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.

Review - "North Carolina's Confederate Hospitals 1864-1865, Volume II" by Wade Sokolosky

[North Carolina's Confederate Hospitals 1864-1865, Volume II by Wade Sokolosky (Fox Run Publishing, 2025), Hardcover, 7 maps, photos, tables, footnotes, bibliography, index. Pages main/total:viii,216/263. ISBN:978-1-945602-30-6. $32.95]

By now the vast majority of significant Civil War campaigns, raids, and battles fought in the state of North Carolina, beginning with the Union captures of Forts Hatteras and Clark in August 1861 and concluding with the Confederate surrender at Bennett Place in April 1865, have received noteworthy treatment in the military history literature. However, the Confederate medical service's tall task of dealing with the human cost of those conflicts, from serious illness and disease acquired in camp or on the march to wounds received on the battlefield, has not been followed in like depth and fashion. Making enormous inroads into bridging that gap is Wade Sokolosky, who has not only contributed immensely to the documentation of the late-war campaigns in North Carolina but is now in the middle of producing a multi-volume history of the military hospital system in North Carolina. The newest installment in that project, North Carolina's Confederate Hospitals 1864-1865, Volume II, represents the middle volume of a planned trilogy.

As one might expect, Volume II closely follows the structure and style of presentation first established by the author in North Carolina's Confederate Hospitals 1861-1863, Volume I. At this late stage of the war, the bureaucratic conflicts between the Richmond government and state and local authorities that were covered so well in Volume I were largely resolved. Many other important topics and themes, however, are common to both books. Volume II continues to feature detailed profiles of every general hospital and wayside hospital in operation during the covered period, the wayside hospital being responsible for the feeding and temporary care (ex. examination and redressing of bandages) of wounded and sick soldiers in transit. Hospital location, its physical description, bed capacity, and personnel matters related to it are major features of each facility profile. Firsthand accounts gleaned from Sokolosky's deep primary source research also provide readers with keen insights into hospital operations from both staff and patient perspectives. Specific administrative issues, both internally and within the system at large, are also frequently discussed.

The tireless and highly competent leadership of Medical Director Peter Hines is commended throughout. In addition to the doctor's adept display of large-scale hospital system management skills, Hines always did his duty with an eye toward enhancing the quality of patient care. Examples cited by the author include Hines's decision, during mid-war hospital expansion, to adopt the pavilion-style designs that both sides came to favor and his establishment of specialized care destinations within the system (ex. the Greensboro location having particular expertise in treating wounds to the face). The leadership and accomplishments of many other military surgeons are also recognized, as are the contributions of lower staff and civilian nurses. While the well-known writings of, for example, volunteer nurse Kate Sperry ensure that her own viewpoints and activities are never forgotten, the author points out in both volumes that that was not the case for the many black nurses and hospital attendants for whom sources documenting their service do not exist.

A prominent theme in both books is the profound effects military campaigns, both inside and outside the state, had on hospital locations and operations. In Volume I it was primarily mounting casualties on the Virginia fighting front that drove hospital expansion, while Union raids launched from the occupied tidewater region of the state periodically threatened locations where major hospitals were situated. By 1864, expansion of the military hospital system centered around the three new pavilion-style hospitals referenced earlier, which were not entirely completed before being overtaken by events. As Sokolosky documents, the hospital system as a whole became threatened from all sides by large-scale military actions as 1864 progressed into 1865. In addition to renewed coastal incursions, the state was invaded from the south by General Sherman's unstoppable host and from the west through the mountains by increasingly daring cavalry raids (Stoneman's Raid in 1865 being the most prominent). To the north, the incessant stream of casualties from battles fought during the 1864 Overland and 1864-65 Richmond-Petersburg campaigns imposed unprecedented capacity stresses on North Carolina's hospitals. Those stresses, combined with mounting supply and material scarcities, threatened to overwhelm the entire system.

As first explained in Volume I, general hospital location, in addition to striking a delicate balance between proximity to the front and safety from enemy attack, was also driven by logistical considerations. That limiting factor made their establishment near cities and along major rail lines a practical necessity. In Volume II, Sokolosky recounts the constant struggles involved in maintaining hospital operations in the face of competing military demands for rail transport, the general breakdown in the Confederate economy, and the gradual shutting off of foreign supply sources through the blockade. Of course, the logistical hubs in and around which those hospitals were located were also prime military targets for the enemy, and Sokolosky carefully documents the constant relocation of hospitals and patients into the interior as the state's major cities rapidly fell to approaching Union forces in 1865. While reading those sections of the book, one cannot help but appreciate the administrative marvel that kept North Carolina's hospital system in some semblance of existence and order until the guns finally fell silent.

The trilogy's first two volumes are both heavily illustrated. In addition to pinpointing the shifting locations of North Carolina's general and wayside hospitals through a series of excellent maps, other visual supplements found in Volume II include images of persons and locations, useful data tables, and photographic reproductions of staff and admission-related documents from the archives.

So, with Volume II taking readers through the end of the war, what's left to cover in the final installment? As the author explains, Volume III will house a collection of additional topics, the prior integration of which would have proved too disruptive to the chronological flow maintained throughout the first two books. Being witness to the quality level thus far displayed, one looks forward to the final volume with relish as well as with a strong sense of appreciation for Wade Sokolosky's dedication in producing a definitive-scale history and reference guide to North Carolina's Civil War military hospitals.

Review - "The Confederate Navy Medical Corps: Organization, Personnel and Actions" by Guy Hasegawa

[The Confederate Navy Medical Corps: Organization, Personnel and Actions by Guy R. Hasegawa (McFarland, 2024). Softcover, photos, illustrations, roster, notes, bibliography, index. Pages main/total:v,188/244. ISBN:978-1-4766-9451-1. $39.95]

Pharmacist Guy Hasegawa is the author of a number of notable studies related to Civil War science and medicine, and he's also delved deeply into bureaucratic histories. His Matchless Organization: The Confederate Army Medical Department was released in 2021, and his research into that department's smaller naval counterpart, the Confederate States Navy's Office of Medicine and Surgery (OMS), has resulted in the publication of The Confederate Navy Medical Corps: Organization, Personnel and Actions. The CSN grew steadily throughout the war, peaking at just over 5,000 officers and men along with around 500 additional personnel in the CS Marine Corps. All of those men needed medical care, and it was the task of Surgeon William A.W. Spotswood and his OMS to provide it on land, river, and sea.

