Review - "Matchless Organization: The Confederate Army Medical Department" by Guy Hasegawa

[Matchless Organization: The Confederate Army Medical Department by Guy R. Hasegawa (Southern Illinois University Press, 2021). Softcover, photos, illustrations, appendices, notes, bibliography, index. Pages main/total:xiii,183/275. ISBN:978-0-8093-3829-0. $26.50]

The American Civil War's mass mobilization of the military-age populations of both sections presented near insuperable challenges to the army medical departments of the US and Confederate governments. Though neither belligerent was adequately prepared to meet the healthcare needs of hundreds of thousands of newly inducted men, or the casualties incurred during war's early battles (which were small by later standards), the United States did have the benefit of an existing bureaucracy to help it at least begin to effectively address those trials. On the other side, the Confederate medical department possessed nowhere near the same resources but also did not have to start completely from scratch. A number of senior and experienced medical department officers left their posts in the US Army and were able to essentially copy that well-established bureaucratic system and put it to use in the new Confederate Army. The history of that process and its wartime application is the primary focus of Guy Hasegawa's excellent new book Matchless Organization: The Confederate Army Medical Department.

Hasegawa's study is remarkable through the extent by which the author was able to mitigate basic source limitations. Most of the records of the Confederate Army Medical Department did not survive the chaos of the war's final moments, being either destroyed at Richmond or lost during the retreat from the capital. Nevertheless, Hasegawa's research effort was able to collect more than enough supporting sources of all types to provide a very comprehensive survey of the medical department's key personnel, organization, breadth of operations and responsibilities, and overall war record.

In the book, Hasegawa explains at some length the duties and responsibilities of the key cogs in the medical department bureaucracy—most specifically the Surgeon General but also the medical directors of army hospitals, medical inspectors responsible for enforcing regulations, and medical purveyors tasked with obtaining all of the department's necessary medicines and supplies. It quickly became apparent to the last group of officers that obtaining adequate medical supplies would be an enormous challenge that could only be adequately met by a combination of importation through the blockade and renewed exploitation of domestic sources. Procurement would always be limited by supply and payment shortages, but there was also considerable resistance to the official use of many native remedies (especially from the allopathic medical community), and that conflict within the profession (which still exists today) is outlined in the text. Also addressed in some detail are the roles of medical department officers and personnel in battlefield care, general hospital administration, and prison hospital operation. The department's recognition of the need for examining boards to ensure competence of surgeons and other medical staff is discussed as well. In conjunction with Confederate lawmakers, the department also assumed a key role in the army's disability certification, medical discharge, and even furlough procedures. The ways in which that process became more involved and more controversial as the war progressed (particularly after national conscription was enacted) is well explained in the book.

As much as the volume serves the reader well as a general history of the medical department, it is just as much an account of the wartime role of the Confederate Office of the Surgeon General (SGO) and a detailed professional biography of its longest serving and most influential leader, Surgeon General Samuel Preston Moore. Though he could be abrupt in manner, Moore was by nearly all accounts a gifted, no nonsense administrator. While, as mentioned above, the Confederacy avoided having to create a medical department out of whole cloth by adopting the existing US Army system of organization, regulations, and seniority, that mostly sound decision sometimes had the detrimental effect of stifling innovative initiatives that might have helped mitigate problems attached to the Confederacy's inferior material and human resources. Nevertheless, Moore often took a pragmatic approach to addressing those problems. For example, like his Union counterpart, Moore was impressed with the French model of battlefield casualty care and evacuation, but he also recognized that his own organization did not have the resources to emulate it for every major army. Instead, Moore attempted to create a "Reserve Surgical Corps" that would be sent as needed to major battlefields, which was a good idea in theory that was derailed in practice by legal barriers and resource, staff availability, and transportation limitations outside of his control. The impossibility of being able to anticipate when or where major battles would occur was another drawback to Moore's otherwise promising idea of a central medical reserve. Another Moore initiative was in the area of medicine procurement. With the blockade affecting supplies of prepared medicines, Moore sought, with considerable opposition in some quarters, to supplement unreliable supplies of allopathic medicines with plant remedies indigenous to the South by creating a regulated procurement and testing program. Moore also recognized the need to document for future education purposes the discoveries and advances made in military surgery and medicine, and made that a priority as well (although, as Hasegawa explains, those efforts mostly went unappreciated at the time because much of the data was collected immediately but held back for publication until after the war).

While the medical department was described by one qualified contemporary observer as a "matchless organization," a combination of forces frequently thwarted promising initiatives involved with the ongoing quest for improvements in organizational structuring and patient care. Those self-constructed barriers against further refinement form one of the book's major themes and offer a powerful explanation of the ways by which SGO efficiency, while laudable overall, was negative impacted by factors outside of money, manpower, and resource scarcity. As an example, the stubbornly honest Moore as a rule refused to grant special favors to influential persons and in that way failed to procure powerful legislative friends in Congress. While he seems to have got along well with President Davis on a personal level, Moore found many of his plans and suggestions that did make it through Congress thwarted by presidential veto, frequently on the grounds of legal technicality. In another example, army commanders often interfered with medical department prerogatives when it came to authority over army general hospitals. Intra-departmental interferences included things such as surgeon resistance to examining boards and officers assuming grand titles and responsibilities of no legal basis. While these factors challenge the admittedly exaggerated idea that the Confederate Medical Department operated as a truly matchless organization, they do not collectively muster striking opposition to the book's conclusion that the department generally exceeded expectations.

In Matchless Organization: The Confederate Army Medical Department, author Guy Hasegawa has created a history that is arguably the greatest single-source advancement in our knowledge of the Confederate Army's medical apparatus since Cunningham's Doctors in Gray (1958). The book's highlighting of the talents and achievements of Surgeon General Moore, a figure largely unknown to most Civil War students, also effectively reminds us that the Union did not possess a complete monopoly on the war's most talented top-level administrators. While there isn't enough surviving source material to offer a fair comparison between the Union and Confederate medical departments, Hasegawa makes a strong argument that Moore's organization could very well have been the Confederate government's best-run department, one that served its wounded soldiers remarkably well given the many limitations imposed upon their care.