Union Medical Staff and Materia Chirugica

Source for this article:  "The Medical and Surgical History of the War of the Rebellion. (1861-65.)  Part III, Volume II, Chapter XIV.--The Medical Staff and Materia Chirugica

        Previous to the outbreak of the rebellion the regular army numbered one thousand one hundred and seventeen (1,117) commissioned officers and eleven thousand nine hundred and seven (11,907) enlisted men. The Medical Department was composed of one Surgeon General with the rank of Colonel; thirty Surgeons with the rank of Major, and eighty-four Assistant Surgeons holding for the first five years the rank of 1st Lieutenant, and subsequent to that period, until promotion to Surgeon, the rank of Captain. The officers of the Medical Department formed a portion of the General Staff of the army; were not permanently attached to any regiment or command, but were subject to duty wherever their services were needed. Experience had demonstrated this system to be the best for the necessities of an army widely scattered over an immense area of territory, serving in commands of less than regimental strength, while it possessed the advantage of increasing the efficiency and value of the medical force in a professional point of view.
        At the beginning of hostilities, in 1861, large forces of State troops, or militia, responded to the several proclamations of the President calling for aid in suppressing the rebellion. Each regiment was provided with a Surgeon and an Assistant Surgeon commissioned by the States in which the troops had been enlisted. These officers were borne on the muster-rolls and permanently attached to the regimental organization, being seldom detached except for urgent reasons.
        During the early military operations the administrative duties pertaining to the Medical Department were performed by officers of the regular medical staff, detailed for the purpose, or by volunteer Surgeons appointed as Medical Directors of Divisions, as allowed by the President's proclamation of May 3, 1861.
        On the 22d of July, 1861, Congress passed an act authorizing the President to raise a force of volunteers, not exceeding 500,000, and prescribing the organization of this levy into divisions of three or more brigades, and that "each brigade shall be composed of five or more regiments, and shall have one Brigadier General, two Aids-de-Camp, one Assistant Adjutant General with the rank of Captain; one Surgeon,' one Assistant Quartermaster, and one Commissary of Subsistence." The Surgeons authorized by this act were known as Brigade Surgeons, and were borne as such on the official army registers of September, 1861, and January, 1862; they held the rank of Major.
        The duties, prerogatives, and responsibilities of Brigade Surgeons being somewhat vaguely defined, the following bill was passed by Congress on July 2, 1862: "From and after the passage of this act Brigade Surgeons shall be known and designated as Surgeons of Volunteers, and shall be attached to the general medical staff under the direction of the Surgeon General; and hereafter such appointments for the medical service of the army shall be appointed Surgeons of Volunteers."
        The Brigade Surgeons, or Surgeons of Volunteers as they were henceforth called, were assimilated to those of the regular staff, holding equal rank with the latter under commissions conferred by the President and confirmed by the Senate. They became eligible to all the duties and prerogatives pertaining to the medical officers of the army, whether in the field as Directors of Armies, Corps, or Departments, or in charge of hospitals, etc. From time to time, by acts of Congress, additions were made to the regular and volunteer corps, and such changes effected as were necessarily demanded. The act of April 16, 1862, was one of the most important of these acts, wherein the rank of Brigadier General was conferred upon the Surgeon General. Provisions were also made in this act for an Assistant Surgeon General and a Medical Inspector General, both with the rank, pay, and emoluments of Colonel of Cavalry, and for eight Medical Inspectors with the rank, pay, and emoluments of Lieutenant Colonel of Cavalry, also for Medical Purveyors and Medical Cadets. The text of the act is here inserted:

An  Act to Reorganize and Increase the Efficiency of the Medical Department of the Army

        Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That there shall be added to the present medical corps of the army ten Surgeons and ten Assistant Surgeons, to be promoted and appointed under existing laws; twenty medical cadets, and as many hospital stewards as the Surgeon General may consider necessary for the public service, and that their pay and that of all hospital stewards in the volunteer, as well as the regular service, shall be thirty dollars per month, to be computed from the passage of this act. And all medical cadets in the service shall, in addition to their pay, receive one ration per day, either in kind or commutation.
        SEC. 2. And be it further enacted, That the Surgeon General to be appointed under this act shall have the rank, pay, and emoluments of a Brigadier General. There shall be one Assistant Surgeon General and one Medical Inspector General of Hospitals, each with the rank, pay, and emoluments of a Colonel of Cavalry, and the Medical Inspector General shall have, under the direction of the Surgeon General, the supervision of all that relates to the sanitary condition of the army, whether in transports, quarters, or camps, and of the hygiene, police, discipline, and efficiency of field and general hospitals, under such regulations as may hereafter be established.
        SEC. 3. And be it further enacted, That there shall be eight Medical Inspectors, with the rank, pay, and emoluments each of a Lieutenant Colonel of Cavalry, and who shall be charged with the duty of inspecting the sanitary condition of transports, quarters, and camps, of field and general hospitals, and who shall report to the Medical Inspector General, under such regulations as may be hereafter established, all circumstances relating to the sanitary condition and wants of troops and of hospitals, and to the skill, efficiency, and good conduct of the officers and attendants connected with the medical department.
        SEC.
4. And be it further enacted, That the Surgeon General, the Assistant Surgeon General, Medical Inspector General, and medical inspectors, shall, immediately after the passage of this act, be appointed by the President, by and with the advice and consent of the Senate, by selection from the medical corps of the army, or from the surgeons in the volunteer service, without regard to their rank when so selected, but with sole regard to qualifications.
        SEC. 5. And be it further enacted, That medical purveyors shall be charged, under the direction of the Surgeon General, with the selection and purchase of all medical supplies, including new standard preparations, and of all books, instruments, hospital stores, furniture, and other articles required for the sick and wounded of the army. In all cases of emergency they may pro. vide such additional accommodations for the sick and wounded of the army, and may transport. such medical supplies as circumstances may render necessary, under such regulations as may here. after be established, and shall make prompt and immediate issues upon all special requisitions made upon them under such circumstances by medical officers; and the special requisitions shall consist simply of a list of the articles required, the qualities required, dated, and signed by the medical officers requiring them.
        SEC. 6. And be it further enacted, That whenever the Inspector General, or any of the medical inspectors, shall report an officer of the medical corps as disqualified, by age or otherwise, for promotion to a higher grade, or unfitted for the performance of his professional duties, he shall be reported by the Surgeon General for examination, to a medical board, as provided by the seventeenth section of the act approved August third, eighteen hundred and sixty-one.
        SEC. 7. And be it further enacted, That the provisions of this act shall continue and be in force during the existence of the present rebellion and no longer: Provided, however, that, when this act shall expire, all officers who shall have been promoted from the medical staff of the army under this act shall retain their respective rank in the army, with such promotion as they would have been entitled to."

Approved April 16, 1862.

        Beside the medical officers of the regular and volunteer staff, and the medical officers of regiments, there was a class designated as Acting Assistant Surgeons, who were private physicians, uncommissioned, serving under contract to do duty with the forces in the field or in general hospitals. This class was very large and embraced in its number some of the most eminent surgeons and physicians of the country. The Medical Cadets were generally young men, students of medicine, who were assigned to duty in general hospitals as dressers and assistants. The Medical Department was still further increased by a number of Hospital Stewards, who were enlisted as needed, and who performed the duties of druggists, clerks, and storekeepers.
        During the years of the war the organization of the Regular Staff had been increased so as to number one Surgeon General, one Assistant Surgeon General, one Medical Inspector General, sixteen Medical Inspectors, and one hundred and seventy Surgeons and Assistant Surgeons; there had been appointed five hundred and forty-seven (547) Surgeons and Assistant Surgeons of Volunteers; there were mustered into service between April, 1861, and the close of the war, two thousand one hundred and nine (2,109) regimental Surgeons, three thousand eight hundred and eighty-two (3,882) regimental Assistant Surgeons. During the same period there were employed eighty-five (85) Acting Staff Surgeons and five thousand five hundred and thirty-two Acting Assistant Surgeons.(1)
        To the fidelity and efficiency of this vast body of professional men the Surgeon General, in his annual report of 1865, bears the following well-deserved tribute: "I desire to bear testimony to the ability, courage, and zeal manifested throughout the war by the. officers of the Medical Department under all circumstances and upon all occasions. With hardly an exception they have been actuated by the highest motives of national and professional pride, and the number who have been killed or wounded bear honorable testimony to their devotion and duty on the field of battle."
        The following record of casualties of the Regular and Volunteer Staff during the war shows well for the honor of those who are erroneously supposed to escape the dangers and chances of war: "Thirty-two (32) were killed in battle, or by guerillas or partizans, and nine (9) by accidents; eighty-three (83) were wounded in action, of whom ten (10) died; four (4)
died in rebel prisons, seven (7) of yellow fever, three (3) of cholera, and two hundred and seventy-one (271) of other diseases, most of which were incidental to camp life or the result of exposure in the field.''(2)

(1) BROWN (H. E.), The Medical Department of the United States Army from 1775 to 1873, Washington, Surgeon General's Office, 1873, p. 245.
(2) BROWN (H. E.), (loc. cit.), p. 246.