During the chaos and destruction of Richmond's evacuation in 1865, much of the Confederate Navy's records were lost. Making Hasegawa's task even more difficult, CSN surgeon diary, journal, and letter resources are few in number. Recognizing that many gaps can probably never be adequately filled, the author nevertheless dove into newly searchable archives and was able, with the help of other key sources, to piece together a more than respectable volume tracing the history, staffing, organization, duties, and actions of the naval medical corps. As expected, the CSN adopted (or adapted) a great many legacy aspects from the USN, and Hasegawa, with due care, explores the strong possibility that missing information about the CSN medical department's organization and practices can be addressed at least to some degree by extrapolating from how the USN was run.

Recruitment and evaluation of top personnel is a major part of Hasegawa's study. While Confederate authorities hoped and expected that resigned USN medical officers would form the core around which an effective medical service might be built, the level of need rapidly outstripped supply. Meeting that need meant that other sources, such as state navies, civilian doctors (who would be accorded standing as acting assistant surgeons), and even the Confederate Army, had to be tapped. In the end, roughly a third of the 106 appointees as surgeons in the CSN previously served in the USN. Assisting the surgeons directly were surgeons' stewards and hospital stewards (another carryover from the USN). The author recounts the duties of each and notes that, even though they were very different by USN tradition (surgeons' stewards were appointed from the enlisted ranks and were tasked with medical care as well as record-keeping while hospital stewards were civilians who supervised staff and performed administrative duties but were not involved in direct patient care), sometimes the distinction between the two was not so clear in the CSN.

As one might have expected, it was a struggle for Confederate authorities to locally source enough medical supplies to meet the needs of the service. It was hoped that the balance, particularly in prepared medicines that Confederate labs were unable to replicate en masse, could be obtained through the blockade. Even though much of that critical supply entered the country through widely dispersed port cities, Richmond still insisted upon a central depot for their dispersal. Hasegawa keenly observes that the government's failure to create satellite medical supply depots closer to the major blockade-running ports represented a significant and needless inefficiency in the purveying department's distribution operations. The author also found discrepancies between official department reports prepared at the top and those submitted downstream. For example, while the head of purveying in late 1864 confidently reported that all vessels in the CSN were adequately stocked with medical supplies, the author's deeper digging into the sources reveals that not to have been the case.

Hasegawa comprehensively lists and describes the many different types of assignments that were required of CSN surgeons. These ranged from shipboard postings to naval stations, navy yards, shore batteries, and even army assignments. Another duty, the organized but not exactly standardized process of examining recruits, is also discussed in some detail. While the CSN did not possess far-flung oceanic squadrons, surgeons did serve aboard commerce raiders and blockade runners. It is noted that most surgeons, especially the younger ones, were posted to a number of these different assignments during their Civil War service. With surgeons even accompanying small-boat raids, the personal danger could be considerable and more than a few naval surgeons were captured during the war.

Of course, the staffing and administering of naval hospitals, based either on shore or on a small number of hospital ships, was another major responsibility of the OMS. In the book, Hasegawa briefly recounts the history of naval hospitals established at Richmond and at major cities all along the Atlantic and Gulf coasts. Individuals who served at those places as medical officers are also identified in the text. The range of diseases commonly treated in the hospitals as well as their treatment regimens are documented, and it is noted that malaria was the most challenging disease faced given the commonality of contact with mosquito-infested habitats in the waterborne service.

As an added reference tool, an annotated list of all known medical officers commissioned in the CSN is included as an appendix. Surmounting in many ways the challenges and limitations the author was confronted with during this research project, a coherent portrait of the Confederate States Navy's medical officer corps, their duties, experiences, and wartime accomplishments emerges from the text. As Hasegawa laments, the information does not exist to offer a comprehensive comparison between the medical corps of the Union and Confederate navies, but there is enough raw data scattered about and reliably admiring testimonials from the other services available to enable the author to conclude that the CSN medical department's performance was "quite creditable" (pg. 187) under the circumstances.

Review - "A Place of Rest for our Gallant Boys: The U.S. Army General Hospital at Gallipolis, Ohio, 1861-1865" by Christy Perry Tuohey

[A Place of Rest for our Gallant Boys: The U.S. Army General Hospital at Gallipolis, Ohio, 1861-1865 by Christy Perry Tuohey (35th Star Publishing, 2022). Softcover, photos, illustrations, appendix section, notes, bibliography, index. Pages main/total:xv,94/204. ISBN:978-1-7378575-3-2. $18.95]

Though the troops involved on both sides were small by later Civil War standards, 1861 military operations in western Virginia proved strategically significant. The immense territorial gains secured by Union forces during those early months of fighting permitted the foundation of the new state of West Virginia (formally admitted to the federal Union in 1863). Situated near the confluence of the Ohio and Kanawha rivers, Gallipolis, Ohio was perfectly placed to serve as a forward logistical base. In addition to supporting federal thrusts into the trans-Appalachian counties of Virginia, the river town was also a receiving point for sick and wounded Union soldiers as well as Confederate prisoners. The history of the hospital facility constructed there is the subject of Christy Perry Tuohey's A Place of Rest for our Gallant Boys: The U.S. Army General Hospital at Gallipolis, Ohio, 1861-1865.

The U.S. Army general hospital at Gallipolis complied with regulations that patient wards be of the ridge-vented pavilion style. Period drawings show wards and supporting structures clustered together in close proximity, with parts of the complex arranged in somewhat irregular fashion. Other army general hospitals were more creative in architecture (ex. with ward buildings radiating out from a central hub, like the spokes of a wheel, to facilitate ventilation and staff management), but perhaps the available ground at Gallipolis was only suited to a more stacked approach. While the Gallipolis hospital complex's layout is described along with details of daily operations, the larger focus of the volume is on the human interest stories of staff, volunteers, and patients.

