Review - "The Surgeon's Battle: How Medicine Won the Vicksburg Campaign and Changed the Civil War" by Lindsay Rae Smith Privette

[The Surgeon's Battle: How Medicine Won the Vicksburg Campaign and Changed the Civil War by Lindsay Rae Smith Privette (University of North Carolina Press, 2025). Softcover, illustrations, tables, endnotes, bibliography, index. Pages main/total:xiv,154/221. ISBN:978-1-4696-9027-8. $29.95]

In the twelve months following the July 21, 1861 Battle of Bull Run, environmental extremes significantly impacted a number of major Civil War areas of operation. In the process, those outside pressures further taxed medical services already unprepared to handle the conflict's unprecedented scale of battlefield casualties. In the wake of hard-earned lessons in handling the sick and wounded, the Union Army systematized a number of medical reforms under fresh leadership. Many were the handiwork of Surgeon General William Hammond and Army of the Potomac Medical Director Jonathan Letterman. The westward spread of these much-needed changes, in combination with popular outcry over messy casualty management after the Fort Donelson and Shiloh campaigns, resulted in notable improvements in how U.S. Grant's Army of the Tennessee managed the health and fighting trim of its soldiers during the long December 1862-July 1863 Vicksburg Campaign. That transformation is the subject of historian Lindsay Rae Smith Privette's The Surgeon's Battle: How Medicine Won the Vicksburg Campaign and Changed the Civil War, which examines the medical department's impact upon the course of arguably the conflict's most environmentally challenging military campaign.

Privette shows that by the time Fifteenth Corps commander William T. Sherman launched his December 1862 Chickasaw Bayou operation the Hammond/Letterman reforms were already taking shape. Among the most important initiatives were the reorganization of medical care and distribution of medical supplies. Previously done at the regimental level, it was determined that effectiveness and efficiency demanded that those tasks to be more centralized at the division level, and actual practice confirmed that wisdom. Outfitting well-stocked hospital ships to bed, treat, and transport sick and wounded soldiers was another priority that greatly benefited the health of the western army. As the author notes, perhaps least appreciated among the new mandates was the marked improvement in record-keeping, which was abysmally neglected after Donelson and Shiloh. This system allowed patient location to be tracked as well as the progress of care. Implementation made it possible for the first time to fully document and closely follow case studies that would later be used to improve the quality of wound and disease treatment. Chickasaw Bayou was, by any estimation, a complete military failure, but Privette argues that it did mark a turning point in medical service improvements, though there was still more left to be done.

The many ways in which Northern aid societies enhanced Union soldier health and welfare are well described in the literature, as is the fact that those well-intentioned civilian activities frequently clashed with military administrators, who also didn't appreciate the frequent criticisms that aid society inspectors aimed in their direction. Privette remarks upon the administrative clashes between the army and government-approved soldier aid agencies such as the United States Sanitary Commission (USSC) and Western Sanitary Commission (WSC), showing that their conflicts extended well beyond mere jealousies over authority and into practical matters of managing soldier health. Asserting control over bodily care was also a major issue down the army chain of command, where military priorities frequently clashed with rank and file health concerns. At the bottom of it all was the private soldier, whose options for what we today call "self-care" were limited. After Chickasaw Bayou, Army of the Tennessee soldiers camped along the swamps, bayous, and levees of eastern Louisiana suffered terribly from disease and the elements, and Privette's findings amplify much of what fellow historian Eric Michael Burke revealed in his excellent, award-winning Fifteenth Corps study published in 2022. According to both authors, from the shocking scale of non-combat losses incurred to the widespread believe among the common soldiers that their own health needs, indeed the value of their very lives, lay at or near the bottom of their corps commander's list of military priorities, it was clear that much needed to be done in order to restore faith in the army's high command. General John A. McClernand's Thirteenth Corps also enters the discussion, and the book helpfully reminds readers that heated accusations back and forth in regard to McClernand's alleged neglect of his corps' medical services contributed heavily to the rising friction between the general and army commander Grant.

Citing military necessity and the impossibility of avoiding the ravages of regional endemic disease, Grant and Sherman refused to abandon the Vicksburg canal project that ended up stretching between January and March 1863, even insisting that sickness and loss claims over that period were greatly exaggerated. The army's medical department concurred, and Privette acknowledges the difficulties involved with reconciling critical claims originating from the rank and file level against those from defensive-minded top leadership. Nevertheless, regardless of the weight one might assign to the various factors involved, it was clear to all that general health (measured by the army sick list) had improved substantially by April.

In contrast to other histories of the Vicksburg Campaign, Privette presents an interesting angle centered around the environmental context of the military operation. The cold rains and flooding of the winter months (which restricted camp space, contaminated water, and presented troops with conditions rife for respiratory and intestinal disease) and the summer months (which exposed the army to peak malaria and yellow fever) were essentially a extra defender on the Confederate side. With those environmental obstacles in mind, the author notes that Grant crossed the Mississippi, swept across the state's interior, and invested Vicksburg at essentially the perfect time for the health of his men, the month of May being right between the two aforementioned seasonal extremes. While liberal foraging largely compensated for the inland movement's imperfect supply line situation, as least for the short term, other challenges to soldier mind and body needed to be addressed. Appropriately stressed in the study is the impact that regular sleep deprivation during the rapid marches of May had on the men's immune systems, although it is also acknowledged that the May victories had uplifting follow-on psychological and physical endurance effects. The biggest potential non-combat killer during the active phase of the campaign was high heat exacerbated by the punishing pace of the army's advance. Denied adequate rest, shade, cooling, and fluid replacement, soldiers struck with heat exhaustion resorted to straggling to both save themselves for the present and recharge themselves for the future when they rejoined their units.