        Of the amount of labor performed by the Medical Staff during the war some idea may be obtained when it is stated that 5,825,480 cases of wounds and disease occurred among the white troops and 629,354 cases among the colored troops.(1)
        "The cost of maintaining the Medical Department formed no small portion of the total expenses of the war, and it is a matter of just pride that it can be said that the medical disbursing officers performed their duties faithfully and honestly, and that the immense quantities of medical supplies distributed all over the country were almost without exception properly accounted for. The expenditures on behalf of the Medical Department to the close of each fiscal year, on the 30th of June, from 1861 to 1866, were as follows:

1861      $194,126.77
1862
     $2,371,113.19
1863
     $11,594,650.35
1864
     $11,025,791.33
1865
     $19,328,499.23
1866
     $2,837,801.37

making a total of $47,351,982.24 expended during the war (exclusive of salaries of commissioned officers) for the benefit of the sick and wounded soldiers of the nation."(2)
        After the organization of the forces raised for the suppression of the rebellion was perfected, the medical service in the field was based upon an independent hospital and ambulance establishment for each division of three brigades. The personnel of the division hospital consisted of a Surgeon in charge, with an Assistant Surgeon as executive officer and a second Assistant Surgeon as recorder, an operating staff of three Surgeons aided by three Assistant Surgeons, and the requisite number of nurses and attendants.
        The division ambulance train was commanded by a First Lieutenant of the line, assisted by a Second Lieutenant for each brigade. The enlisted men detailed for ambulance duty were a sergeant for each regiment, three privates for each ambulance, and one private for each wagon. The ambulance train consisted of from one to three ambulances for each regiment, squadron, or battery, a medicine wagon for each brigade, and two or more supply wagons. The hospital and ambulance train were under the control of the Surgeon-in-Chief of the Division. The division hospitals were usually located just out of range of artillery fire. Sometimes three or more division hospitals were consolidated under the orders of a Corps Medical Director, who was assisted by his Medical Inspector, Quartermaster, Commissary, and chief ambulance officer.
        The medical officers not employed at field hospitals accompanied their regiments and established temporary depots as near as practicable to the line of battle.
        As soon as possible after every engagement the wounded were transferred from the division or corps hospitals to the base or general hospitals, which at one time numbered 205; these were under the charge and command of the Regular or Volunteer Staff, assisted by Acting Assistant Surgeons, Medical Cadets, and officers of the 2d Battalion of the Veteran Reserve Corps.
        The following extracts of reports are presented to show the system of the medical organization in one of the corps of the Army of the Potomac. The reports, which give in detail the specific duties of each class of officers, were made in accordance with the following circular letter of Surgeon T. A. McParlin, Medical Director of the Army of the Potomac:

(1) BROWN (H. E.), The Medical Department of the United States Array from 1775 to 1873, Washington, Surgeon General's Office, 1873, p. 246.
(2) BROWN (H. E.), (loc. cit.), p. 246.

HEADQUARTERS ARMY OF THE POTOMAC,
MEDICAL DIRECTOR'S OFFICE,
"September 28, 1864.

"Surgeon J. J. MILHAU, U. S. Army,
"Medical Director Fifth Army Corps.

        "DOCTOR: You will require from one of each of the following named officers a detailed written report of their duties, both sedentary and active, the reports they make and receive, their duties and positions before and after engagements and on the march:

1. Medical Director of Corps.
2. Medical Inspector of Corps.
3. Surgeon-in-Chief of Division.
4. Surgeon-in-Chief of Brigade.
5. Surgeon in charge of Division Hospital.
6. Recorder of Division Hospital.
7. Attending or Prescribing Surgeon of Division.
8. Operating Surgeon.
9. Surgeon of Regiment.
10. Assistant Surgeon of Regiment.
11. Division Hospital Commissary.
12. Chief Ambulance Officer of Corps.
13. Chief Ambulance Officer of Division.
14. Ambulance Officer of Brigade, who will also specify the duties of the non-commissioned officers and privates under him. The reports when rendered you will forward to this office.

"Very respectfully, your obedient servant,

(Signed) "THOMAS A. McPARLIN,
" Surgeon U. S. Army and Medical Director Army of Potomac."