Most chapters revolve around individuals, the book's description of their background and activities being well representative of the duties typically performed by persons filling those hospital roles. Thus readers are introduced to local teacher turned volunteer nurse Hannah Maxon, army surgeon James Bell, hospital steward Joseph Lunbeck, hospital chaplain Charles Blake, contract surgeon George Livesay, and many others. A host of patient stories are also sprinkled about. Some interesting side themes are raised, too, among them the use of army hospitals (such as the one at Gallipolis) as conduits for furloughing convalescents home to vote in vital late-war elections.

The volume is well illustrated with numerous photographs of individuals with connections to the Gallipolis hospital. No photographic images of the hospital itself can be found in the book (and perhaps do not exist), but, as mentioned before, there are several drawings included. Useful reference material is provided in the form of surgeon, staff, nurse, and patient rosters. Compiled from numerous sources, Tuohey's patient list of Union sick and wounded is quite extensive. Research for the book on the whole is based on a diverse collection of primary and secondary sources. The medical history of the Civil War continues to be a burgeoning field, and A Place of Rest for our Gallant Boys offers yet another meaningful contribution to Civil War hospital studies.

Review - "North Carolina's Confederate Hospitals 1861-1863, Volume I" by Wade Sokolosky

[North Carolina's Confederate Hospitals 1861-1863, Volume I by Wade Sokolosky (Fox Run Publishing, 2022). Hardcover, 6 maps, photographs, illustrations, tables, footnotes, appendix section, bibliography, index. Pages main/total:vi,180/243. ISBN:978-1-945602-23-8. $32.95]

Scholarship published over the past few decades has dramatically improved our understanding of the professionalism, compassion, scientific curiosity, and innovative drive displayed by many practitioners of Civil War military medicine. What effect this revisionist work has had on the wider reading public's generally dim view of the army physician is anyone's guess. Hopefully, the popular stereotype of the Civil War surgeon only too happy to ply his patients with blue mass and cut off an injured limb at the drop of a hat are long gone. A more accurate picture of Civil War military hospitals has also matured over time. A notable new contribution to that expanding literature is Wade Sokolosky's North Carolina's Confederate Hospitals 1861-1863, Volume I.

At its heart, Sokolosky's book is an organizational history of the military hospital system in North Carolina. The early sections present, through both synthesis and the author's own considerable primary source research, a state-level picture of an evolving bureaucracy that was both informed by and frequently clashed with the national-level management system documented so well in Guy Hasegawa's recent book Matchless Organization: The Confederate Army Medical Department (2020, SIU Press) [review]. The tireless activities of many physicians, from state Surgeon General to hospital directors, are explored in the book, as are the roles of female matrons, nurses, and volunteers. As indicated by the author, the experiences of black hospital attendants, who served in sizable numbers according to hospital rolls, cannot be revealed in detail due to source limitations.

A major theme of the book is how the state's logistical apparatus and military events, particularly the latter, shaped the establishment, location, and scale of North Carolina's military hospital system. With the entire coastline threatened by Union army and naval forces in 1861-62, a corresponding influx of defenders led to the establishment of a number of general hospitals in vulnerable forward positions. The startling success of the 1862 Burnside Expedition forced relocation inland, but the need to be tied to railroads also placed those facilities in the path of subsequent infantry and cavalry raids launched from the Union Army's recently seized coastal bases. Proximity to the Virginia front and the bloody escalation of the fighting there also forced an expansion of North Carolina hospital capacity.

Where documentation exists, physical descriptions of the hospitals, their capacity, their staff, and their local sources of support (or, in some cases, opposition) are also conveyed in the book. In addition to the state's system of general hospitals, the more controversial wayside hospitals are also discussed at length. Meant to handle convalescents, visiting family, and transient patients, wayside hospitals proved effective, but critics still saw them as a waste of resources. In contrast to general hospitals, wayside hospitals in North Carolina were more often able to maintain state and private management.

As Sokolosky abundantly demonstrates, management of the hospital system in North Carolina during this period mirrored many other aspects of the Confederate war effort in that it was subjected to frequent and often intense States Rights versus centralization clashes. With North Carolina governor Vance being one of the most ardent defenders of state prerogatives, that tug and pull between Richmond and Raleigh was present at all levels of medical department leadership and management. Who should manage, supply, and fund general hospitals in North Carolina was an ongoing subject of debate. As the war progressed, however, the forces of centralized integration gathered momentum, and by December 1863 the Confederate Medical Department was in charge of all of North Carolina's general hospitals and the majority of its wayside hospitals.

With fresh data and insights drawn from extensive original research, Wade Sokolosky's North Carolina's Confederate Hospitals, 1861-1863 provides us with the first comprehensive history of the personnel, organization, and management of military hospitals in the Old North State during the first half of the Civil War. The quality of this study certainly heightens the anticipation level for the second and final volume, which will document further expansion of Confederate hospitals in the more central part of the state and explain how the great military events of 1865 (e.g. Sherman's Carolinas Campaign and the fall of Wilmington) pushed the entire system to the point of collapse.

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.

Review of Loperfido, ed. - "DEATH, DISEASE, AND LIFE AT WAR: The Civil War Letters of Surgeon James D. Benton, 111th and 98th New York Infantry Regiments, 1862-1865"

[Death, Disease, and Life at War: The Civil War Letters of Surgeon James D. Benton, 111th and 98th New York Infantry Regiments, 1862-1865 by Christopher E. Loperfido (Savas Beatie, 2018). Softcover, photos, illustrations, footnotes, 5 appendices, bibliography, index. 164 pages. ISBN:978-1-61121-359-1. $16.95]

Originally published in 2011 under the title A Surgeon's Tale: The Civil War Letters of Surgeon James D. Benton, 111th and 98th New York Infantry Regiments, 1862-1865, Christopher Loperfido's Death, Disease, and Life at War: The Civil War Letters of Surgeon James D. Benton, 111th and 98th New York Infantry Regiments, 1862-1865 is more than just a reprint with a new title. Even without a copy of the original for side by side comparison, it seems clear from the limited online preview of the first edition that much in the way of new material has been added.

It's easy to see why Loperfido believes the Benton letters worthy of publication (and re-publication!). As a busy army surgeon with limited free time (especially after major battles), Benton's writings home largely dispensed with mundane observations and concerns in favor of war news and views of all kinds. To our benefit, direct requests from interested family members frequently prompted Benton to provide historically interesting details of military matters and movements along with descriptions of his medical duties and experiences.