Though General Grant had a reputation for being a strong supporter of the medical service, his army did prioritize ammunition over medical supplies when it came to utilizing the limited transportation that accompanied the army across the river into Mississippi. This isolation had the potential for disaster, as, just like it was for supplies, the army's tenuous path of supply and communications back to Grand Gulf would have been dangerously insecure if the army was bogged down into static, high-casualty warfare before reaching Vicksburg itself. Fortunately, Union casualties were manageable for the series of battles fought between Port Gibson and Big Black River, and the failed assaults that caused half of the army's total casualties for May occurred after establishment of a secure logistical base nearby on the Yazoo River had been assured. It is also noted that the administration and requisition policies of the army's recently appointed medical director, Madison Mills, had resulted in medical supply stockpiles in close proximity west of the Mississippi that were sufficient to handle the influx of patients that preceded the investment of Vicksburg.

The author also sees the geographical and logistical isolation that Grant's army operated under during much of the Vicksburg Campaign as having positive aspects. For the medical services, they were able to go about their business with less direct civilian and political interference than ever before, and Privette also considers that isolation an opportunity for surgeons to improve their self-reliance in ways that would serve them well over the balance of their Civil War careers. It is also noteworthy that case studies authored by Vicksburg Campaign surgeons as well as other documentation created in fulfillment of Mills's new requirements formed significant contributions to the medical literature.

After the failure of the May 19 and 22 assaults, the beginning of summer siege operations heralded the return of health concerns inherent to static warfare, namely camp sanitation and contaminated water. From May into June, the flooding, cold, and wetness that caused so many problems was replaced by spring into summer challenges such as high heat, humidity, and dried up water sources. However, as Privette notes, the medical corps's enhanced operations over previous months resulted in improved care, better defined authority, and refined administration, and the army's close proximity to its river communications made possible a constant flow of medical and aid society supplies along with rapid evacuation of the most ill and most severely wounded soldiers.

Lest one think that weather changes and other environmental factors chiefly explained the army's healthier state, Privette notes that private-sphere medical inspectors previously critical of the army, such as physicians employed by the USSC and WSC, abruptly changed their tune after witnessing the surprisingly (in their view) strong health of the soldiers besieging Vicksburg and improved efficiency of army medical services. Rather than try to block civilian aid workers altogether, Grant sagely facilitated aid society medical supply supplementation with the caveat that it be tightly regulated by army officials. The reshaped relationship worked well, and, in the author's view, the army at Vicksburg experienced far less civilian interference and authority conflicts than it did during the contentious aftermath of Shiloh.

By June, however, malarial diseases and diarrhea/dysentery exploded among the heavily reinforced Vicksburg besiegers, with total sick numbers double what they were during the earlier canal-building winter. Nevertheless, only the worst cases were evacuated to general hospitals upriver, and the new division and corps field hospitals (with assistance from the hospital ships) were able to keep the temporarily disabled soldiery nearby and, working together, managed the army's health well enough to earn credit for being a strong sustaining force along the army's path to final victory. Aiding those efforts, supplies and medicine (one of the most critical being quinine) flowed into the field hospitals via the Milliken's Bend transit depots with noteworthy, albeit imperfect, consistency.

During the siege itself, oppressive heat and humidity affected both sides regardless of the impression that southerners were more physically accustomed to it. With the besieging army swelling to 77,000 men, getting sufficient supplies of potable water was paramount, and both sides utilized the nearby Mississippi River as a supplement to local sources. Just as important as medical care for Grant's soldiers was the positive effect the practice of regular unit rotation into and out of the trenches had on the men's physical and mental well-being. The Confederate defenders did not have that luxury. Though drawing detailed comparisons between Union and Confederate medical services lies beyond the scope of this study, it is clear that by the end of the siege, when a third of the defenders were in hospital and much of the rest seriously debilitated by constant front line duty, the "surgeon's battle" was one that the Confederates could not have hoped to match.

The Surgeon's Battle: How Medicine Won the Vicksburg Campaign and Changed the Civil War represents a noteworthy addition to the medical services history of the Civil War. Keeping in mind the environmental extremes within which the Vicksburg Campaign was fought as well as period limitations in the scientific knowledge of disease processes and transmission, Privette's study nevertheless successfully argues that Grant's Army of the Tennessee incorporated improvements in medical department organization and practices that were numerous and significant enough to mitigate the effects those unavoidable factors had on soldier health and fighting efficiency. While the subtitle's lofty claim that medicine "won" the campaign is certainly attention-grabbing, it is actually more representative of the book's content and interpretation to maintain that advancements in Union Army medicine "helped win" the contest for Vicksburg. That more measured conceptualization, as developed by Privette, is persuasive.