        The responses to this circular were collected by Surgeon J. J. Milhau, U. S. A., and by him transmitted to the Medical Director, T. A. McParlin. Omitting the official verbiage and forms the substance of the reports is here given:

"Duties of the Medical Director of a Corps- The Medical Director of a Corps is the head of the Medical and Ambulance Departments of the corps, and he is held responsible by the Corps Commander that they be properly and effectively managed under all circumstances. It is therefore impossible to specify definitely his duties in every case. He should possess the confidence of his Commander and ask for instruction in all cases of doubt. He should have an office and at least two clerks, of whom one should be 't Hospital Steward. The following books should be kept, viz: 1st, a Register of all Medical Officers and regular Hospital Stewards belonging to the Corps; 2d, an Endorsement Book; 3d, a Record of Certificates of Death, and action thereon; 4th, a Letter and Order Book; 5th, a Blotter, in which are checked off the regular requisitions and Monthly Reports of Sick and Wounded as received; 6th, a Manifold Writer. The following regular reports are received: 1st, Daily Report of the Medical Inspector of the Corps; 2d, the Weekly Report of Sick and Wounded; 3d, the Weekly Report of the Ambulance Corps (in duplicate); 4th, the Weekly Report of Brandy and Whiskey received, issued, etc., from each Brigade and from each Hospital; 5th, the Monthly Returns of Medical Officers from Divisions and Brigades; 6th, the Monthly Returns of Hospital Stewards, U. S. A.; 7th, the Monthly Returns of Ambulance Officers (in duplicate); 8th, Statement of Hospital Fund from each Hospital. After engagements are to be transmitted to the Medical Director of the Army: 1st, Nominal Lists of Wounded, for transmittal; 2d, Classified Returns of Injuries and Wounds (in duplicate); 3d, Aggregate Mean Strength of Command (per regiment); a Report of the Operations of the Ambulance Corps. The following Consolidated Reports for the Corps are made at stated periods to the Medical Director of the Army: 1, Weekly Report of Sick and Wounded; 2d, Monthly Return of Medical Officers; 3d, Monthly Return of Hospital Stewards, U. S. A.; 4th, Statement of Balance due Hospital Fund; 5th, Record of Certificates of Disability, and action thereon. All other reports are simply transmitted without consolidation, including certificates of death. The following papers are referred, by order of the Corps Commander, to the Medical Director for approval, recommendation, expression of opinion or disapproval, viz: All tenders of resignations on account of disability; all applications for leaves of absence; all certificates of disability for discharge, and invalid rolls when doubtful; all recommendations and complaints referring to the Medical and Ambulance Departments or affecting the health and well being of the troops; all applications for leave of absence or resignation of Medical or Ambulance Officers--in fact, all papers relating to the Medical Department are referred to the Medical Director prior to the action of the General Commanding. The following papers require to be examined and acted upon by the Medical Director: All requisitions for Medical and Hospital Supplies, and all requisitions and estimates for supplies for the Ambulance Corps. Written circulars and instructions from the Medical Director of the Army and from the Surgeon General should either in whole or part be promptly published to the Surgeons-in-Chief of Divisions and Surgeons-in. Chief of separate commands. The health and welfare of the troops, as well as the comfort and proper care of the sick and wounded, should receive the unceasing attention of the Medical Director. It therefore 'becomes his duty to ascertain, through the Medical Inspector, the Surgeons-in-Chief of Divisions, and, from his own observation, the existence of irregularities and of deficiencies in the hospitals or in the command, and he must issue the necessary instructions to have the one corrected and the other supplied. In matters of defective police, bad drainage, unhealthy camp grounds, insufficient shelter, improper or damaged food, etc., etc., he should first call the attention of the Medical Officers to the fact and suggest remedies; but if these suggestions be not promptly attended to, a written report with recommendations should be made without delay to the Corps Commander. Special attention must be given to the keeping up of supplies, both medical and hospital. Circulars should be issued from time to time, giving information to the medical officers as to what articles can be obtained, specifying the manner of obtaining them. The Ambulance Corps being under the direction of the Medical Director, the ambulances and everything connected with them claim a full share of his attention. In conjunction with the Chief Ambulance Officer he must therefore see that nothing is neglected to render them efficient in every respect and the intention of the law be carried out. The Surgeons-in-Chief of Divisions look to the Medical Director for orders, instructions, and suggestions in reference to the fitting up of the different hospitals; he should therefore instruct them as to the number of tents to be pitched, and as to whether it is desirable to construct fire-places, erect bunks, dig wells, etc., etc. As a general rule, verbal orders will be sufficient. When a movement is ordered, the Medical Director should ask for instructions in reference to the sending off of sick and wounded, the breaking up of the hospitals, the number of ambulances and wagons allowed to march with the troops, and the number to be sent to the rear, and on receiving them will give the necessary orders in writing, specifying the number of tents and flies to be carried, as well as the amount of hospital supplies, medical stores, clothing, and rations, and directing the Surgeons.in, of Divisions to see that the "hard bread" is put up in the ambulance boxes, and the field companions and hospital knapsacks are filled. Orders should be given to the Chief Ambulance Officer in reference to the position of the stretcher bearers; as a general rule they should all march with their commands, with stretchers. When only a limited number of ambulances accompany the troops, all the stretchers should go to the front strapped on the ambulances. Orders should be given to have the water-kegs flied. On the march the Medical Director accompanies the Staff', acquainting himself as far as practicable with the nature of the country passed over, the general direction and condition of the roads, the position of the houses, streams, woods, etc., etc. This knowledge will materially assist him in the selection of hospital sites. When an engagement commences the Medical Director should ascertain the position of the troops, and should immediately communicate with the Surgeons-in-Chief