Benton's Civil War service began very inauspiciously, with he and his regiment part of the Harpers Ferry garrison that was humiliatingly surrendered and then forced to spend an extended period of time on parole. Benton's detailed descriptions of his surroundings (at places like the parole camp part of the Camp Douglas (Ill.) prison complex, the Fairfax and Centerville garrison posts in Virginia, and other locations) definitely have value to the readers and scholars of today. Some of the most vivid passages involve the physical ruins of war and the environmental desolation wrought by the conflict across northern Virginia.

Benton was quite unusually forthright in baldly admitting a pecuniary motivation for joining the Union Army. "It is not patriotism that has made me take this course but I wanted to make money for my family. If it had been patriotism I should have been sick of it long since..."(pg. 7). He does also periodically comment upon larger social and political issues. While telling relatives that Lincoln was his idol as a national leader, Benton criticizes the Emancipation Proclamation  (though he personally agreed with the sentiment) as a gross overstepping of presidential authority and heavy obstacle to peace and reunion.

While Benton seems more naturally inclined to write about military matters, when prompted by return letters from home (as mentioned before) he does occasionally provide some interesting insights into his medical duties, first as an assistant surgeon with the 111th and later as a division hospital administrator during the Richmond-Petersburg Campaign. Very late in the conflict, he was appointed military surgeon for the 98th NY, serving out the rest of the war in that capacity. It's clear from his wartime letters and also from the book's postscript material that the war permanently damaged Benton's health. Never completely well again, he would suffer an early death at the age of 54.

The editorial aspect of the book appreciably enhances the material. Loperfido's introduction offers both background information on Benton and a general overview of Civil War military medicine organization and practices. Helping fill the frequent and large time gaps that exist, the editor's bridging narrative effectively ties the letters together. While not particularly numerous, footnotes point readers toward useful sources and provide definitions of older terms along with the usual persons, places, and events descriptions. Many of the notes reference works published after 2011, so it's clear that that feature of the book has been significantly revised between editions.

New to this edition, the five-part appendix section consists of contributions from two outside authors, two pieces from Meg Groeling and three from Dennis Rasbach. Groeling writes about the Letterman field medicine reforms and the U.S. Sanitary Commission while Rasbach traces the development of the army ambulance system and explores amputations and the significant role of lint in bandaging. Lint is very frequently mentioned in Civil War books but rarely explained, and Rasbach helpfully describes the types of lint developed, how they were used, and where they came from.

Useful on multiple levels, the historical value of the Benton letters contained in Death, Disease, and Life at War significantly exceeds that of the average set of Civil War correspondence edited for publication. This expanded repackaged edition is well worth the attention of new and seasoned readers alike.

Review of Reid, ed. - "RECOLLECTIONS OF A CIVIL WAR MEDICAL CADET: Burt Green Wilder"

[Recollections of a Civil War Medical Cadet: Burt Green Wilder edited by Richard M. Reid (Kent State University Press, 2017). Hardcover, map, photos, illustrations, appendices, notes, index. 158 pp. ISBN:978-1-60635-328-8. $29.95]

The position of medical cadet was created by Congress in 1861 in response to volunteer army mass mobilization and the sudden need to treat vast numbers of sick and wounded soldiers. Directly assigned to an army surgeon, a cadet's primary purpose was to dress wounds in army general hospitals and, while in the field, serve as an ambulance attendant. The term of service was set at one year, and medical cadets were accorded officer-equivalent rank and pay level equal to that of West Point cadets. While some medical education background was required by law, the urgent need for hospital attendants combined with the predictable shortage of qualified candidates led to the acceptance of individuals with no prior medical training. One of these promising yet entirely inexperienced inductees was Bostonian college graduate Burt Green Wilder. His outstanding memoir of his time spent as a medical cadet at an army general hospital in Washington, D.C. was recently published by Kent State University Press under the title Recollections of a Civil War Medical Cadet (edited by Richard Reid^*).

In the summer of 1862, Burt Green Wilder had just completed a degree in anatomy and physiology at Harvard's Lawrence Scientific School. Faced with the decision of either joining the army or trying to make use of his scientific background in the medical service, he chose the latter and applied for a medical cadet position. Glowing faculty recommendations convinced hard-pressed authorities to waive the medical training requirement, and Wilder was duly appointed (along with his friend James Adams) medical cadet at Washington's Judiciary Square Hospital.

Wilder used his retirement years to write prolifically about many different aspects of his life and career. He started composing his cadet memoir in 1910. Wilder used his letters to then fiance Sarah Nichols as the basis of the memoir, but he didn't stop there. In order to both enhance his narrative and fill in various gaps, he incorporated wider research from a number of other sources, including friend and cadet colleague James Adams's diary. Excising all personal material, the result is a remarkably intimate and detailed account of the duties of a medical cadet serving at an army general hospital. In addition to being deeply informative, the memoir is composed in a lively and frequently charming manner that is a pleasure to read.

Helped along by his anatomical and scientific background, Wilder learned his medical functions quickly and his competence made him highly regarded by army surgeons and patients alike. Initial duties were similar to those of today's hospital nursing staff, but Wilder also proved to be very adept at administering surgical anesthetic and even conducted autopsies under physician supervision. He prepared specimens for the Army Medical Museum, and his exceptionally well-written case histories brought him to the attention of the planners of the Medical and Surgical History. Indeed, as his memoir demonstrates, Wilder had many interesting personal interactions with prominent Civil War medical figures like Dr. John Brinton and Surgeon General William Hammond.

In addition to being a highly useful historical record of the role of medical cadet in the army medical service, Wilder's memoir is an equally important contribution to the history of the Judiciary Square Hospital. Along with his personal portraits of various staff members, Wilder's remarkably detailed firsthand descriptions of the physical layout of the hospital, its patient care, and its day-to-day operation are invaluable.

Wilder's unpublished manuscript also includes a large number of interesting appendices. Some were written in defense of the operation of Judiciary Square Hospital, which came under fire later from Walt Whitman and others. Other topics in the appendix section include staff bios, supporting documents of all kinds, case studies, and other interesting ephemera from Wilder's cadet service.

