The Medical and Surgical Journal of the Confederate States. (Part 1)
The American Civil War was a crucial moment in the history of American medicine. When I mention the study of Civil War Medicine to most people, they always assume the worst. “Oh, what was that like? A shot of brandy while they hacked off your leg?” or, “They just cut off everything! What else could they do without modern science?”
While this article isn’t about exposing the truth surrounding Civil War Medicine (that day will come), we need to see the war as an important medical moment for context. The Civil War was central to modernizing medicine, turning it from an individualistic practice toward a collaborative science. The Union Army Medical Department ordered physicians to keep thorough medical records, and the massive general hospitals built in the name of hygiene and organization made this practice easier.
Surgeries were conducted more conservatively, especially as the war went on and knowledge surrounding operations changed. Medical boards, which were organized based on merit and ability, determined the need for surgeries. Army medical standards were raised, and rigorous medical exams weeded out the ill-fitting army surgeons with low skills.
Science became a central part of Civil War Medicine. Modern medical and scientific devices like microscopes, chemistry equipment, thermometers, and stethoscopes were introduced. Central record keeping was part of the new army medical regulations, and all surgical reports were sent to a central repository. A large-scale medical history of the war was organized and put together, making it one of the most thorough of any conflict.
While this depicts a Union Surgeon in action it is one of the few photographs we have of Civil War Surgeons at work.
Great strides were made on both sides of the conflict.
Since the war ended, the Union victors have drawn the majority of medical history interest. It’s understandable. The South lost most of its medical records during the conflict. The wealth of medical data collected by the Union Army during the war became one of the largest official medical histories of any war.
What happened in the Confederacy?
The Confederate Medical Department suffered through many of the same growing pains. They had to bring in civilian doctors with little to no surgical experience of medical training. They came in from receiving training at various medical colleges or apprenticeships where they learned different things or different methods. They witnessed unprecedented casualty rates, gruesome battlefield injuries, and hospitals filled with diseased patients. There was a massive learning curve.
The Confederacy also faced a different list of issues. The South was almost exclusively an agrarian society. They didn’t have the industrial capacity of the North. Pressure was placed on Confederate supply purveyors as the Union blockade was ramped up. This meant crucial medicine, surgical supplies, medical equipment, and needed materials barely squeezed through. The Confederate Medical Department, headed by Dr. Samuel Moore, worked diligently to come up with different methods of obtaining the needed supplies, even resorting to asking Southern women to grow opium poppies for the cause.
While there were struggles, the Confederate Medical Department used the Civil War as a learning experience.
Think of what the war offered. When the discovery of anesthesia was presented to the world in 1846, surgery was in its infancy. Most doctors lacked any operating experience, but the Civil War gave them plenty of opportunities to learn.
Pre-Civil War society was averse to post-mortem examinations and cadaver training for medical students. The Medical Department received the right to conduct post-mortem exams, allowing doctors to explore pathology and the human body further.
Like the Union, the Confederacy learned a lot about hygiene, proper hospital construction, antiseptics, disease, pathology, and a tremendous amount about battlefield medicine.
The Confederate States Medical & Surgical Journal
In the 19th Century, the number of medical journals in the United States exploded. While many were just printed for a few issues, the rising interest in medical science and shifting ideas surrounding American Medicine made medical journals the quickest way to disseminate new medical information.
Major medical reforms for both the Union and the Confederacy focused on the accumulation of medical information and its dispersal among each side’s ranks. Union Army Surgeon General William Hammond modernized his medical department, and one major reform involved placing cutting-edge medical journals in each general hospital for his surgeons to study.
The Civil War was sort of a golden age for medical journals. The war involved taking doctors from every American state (both the Union and Confederacy) and placing them in a position where they were overwhelmed with medical material and subjects. At the outset of the war most states had their own medical journals and naturally doctors serving in the war sent back their experiences, studies, questions, and other writing of note to the editorial boards of their local journals.
From a medical standpoint, however, the war was a unifying experience for doctors who worked with their colleagues in large numbers for the first time in history. National medical journals started to garner more attention like the American Medical Times, Journal of the American Medical Association, American Journal of the Medical Sciences, and others became definitive journals in their field.
The Confederate Medical Department took on its own project to gather and share the medical knowledge they gained from the war. That’s where we get to the focus of all this: the Confederate States Medical & Surgical Journal.
Only two volumes were ever published.
The Confederate Capital of Richmond was only a little over 100 miles from Washington, D.C. As the war rolled on, the destruction of Richmond was inevitable. All throughout the Confederacy, Union forces rolled along, burning and destroying as they went, hoping to force a Confederate surrender. However, the Confederate capital would burn at their own hands as the war drew to a close.
The Confederate Medical Department was situated in the Confederate capital, which, by 1863, occupied rooms inside the Mechanics Institute. It was there that Confederate Surgeon General Samuel P. Moore and his handful of department staffers directed the complicated work of the Confederate Medical Department. The Surgeon General’s office accumulated mountains of medical data stored in the city, but it was all fated for destruction.
On April 1, 1865, a little over one week after Robert E. Lee’s surrender, his forces lost the Battle of Five Forks. Their vital supply lines were now cut off, and Lee was forced to abandon Petersburg, where his army had been entrenched for months. His abandonment of Richmond was necessary if his army was going to survive, and on April 1st, he wired Richmond, ordering an evacuation. Confederate President Jefferson Davis passed the word along, it was time to leave.
With vital stores in the city, the Confederate government ordered it all destroyed, including warehouses filled with tobacco, food, and stores of alcohol. The government ordered the incineration of sensitive documents. Chaos ensued as the destruction of alcohol resulted in citizens drinking it and starving citizens raiding remaining food stores. The document fires grew out of control as rioting citizens kept the fire department away. The fires spread, swallowing up much of the city, and by the time Union occupiers arrived, over 800 buildings had burned. The Richmond Evacuation Fire destroyed four years’ worth of medical records accumulated by the Confederate Medical Department.
By the time fires engulfed Richmond, only two volumes of the Confederate States Medical & Surgical had been published. The entire year of 1864 made it into the journal as volume I, running from January to December 1864 (12 issues total). For 1865, January and February made it to the press, but the third issue of volume two burned where it was, ready to ship off to the world, now lost forever.
Dr. Michel Middleton, who was the head of the Manchester, Virginia Hospital during the war, also served as the journal's editor. Middleton wrote in an 1883 letter to Dr. Thomas Wood,
“My Dear Doctor, the January and February numbers of our Confederate States Medical and Surgical Journal for 1865, were, indeed, the only ones ever issued. The March number, however, was printed and ready for issue when all was burnt up in the Richmond conflagration!”- Middleton to Thomas Wood, February 10, 1883.