of Divisions, directing the establishment of field depots for the wounded at such points as will be most convenient for collecting them and where the ambulances can come up. In locating these depots special care must be taken to have them as near the line of troops as possible, so as to diminish the distance of stretcher transportation. Ravines and woods should be taken advantage of as a protection against the enemy's fire; if necessary, a breastwork can be thrown up by the attendants. An occasional bullet or an occasional shell is not sufficient to warrant Medical Officers in leaving their posts. If practicable, the Medical Director should himself visit and inspect these depots, and give orders that will insure the object of their establishment; he should also consult with the Chief Ambulance Officer as to the best roads, everything considered, to be taken by the ambulances. Should the enemy fall back these depots should be removed farther to the front; should our own troops yield the ground, the depots must be moved farther to the rear. The moment the number of wounded warrants the establishment of Division Hospitals the Corps Commander should be consulted as to the locality of these hospitals, in a military point of view. The Medical Director then selects the site himself, or designates some one to do it in his name. Orders should be immediately given to the Surgeons-in-Chief of Divisions and to the Chief Ambulance Officer, designating the locality chosen. Should a lull occur in the firing or the enemy be driven back, orders must be immediately given to advance the field depots and to take all the available ambulances to the front, to pick up the wounded as rapidly as possible, and to convey them to the hospitals. During an engagement the duty devolving upon the Medical Director of a Corps to select a site for the different hospitals of the Corps is not always an easy one. As a general rule they should be placed near the most practicable roads, in rear of the centre of the troops, and sufficiently to the rear to be out of the ordinary range of the enemy's guns; suitable ground, good water, and plenty of fuel must of course decide the choice of locality. During the action the Medical Director must keep himself thoroughly acquainted with the movements of the troops and' act accordingly. The Corps may lake up a new position with a different front; sometimes a part or even the whole of a Corps may meet a superior force and be repulsed; under such circumstances the Medical Director should be ready to act promptly, and to transfer his wounded to a safer locality. Should the Corps Commander be present he will advise his Medical Director of the state of affairs and give orders in reference to the removal of the hospitals. There are times, however, in which the Director is called upon to act upon his own responsibility. Should it become necessary to leave the wounded in hospitals in the hands of the enemy, the Medical Director will see that they are properly sheltered, that a sufficient number of Medical Officers, Hospital Stewards, and attendants remain with them, and that an ample supply of medical and hospital stores, dressings, and provisions be left for their comfort. After an engagement, the Medical Director of the Army should be communicated with as to the means of transportation for the wounded to General Hospital; he should be informed of the number and of the time at which they will be ready for such transit; on receiving instructions the necessary orders are given. The Medical Inspector generally attends to the shipment of wounded. During action the duties of a Medical Director require his presence at Corps Headquarters, where he can be found, and where he can obtain the earliest information and receive orders and reports. As a general rule, therefore, he cannot stop to operate during an engagement; he should remember that he is responsible for all the wounded, and that there are occasions in which the delay of half an hour will result in the loss of his hospitals. The Corps Commander should be kept informed of the operations of the Department both during and after engagements, and should always be consulted in matters of importance. As it is necessary for the Medical Director to visit his hospitals and field depots from time to time, he should always leave a competent Medical Officer at headquarters to represent him. When practicable, the hospitals of the different Divisions should be located near together--each one, however, to be kept perfectly independent and distinct in its management. This will much facilitate the operations of the Ambulance and Medical Departments, enabling the divisions to assist each other in taking care of the wounded. For instance, should one Division suffer more than another, an operating staff, or more if necessary, with the Autenrieth wagon, can be ordered to the suffering Division; again, should one Division be deficient in shelter or supplies, they can be obtained from the other Divisions; another advantage is the facility given for inspection, and for giving instruction, and in distributing the wounded as they come in; for instance, all available ambulances are used when wanted, without reference to their Divisions. An ambulance reaches the hospital containing wounded of different Divisions, no difficulty is experienced in distributing them, each to his own Division Hospital, thus enabling them to be treated by their own Medical Officers and to be registered in their own Divisions. Again, in sending off the wounded to General Hospital, the loading of the wagons will be much facilitated and a corps train readily found. When avoidable, the wounded should not be sent off from the field Division Hospital until they have been operated upon, properly dressed, fed, and have obtained some rest, and have somewhat recovered from the shock. In sending sick and wounded off to General Hospital the Corps Director gives the necessary orders to have the wagons or cars properly bedded with brush or hay, specifies the number of rations to be taken, and the number of Medical Officers, Stewards, and attendants that should accompany the train, giving any instructions that he may deem important in reference to the roads, camping, etc. When the troops remain in camp some time, it will be found convenient to have near each Division a few ambulances, with horses hitched up ready to convey a patient to the hospital. These are known in the Corps as picket ambulances, and are relieved every twelve hours. At this post there should be a medicine wagon, under the charge of a Steward, to issue medicines to the regimental Surgeons. The post should be marked by an ambulance guidon; this wagon to be relieved as often as emptied. As a large number of stretchers and lanterns are always broken or lost during an engagement, orders should be given after an action to have the deficiencies supplied as early as possible.