In addition to assembling a continuous narrative, Wilder also extensively annotated all of the collected material contained in his memoir. These later notes are integrated into the main text but helpfully separated from the contemporary material by parentheses (and the text within italicized by Reid). Wilder's post-retirement notes offer factual correctives and much in the way of additional information. Perhaps most interesting are the commentaries on the differences between 1860s medical care and that of the early twentieth century. While expressing some bemusement at mid-18th century ignorance of antiseptic and aseptic technique, Wilder's memoir does confirm the employment of some elements of progressive care at the hospital. The younger staff, including Wilder, opposed the old guard's general use of mercury preparations, and Wilder's writing also discusses the testing of bromine solutions at Judiciary Square for wound care, noting the treatment's beneficial effect on gangrene prevention.

Editor Richard Reid contributes a fine introduction to the volume. In addition to providing background information on Wilder's life, career, and manuscript preparation, the lengthy introduction also explores the scholarly utility of Wilder's memoir in a variety of contexts. In the end, Reid makes a very strong case for the value of Wilder's manuscript. The editor also added his own annotations to the main text. These are mostly biographical in nature, but others consist of brief introductions to select appendices.

Recollections of a Civil War Medical Cadet is an important contribution to the literature of Civil War medicine on several levels. In no other book is the practical role of medical cadet explored in such a comprehensive manner. Wilder's memoir also constitutes an unusually rich record of the daily operation of a Civil War general hospital from a unique perspective. Wilder's writings additionally offer abundant confirmation of the emergence during the war of a new emphasis on innovative scientific principles, a trend that would accelerate real advances in American medical practices. This volume is highly recommended.



* - Reid has published Wilder documents before. Like many medical cadets, Wilder did not complete his full term of service, leaving Judiciary Square after ten months for a coveted post as assistant surgeon with the 55th Massachusetts. See Reid's Practicing Medicine in a Black Regiment: The Civil War Diary of Burt G. Wilder, 55th Massachusetts (UMass Press, 2010) for thorough coverage of Wilder's post-cadet Civil War career.

Review of Flannery - "CIVIL WAR PHARMACY: A History, Second Edition"

[Civil War Pharmacy: A History (Second Edition) by Michael A. Flannery (Southern Illinois University Press, 2017). Softcover, photos, tables, notes, biblio essay, index. 335 pp. ISBN:978-0-8093-3592-3.$34.50]

Hopefully, the studies of Civil War surgery and medicine published over the past few decades have helped dispel the popular myth of army surgeons as incompetent sawbones largely immune to scientific curiosity and progress. On the other hand, in contrast to the many fine published works on Civil War medicine and surgery, just about everything related to pharmacy—the drugs; the persons and firms involved in the development, manufacture, and distribution of therapeutics; and the duties and challenges of those that dispensed these chemical and botanical agents directly to the soldiers in the field—has been less well represented in the literature. Michael Flannery's Civil War Pharmacy (2004) went a considerable distance toward bridging the gap, but new scholarship, along with some omissions noted by reviewers, has led Flannery to update his award-winning book. The resulting Civil War Pharmacy: A History, Second Edition incorporates current work in the field while also adding two new chapters on battlefield pharmacy and naval pharmacy.

In 1861, there were only six established schools of pharmacy in the U.S. As a regulated profession, pharmacy was in its infancy, as was the pharmaceutical industry as a whole. Most pharmacists prepared their own remedies and learned their craft through apprenticeship (or were self-taught). Even so, Flannery contends, with some justification, that the pharmacy trade and practice in the country were not as backward in comparison to their western European counterparts, and domestic drug manufacturing much more complex, than the more dismissive critics have asserted. The author also cites in his introductory section noticeable regional differences in antebellum American pharmacy. Predictably, production was even more scaled-down and dispersed in the South than in the North, but most readers would probably be surprised to learn that several southern states were pioneers in regulatory law.

The book fully describes the official duties and responsibilities of those within the army tasked with ordering and maintaining drug supplies and distributing them to the soldiers in the field. Of these two positions—medical purveyor and medical storekeeper—the latter were by 1862 law tested for both pharmaceutical knowledge and business management acumen prior to appointment. Wider were the duties of hospital steward. Over time, these bled into almost every aspect of army hospital and surgical care, but pharmacist was the post's chief responsibility. One steward was attached to every general hospital as well as to each company in the field (although approved numbers were never achieved and less than a handful were typically assigned to each regiment).

Through national aid organizations like the U.S. Sanitary Commission, women played a key role in raising funds for the purchase of drugs and medical supplies. Supplementing medicines obtained through official army channels, these additions to the pharmacopeia were a godsend to the sick and wounded. Flannery also presents evidence that female nurses and volunteers, though faced with strong opposition from Union army surgeons and hospital stewards, were involved in drug preparation, dosing, and administration. Many also applied their own experiences in home remedies to the benefit of grateful soldiers. As the book shows, the Confederacy's lack of a similar national aid organization meant that its own sick and wounded were placed at a significant disadvantage in comparison.

Flannery's research led him to the conclusion that pharmaceutical manufacturing and distribution in the North were both efficient and adequate to the needs of the army. According to the author, fears that government labs would stifle private industry proved to be unfounded, and there's little data to support allegations of price fixing and war profiteering even when, in the case of quinine, only two firms were responsible for essentially the entire supply.

Citing considerable evidence, the book marks the year 1863 as the turning point in the South's ability to meet its pharmaceutical needs. Until that time importation and native manufacturing were sufficient, but the tightening of the blockade and the failure to find native substitutes meant that the disparity in sickness levels between Union and Confederate regiments widened even further. While plagued by nutritional deficiencies not suffered by their Union opponents (which resulted in debilities almost unique to Confederate soldiers, like pellagra and night blindness), the author is generally impressed with Confederate efforts to maintain the health of its soldiers with far less resources available. Making the procurement challenge even more difficult, the drugs that did make it through the blockade also had to serve the civilian population.

