbell is an Associate Professor and RN Coordinator at Salisbury University in Salisbury, MD. He has been with the faculty of the Department of Nursing at SU for fifteen years and has been a Registered Nurse (RN) for 31 years. He teaches undergraduate nursing courses in pediatrics, pharmacology, and health assessment. Dr. Campbell attended Philadelphia College of Pharmacy & Science, completed undergraduate degrees in biology, psychology, and nursing at the University of Delaware, a masters degree in family nursing at Salisbury University as a clinical specialist, and his doctor of education in educational leadership at the University of Delaware. He is a member and docent of the NMCWM, and spends much of his free time reading, researching, and speaking as a living history interpreter on topics of Civil War era medicine and nursing.