"Duties of the Medical Inspector of a Corps: A Medical Inspector of a Corps has but few specific duties assigned to him, and these, with one exception, are such as the Medical Director may direct to facilitate the management of the Medical Department and keep him informed of the deficiencies which need correcting and errors that should be rectified; as his relative position to the Medical Director is analogous to that occupied by an Assistant Adjutant General to his Commanding General, any authority he may exercise in the discharge of duty is entirely delegated power. The only reports made to him are the daily morning reports of each hospital from which the Corps report is made. A monthly report of the inspection of troops has been used, but since that has been abandoned reports, not in tabular form, have been made of the condition of the troops only to the Medical Director, calling his attention w any violation of sanitary rules that may have been observed. Previous to an engagement, or march, he sees that the direction of his superior officers relative to the proper disposition of the flying hospital and medicine wagons are obeyed, and that they are in readiness to accompany the troops. The principal duty devolved upon him during an engagement has been to represent the Medical Director at the hospitals, to see that the men are properly provided for, and when instructed to send wounded to the rear to assist the Chief Ambulance Officer in the proper apportioning of the means of transportation, to make the detail of Medical Officers and attendants to accompany the train, and ascertain that they are provided with stimulants and other essentials to render the patients confided to them as comfortable as possible.

"Duties of the Surgeon-in-Chief of a Division: 1. The Surgeon-in. Chief of a Division promulgates to Surgeons-in-Chief of Brigades all orders, circulars, and communications that are received from the Medical Director Of the Corps, also all orders, circulars, and communications pertaining to the Medical Department that emanate from Division Headquarters. 2. He receives all reports that are made by the Surgeons-in-Chief of Brigades and consolidates them before forwarding them to the Medical Director of the Corps, except the 'Monthly Report of Sick and Wounded' furnished by the regimental Surgeons, and the weekly report of 'Brandy and Whiskey' furnished by the Surgeons-in-Chief of Brigades: these are forwarded without any action from him. The only reports made directly by him are the 'Monthly Return of Medical Officers' of the Division, which he forwards to the Medical Director of the Corps, and the Personal Report to the Surgeon General from the post at which he is serving. 3. All requisitions for medicines and hospital supplies, made by the Surgeons-in-Chief of Brigades, are received by him and forwarded to the Medical Director of the Corps, without any action from him except 'Special Requisitions,' which are either approved or disapproved before being forwarded. 4. All applications for leave of absence and resignation on Surgeon's certificate, and all Certificates of Disability for discharge of enlisted men, are forwarded from their regiments through the regular military channel and referred to the Surgeon-in-Chief of the Division by the Assistant Adjutant General of the Division; each case is personally examined by the Surgeon-in-Chief and the action indorsed on the official paper. Applications for leave of absence of Medical Officers are referred to the Surgeon-in-Chief by the Assistant Adjutant General for his action. 5. All details of Medical Officers and enlisted men for duty at Division Hospitals are made by the Assistant Adjutant General, to whom the names, rank, regiment, and company are furnished by the Surgeon-in-Chief. 6. The Surgeon-in-Chief of a Division has no official relation with any Staff Officers except the Assistant Adjutant General. 7. A detail of one Medical Officer as 'Officer of the Day' is made each day by the Surgeon-in-Chief, with instructions to visit each regiment of the Division and inspect carefully its hygienic and sanitary conditions, also to visit the Division Hospital and see that proper attention is given to cleanliness and to the comfort of the patients; examine the cooking and whether the attendants perform their duties faithfully. A written report to be furnished of these investigations. 8. Before an engagement the detail for the 'Field Hospital' is announced by the Surgeon-in-Chief of the Division: the Surgeon in charge of the Division Hospital remains in charge and has control of all the shelter; the officer detailed as Hospital Commissary provides the food; the records are kept by a Hospital Steward, U. S. A. Three (3) Surgeons are detailed as operators, and three (3) Medical Officers are assigned to each operator as Assistants. One Cook, two Nurses, and one Hospital Steward are taken from each regiment for the 'Field Hospital.' 9. The Medical Officers who remain on the field at the time of and after an engagement are instructed to form their depots and locate them by Brigades, and are to select their positions in compliance with instructions of 'Circular' from Headquarters, Army of the Potomac, Medical Director's Office, dated October 30, 1862, and to examine each man before he is put in an ambulance. 10. The position of a Surgeon-in-Chief of a Division during an engage-merit is, first to locate the 'Field Hospital' and see that the details are properly filled, then to visit the flout and confer with the Ambulance Officer of the Division, ascertain that the depots are properly located and that the Ambulance Sergeants have been notified of their positions, then to report to the General Commanding and receive any instructions he may have; afterwards to return to the hospital and assist in making the wounded comfortable. 11. On the march the Surgeon-in. Chief of a Division remains with the General Commanding.