The officially approved medicine chest for the armies contained a long list of manufactured and plant-based agents ranging from highly beneficial to downright harmful. Several figures and tables catalog these therapeutics, but Flannery wisely limits his most detailed analysis to those drugs used to treat the most common ailments (diarrhea, dysentery, fevers, respiratory illnesses, and digestive problems). The book contains a long and useful discussion of the procurement, manufacture, and efficacy of quinine preparations, which were truly effective against malaria but also misused as a kind of general therapy. The popular view of Civil War hospitals being helpless in the face of infection is successfully challenged by the book's well documented account of the startling effectiveness of bromine and iodine disinfectants (especially the former) in reducing post-operative mortality and managing wound infections. This revealing look at disinfectants is the salient feature of the Second Edition's new chapter on battlefield medicine. The surgical anesthesia section is also quite good. While appropriately noting widespread institutional stubbornness when it came to using mercury-based products, Flannery does cite a small core of enlightened opposition within the army. The author singles out for special recognition one brave dissenter in particular, Union Surgeon General William A. Hammond, who was court-martialed and cashiered for directing the army to remove mercury from its medicine chest.

The new navy chapter is largely descriptive in nature, with little discovered in the way of distinctive differences between army and naval pharmacy. It does praise (appropriately, it seems) the efficiency of the naval laboratory, which preceded the army's facility by a decade. Problems emerged here and there during the war, but the well-established Bureau of Medicine and Surgery and its lab together did a fine job of meeting the significant challenges of supplying and managing the pharmaceutical needs of the Union Navy's far flung fleets.

Flannery's contention that the war was a key event in the wider development of the pharmaceutical industry in the U.S., with many individuals involved in wartime research and production becoming household names by their association with the many eponymous firms that would rise to prominence in the following decades, is a persuasive one. Unlike the small arms industry, the drug companies were able to maintain and even expand their wartime economies of scale. The book makes scant mention of Civil War connections to the parallel post-war patent medicine industry boom, but it's likely the author felt such a large tangential topic outside the scope of this study.

Michael Flannery's Civil War Pharmacy represents a very thorough introduction to a significant and often misunderstood topic. On a macro level, the book effectively charts the evolution and economic transformation of the pharmaceutical industry before, during, and after the Civil War. At the ground level, the study affords readers a detailed picture of the organization and practice of pharmacy in the Union and Confederate armies and navies. The roles of several of the war's most significant therapeutic agents are discussed at length, and many prevailing beliefs and myths convincingly challenged. This volume is a very important addition to the Civil War medical literature, but it is also hoped that a wider readership will be exposed to the book's many corrective features regarding the nature of Civil War pharmacy and the progressiveness of its practitioners.

Hambrecht & Reimer, eds.: "CALEB DORSEY BAER: Frederick, Maryland’s Confederate Surgeon"

[Caleb Dorsey Baer: Frederick, Maryland’s Confederate Surgeon edited by F. Terry Hambrecht, M.D. and Terry Reimer (National Museum of Civil War Medicine Press, 2013). Softcover, photos, notes, bibliography, index. 238 pp. ISBN:978-0-9712233-7-0 $17.95]

Doctor Caleb Dorsey Baer, a native Marylander and 1848 graduate of Jefferson Medical College, moved to Dover, Missouri with his young wife sometime between 1852-55. In Lafayette County, Baer did double duty as Justice of the Peace and practicing physician. When a clash with the federal government seemed imminent, he joined the Missouri State Guard, a move unpopular with his Unionist family back east. With the commencement of hostilities, Baer was appointed regimental surgeon with two different commands and he also helped administer a military hospital in Carthage.  When the pro-secessionist Missouri state military apparatus was scaled down, Baer joined the Confederate army. He was Staff Surgeon attached to the 9th Battalion Missouri (Pindall's) Sharpshooters, regimental surgeon with the 9th Missouri Infantry of Mosby Monroe Parsons's brigade, and later occupied a string of other divisional and brigade level postings until disease took his life on August 30, 1863.

Like many Civil War diarists, Dr. Baer frequently comments on matters far outside his own sphere of duties. While he certainly does in many places mention his medical department responsibilities and health problems, Baer devotes greater space to military events, personalities, and places encountered while on the march. He writes some informative passages about the Battle of Wilson's Creek and the Lexington siege, but his discussions of the battles of Carthage, Helena (Ark.), and Dry Wood Creek should draw special attention. Baer's accounts of his medical role at Carthage (and accompanying hand drawn maps of the locations of his field dressing stations) and Helena add a new dimension to the source information available for those battles, while his description of the Dry Wood Creek fight is more detailed than those found in most published histories. Some of the most extensive and vividly written passages [the one relating his observations of the crossing of the Boston Mountains was particularly memorable] document a long journey, accompanied by General Parsons, to Memphis. However, upon arrival, Baer seemed almost to have been forgotten by his superiors and no explanation of the mission's original purpose is offered.  The whole episode is rather indicative of chaotic organization of the Confederacy's Trans-Mississippi war effort, especially early on.

Baer's written opinions expose many of the provincial qualities that marred relations between Trans-Mississippi allies. He expresses nothing but contempt for Confederate General Benjamin McCulloch (a sentiment returned in spades by the Texan, who never reserved a kind word for Missouri state forces) and high praise for MSG commander Sterling Price. Baer also has little positive to say about Arkansas forces, who fought side by side with Missouri state forces on several occasions, accusing them of not possessing the same spirit and fighting qualities of their friends to the north. He also has a low opinion of the patriotism of Memphis's civilian population, believing them to elevate crass money concerns above all thoughts of the welfare of the Confederacy. In one of his rare moments of directing venom toward a fellow Missourian, the doctor labels General John S. Marmaduke a coward, intimating that it was a widely shared opinion^*.

The original Baer diary, with its many missing pages and drawings (all of which are noted in the book), was in rough physical shape as well before been stabilized and preserved by the archive specialists at the National Museum of Civil War Medicine. For this publication, editors F. Terry Hambrecht and Terry Reimer have transcribed the source writing as closely as possible, with spelling corrections in brackets, and have reproduced good scans of the two surviving map sketches. Rather than scholarly annotation, the footnotes mainly consist of providing the full names of those mentioned only by last name in the text. Sidebar micro-biographies and event descriptions are also scattered about.

The Baer diary's informative qualities largely outstrip those of the average published Civil War primary source, making Caleb Dorsey Baer: Frederick, Maryland’s Confederate Surgeon an important new tool for those researching Confederate Arkansas and Missouri [though one wishes the title, which strongly implies eastern theater related subject matter, better represented the geographical focus of the content]. Additionally, the publication of Missouri State Guard material of any kind is very rare, and this book constitutes a notable contribution to that body of literature. Highly recommended.


^* - Marmaduke had many faults as a general, but this is the first reference to actual cowardice that I've encountered anywhere, leading me to speculate its source to be some sort of personal animus.

[ Thanks to Jim Schmidt from Civil War Medicine for bringing this book to my attention. His own views on it can be found here ]

Schroeder-Lein: "THE ENCYCLOPEDIA OF CIVIL WAR MEDICINE"

Below is a reprint of an earlier post, updated to reflect the recent publication of a new paperback edition.

[The Encyclopedia of Civil War Medicine by Glenna R. Schroeder-Lein (M.E. Sharpe, 2012). Softcover, illustrations, bibliography, timeline, index. Page total:456. ISBN:978-0-7656-2130-6 $34.95]


The Encyclopedia of Civil War Medicine provides the reader with an alphabetical arrangement of over 200 short articles [a complete list is available on the book's publisher webpage] dealing with a broadly inclusive array of related subjects. Historian Glenna R. Schroeder-Lein authored all the articles, covering:

...terms, diseases, wounds, treatments, notable medical personalities, medical offices, generals with notorious wounds, soldiers' aid figures and societies, medical department structure, hospital design and function, the battles with the greatest medical significance, sanitation issues, and other medically related topics.[page xiii-xiv]

Schroeder-Lein, who previously authored another work related to Civil War medicine (Confederate Hospitals on the Move: Samuel H. Stout and the Army of Tennessee, Univ. of South Carolina Press, 1994), is not a physician and her writing is directed toward the lay reader. However, that is not to say the encyclopedia is overly simplistic. Overall, her exposition strikes a good balance between providing usefully detailed medical information and facilitating ready comprehension by the general reader with no scientific background.

The book is well presented and organized. In addition to the bibliography, a short source list is included at the end of each article. A "see also" section helpfully directs the reader to related entries. The coverage is not exhaustive (it's not claimed to be so), and some topics that might reasonably merit separate treatment are typically grouped together. Mostly published source materials were consulted, although manuscript sources were used for biographical information.

Schroeder-Lein's work does contain some surprising revelations. For instance, I was initially puzzled at the absence of typhus, until it was demonstrated that the disease [a major scourge of war torn cities along with POW and concentration camps in Europe during the 20th century] was a rare, almost absent, condition afflicting the soldiers housed in Civil War military and POW encampments.

The Encyclopedia of Civil War Medicine should be a valuable resource for readers, writers, historians, and researchers. The steep price may scare away individual buyers, but academic and specialist libraries will likely give it strong consideration.

Hasegawa: "MENDING BROKEN SOLDIERS: The Union and Confederate Programs to Supply Artificial Limbs"

[Mending Broken Soldiers: The Union and Confederate Programs to Supply Artificial Limbs by Guy R. Hasegawa (Southern Illinois University Press, 2012). Hardcover, illustrations, notes, appendices, bibliography, index. Pages main/total:95/142. ISBN:9780809331307. $24.95]

Nineteenth century factories and farms could be very dangerous workplaces, a consequence of which was a relatively mature northern artificial limb industry by the outbreak of the Civil War. It will come as no surprise that the number of patents for limb replacement devices exploded during the conflict, and it is the programs, U.S. and Confederate, that assisted the return of maimed soldiers to productive lives that are the subject of Guy Hasegawa's excellent little monograph Mending Broken Soldiers.

In 1862, the U.S. government established a board of prominent physicians to select replacement limb designs for military amputees and administer the distribution of funds for their manufacture. In this section of his book, Hasegawa introduces the reader to the various northern firms that produced artificial arms and legs, as well as the individuals who ran them. The Palmer leg was the most common in use, but there were many others. In addition to briefly discussing the design elements of a number of the most prominent devices, the author also delves into the logistical challenges of the programs. Where soldiers would go for fitting, who would pay for their boarding and transportation costs, and who would pay the cost difference for devices that exceeded the board approved amount were all issues that needed to be addressed. Competition among manufacturers was fierce, with patent infringement and questionable marketing claims commonplace. Many readers will be surprised at the level of technological advancement in the limb replacement industry (e.g. ingenious artificial arms were crafted with fully articulated fingers manipulated by spring and lever systems).

The southern program, by contrast, had insurmountable difficulties that led to its supplying of fewer limbs than hoped for at the time. To begin with, the program was established late in the war, in 1864, when the blockade and currency inflation were in full force. There was also no pre-war native limb replacement industry, so many makers had to start from scratch^*. Additionally, as opposed to the U.S.'s government sponsored and funded program, ARMS (the Association for the Relief of Maimed Soldiers) was private, necessitating the expenditure of time and resources in soliciting donations. Two firms supported by ARMS, Hanger and Brother and Wells and Brother, did manage to produce some high quality devices, but, given acute shortages of skilled labor and quality materials, they could never approach promised production levels. Although Reverend Charles Marshall was the founding force behind ARMS, Hasegawa credits the tireless efforts and personal financial sacrifices of Confederate surgeon William A. Carrington with the program achieving as much as it did.

A counterintuitive point raised at the very end was the startling fact that an overwhelming majority of amputees elected instead to receive a cash payment in lieu of a new limb or even replacement of a previously satisfactory but worn out device.  Why this was so (and one can come up with several possible reasons) might comprise a fruitful line of research for another scholar.

In less than 100 pages of narrative, Guy Hasegawa has done a fine job of presenting both descriptive and analytical histories of the Union and Confederate wartime limb replacement programs. Mending Broken Soldiers is an excellent addition to the related historiographies of Civil War medicine, commerce, and technology.


* - Hasegawa relates an interesting tale of the ARMS program's attempt to obtain and reverse engineer Union Col. Ulric Dahlgren's Jewett model leg, originally confiscated with the young officer's body after he was killed leading an infamous 1864 raid on Richmond. According to the author, two different Confederate soldiers wore Dahlgren's device before it was finally repatriated to Dahlgren's father after the war.