"Duties of a Surgeon-in-Chief of a Brigade: 1. The Surgeon-in-Chief of a Brigade has under his charge all the medical supplies allowed to his command. He draws once a month from the Medical Purveyor of the Army all needed to bring what he has on hand up to the requirements of the supply table, and in case of emergency can, during the month, make special requisitions for necessary articles. He issues to Medical Officers in charge of regiments only what they want for immediate use. By this excellent arrangement the Army has been relieved from the encumbrance of the large supplies formerly allowed to regiments and the transportation of the Medical Department is greatly reduced. Under two orders from Surgeon Letterman, Medical Director of the Army of the Potomac, Brigade Surgeons were forbidden, for more than a year, to take receipts from regimental Surgeons for supplies issued to them, and the Brigade Surgeon was ordered to expend them on his annual returns. This proving unsatisfactory to the Treasury Department, a circular from the Surgeon General directed a return to the requirements of Army Regulations in the transfer of all property. As medicines and other expendable articles are issued continuously, and in very small quantities, it is unavoidable for the Surgeon-in-Chief of a Brigade to be forced to expend, on his returns, much property really issued to regimental Surgeons. The transportation granted to each Brigade for its entire medical supplies, including the desks and medicine chests of regimental Surgeons, consists of one Army and one Autenrieth or Perot medicine wagon. In addition, however, to the articles carried in the wagons, the boxes of the ambulances are filled with the material necessary to establish a temporary field hospital in case the supply train during a movement is inaccessible. This arrangement is one of the greatest advances made during the past two years in providing for the wounded--as the conveyances bringing them in have all that is absolutely required to teed them, and the hospital tent and fly generally carried in the ambulance gives sufficient shelter. In the construction of new ambulances it would be desirable to increase the width and depth of the box so that larger camp kettles could be carried, the present only admitting the smallest sized kettle. The Surgeon-in-Chief of a Brigade furnishes the material carried in the ambulance boxes, and assures himself by weekly inspections of them that each box contains all required by the supply table and other orders. He also draws from the Medical Purveyor and is responsible for the stretchers carried on the ambulances. 2. The Surgeon-in-Chief of a Brigade is the Medical adviser of a Brigade Commander in all professional questions affecting the command. Applications for leave of absence, discharge, and invalid rolls, grounded on the certificates of regimental Surgeons, are submitted to him for his opinion of their propriety, to be based on an examination of the applicant. It is the duty of the Surgeon-in-Chief of a Brigade also to keep careful watch over the health of the Brigade, pointing out and endeavoring to correct all infractions of hygienic laws. He receives every Saturday, from each Medical Officer in charge of the regiments constituting the Brigade, a weekly Report of Sick and Wounded of his regiment and of the anti-scorbutics issued to it. Whenever a regimental Medical Officer leaves or returns to his command he should furnish the Surgeon-in-Chief of the Brigade with a copy of the order under which he acts. The Surgeon-in-Chief consolidates the regimental weekly reports of sick and wounded and of anti-scorbutics, and forwards them to the Surgeon-in. Chief of his Division. He sends, at the same time, a report of the liquors drawn and issued by him during the week. He makes also, to the Surgeon-in-Chief of the Division, a monthly return of the Medical Officers of the Brigade. After a battle he sends to the Surgeon-in-Chief of the Division a report of the aggregate strength for duty and names of Medical Officers present for duty, and the killed, wounded, and missing in action, according to the reports received from regimental Surgeons. The losses in skirmishing in the intervals between the battles have been reported weekly.