Burns: "SHOOTING SOLDIERS: Civil War Medical Photography By R.B. Bontecou"

[Shooting Soldiers: Civil War Medical Photography By R.B. Bontecou by Stanley B. Burns, M.D. (Burns Archive Press, 2011) 6 x 6.75 hardcover, 150 illustrations. 168 pp. ISBN:978-1-936002-05-6 $50]

During and after the Civil War, medical photography was recognized as a useful means of documenting the appearance, diagnosis, and treatment of war wounds. In these images, the partially clothed soldier (often directly facing the viewer) was carefully posed to reveal the nature of his injury. One of the best and most prolific practitioners of the art was Troy, New York physician Reed Brockway Bontecou, who treated soldiers at Harewood U.S. Army General Hospital in Washington D.C. His Harewood photographs were collected in several albums.

Fast forwarding to today, ophthalmologist Stanley Burns's Shooting Soldiers is the first of a planned series of titles from the Burns Archive, all intended to showcase Bontecou's pioneering work. In it are the photos of soldiers from 101 regiments that were wounded in the last twelve months of the war in the eastern theater.

The first fifty pages are comprised of text summarizing the origins of medical photography, the directives of the army, and the history of Bontecou's own work. A short biography of the surgeon's life is included, as well as some information about the weapons and battles that led to the wounds featured in the book.

For most readers, the main point of interest of Shooting Soldiers will be the impressive reproductions of the Bontecou album photographs, each accompanied by the soldier's name, unit, nature and anatomical location of the injury, battle where the wound occurred, and discharge date. It appears that all of the subjects survived to be discharged. The hardcover itself is diminutive and almost square in dimension [6 3/4 x 6 in.], with the full page images reproduced in fine clarity on glossy paper.

One thing missing from Burns's work are the words of the wounded men. Coming from an age when medical matters were a much more deeply private matter than today, the thoughts of the soldiers at having their partially nude bodies, mutilations, and injuries permanently exposed to public view would have been interesting to find. Were the soldiers expected to participate, or were they asked to make a voluntary contribution to the advancement of medical science?

Such questions aside, Shooting Soldiers is a beautifully presented compilation of often haunting images that should be of great interest to students of Civil War history and nineteenth century medicine and photography.  One looks forward to the release of future volumes.

[for continually updated information, the Archive also has a blog]

Frazier & Hillhouse (eds.): "LOVE AND WAR: The Civil War Letters and Medicinal Book of Augustus V. Ball"

[Love and War: The Civil War Letters and Medicinal Book of Augustus V. Ball edited by Donald S. Frazier and Andrew Hillhouse, transcribed by Anne Ball Ryals (State House Press, 2010). Cloth, 21 maps, photos, notes, bibliography, index. 523 pp. ISBN:978-1-933337-42-5  $59.95]

Like many contemporaries seeking a better life in the west, 27 year old native Georgian Augustus "Gus" V. Ball planned to emigrate to Texas with his new bride. Unfortunately for the young couple, their timing could not have been worse. Just weeks before their wedding, first Georgia then Texas seceded, casting doubt on peaceful pursuits. Ball was a graduate of the Reform Medical College in Macon, Georgia, an institution that followed the teachings of New England herbalist Samuel Thomson, the founder of a nineteenth century movement to cure bodily ills with botanical concoctions. Licensed only in Georgia, Ball in 1862 was not exempt from conscription in Texas. Joining the war effort a year after his arrival in the state, he enlisted with the 23rd Texas Cavalry as a private and was assigned hospital attendant duties.

In the remarkable new book Love and War: The Civil War Letters and Medicinal Book of Augustus V. Ball, Ball's wartime correspondence (mostly to his wife, Argent, but also to and from friends and family), transcribed by descendant Ann Ball Ryals and edited by noted Trans-Mississippi Civil War historian Donald Frazier, is given a classy treatment. Maps and photographs abound, and Frazier's work goes beyond that usually found in books of this type. The letters are grouped into chapters roughly by campaign, each of which is introduced by an essay preparing the reader for the events that follow with detailed background information and context. In addition to their incorporation of key excerpts from the letters that immediately follow, these narratives expand significantly upon events (mostly military) mentioned by Ball in his letters. The correspondence is also carefully annotated by Frazier and his student assistants. In addition to identifying persons, places, and events, there is a great deal of explanatory material present in their work. The notes are also helpfully placed at the bottom of each page.

The 23rd patrolled northeast Texas until early 1863, when it was sent to the coast to repel Union amphibious attacks. There, camped along the unhealthy mouth of the Brazos River, Ball cared for sick comrades. Although he does not relate much detail about his army duties in his correspondence, insight is provided into the sorry state of his regiment, which suffered from poor leadership (especially at the top with Colonel Gould), indiscipline, and desertion. It is a familiar story to students of many disaffected Trans-Mississippi regiments, but the 23rd seems almost exceptionally dysfunctional.

By the end of the year, Ball found himself transferred to the artillery, appointed a limber driver in McMahan's Battery (previously designated Co. E, 1st Texas Heavy Artillery). The battery participated in the battles of the 1864 Red River Campaign, with Ball being called forward to the firing line to help serve the battered guns during the Battle of Yellow Bayou. Frazier's own contribution to this part of the book is worthy of special mention. His chapter length account of Yellow Bayou and his sequence of eight small scale tactical maps together comprise a wonderful record of the battle and McMahan's battery's role in it [Ball himself writes little of his battlefield experiences].

One of the most valuable aspects of Ball's correspondence is his recording of events occurring between the conclusion of the 1864 Red River Campaign and final surrender, a period of the war in Trans-Mississippi Louisiana little addressed in the literature. Generally speaking, Ball and his unit remained in the Alexandria area during this time, manning fortifications and countering small scale Federal incursions by ships, regular units, and guerrillas.

Another fascinating section of the book is the inclusion of Ball's collection of Thomsonian remedies. Running over sixty pages, and expertly edited by biomedical researcher Dr. Andrew Hillhouse, the recipe book is a large compilation of pharmaceutical formulas from a bygone medical system. Hillhouse diligently identifies the herbs, compounds, and chemicals listed, as well as the often arcane terminology of the period.

Beautifully bound and illustrated, and touching upon several understudied facets of the war in the Trans-Mississippi theater, Love and War is a truly unique contribution to the literature and is highly recommended. Students of Civil War medicine, as well as those with a specialized interest in American nineteenth century medical fads, will also find the recipe book section a valuable historical document.