"Duties of the Surgeon-in-Charge of a Division Hospital: The duties of a Surgeon-in-Charge of a Division Hospital are somewhat varied, depending upon the season of the year and the state of military operations, whether the Army is in winter-quarters or engaged in an active campaign. In one case more permanent arrangements are made with a view of remaining undisturbed for several months; in the other all the appliances of a Division Hospital are arranged and managed to meet certain conditions, definite transportation, general mobility, and despatch in its construction and removal. Procuring all the necessary supplies for the sick and wounded, superintending the care and treatment which they should receive, organizing the hospital attendants, keeping the necessary and suitable records, causing reports to be made, and receiving orders from his superior officers and complying with them, are briefly in the aggregate the duties of the Surgeon-in-Charge of a Division Hospital. On the march the sick and wounded on hand are placed in ambulances, and a. Medical Officer connected with the hospital is assigned the duty of keeping with the ambulance train and rendering such assistance on the journey as the wants of the sick, etc., may demand. In the evening, or at the close of the day's march, the Surgeon-in-Charge will make the necessary arrangements for sheltering and furnishing the sick, etc., present, with food and medical attendance. This is often accomplished in this manner: The Medical Director of the Corps indicates to the Ambulance Officer the place he desires the ambulances to park. The Surgeon-in-Charge then proceeds to pitch a sufficient number of tents, directs the cooks to provide beef tea, hot coffee, etc., orders sinks to be dug, sees that the sick and wounded are unloaded and taken care of, thus affording them attentions and comfort consistent with the nature of circumstances. On the following morning, after food has been served to all, a 'Sick Call' is held, and all that require medicine receive it. Soon after, a morning report is made, signed by the Surgeon-in.Charge, and sent to the Surgeon-in. Chief of the Division. Thereafter, if it is intended to resume the march, the sick and wounded are reloaded, the tents are struck, and everything packed. Thus the routine continues from day to day as long as the march may last. In the event of an engagement, the Surgeon-in-Chief of the Division indicates to the Surgeon in charge of the hospital the place selected for the location of the Division Hospital. The latter then directs the pioneers or fatigue party to police the ground and pitch the tents, establishes the kitchen, appoints a chief cook and a cook for special diet, organizes the nurses and other attendants, unloads the ambulances of the sick, provides operating tables and all necessary appliances for surgical operations, such as chloroform, stimulants, dressings, etc., orders sinks dug, sees that a sufficient supply of water is near, either by opening springs or by digging wells, etc. Thus accommodations are made for the sick on hand as well as for the wounded that may be brought in from the battle-field. The Surgeon-in-Charge selects a Medical Officer to superintend unloading and disposing of the wounded as they come in. Such as require operations are taken to the tables and receive the attention of the Surgeons. Very often comfortable and convenient beds are made by filling sacks with hay or straw, raising them from the ground on crutches or cross-pieces. The Recorder's attention is then called to the wounded, and he takes down their names, rank, regiment, and character of injury, and, in order to prevent confusion, often finds it necessary to attach a small piece of bandage to the button-hole of the wounded man that he may be assured afterwards that his name, etc., has been registered. It is the duty of the Surgeon-in-Charge to see that the records are at the amputating tables and properly kept, specimens preserved and labelled, etc. He selects either a Medical Officer or a Hospital Steward to have immediate supervision of the kitchen, diet, and feeding of the men. He sees also that the wounds of all the wounded men are examined and dressed, and in order to secure this a sufficient number of Medical Officers are assigned to wards as dressers, and a Medical Officer, Surgeon, or Assistant Surgeon appointed each day to act as officer of the day. He is required to be on duty at night, also to attend to any emergency that may arise--sudden haemorrhage, prostration, etc. The dead likewise require the duties of the Surgeon-in-Charge. He selects a suitable location for a cemetery and here inters the dead, giving them a Christian burial by the presence of a Chaplain to officiate and attend to the funeral obsequies. The graves are marked by a head-board, written or inscribed on it the name, rank, company, and regiment of the deceased. His effects are preserved and at a convenient time disposed of according to the requirements of the Army Regulations. His duties consist, likewise, in making out provision returns and drawing from the Commissary of Subsistence a sufficient number of rations for the sick and wounded, as well as for the hospital attendants present. He should see to it that an abundant supply of chloroform, stimulants, beef-stock, blankets, bed-sacks, bandages, dressings, shirts, drawers, and socks is on hand to meet almost any emergency that may occur. When the sick and wounded are ordered to be sent to the 'Depot Hospital' a list of them will be made out complete, which, when approved by the Medical Director of the Corps, will be sent with the Medical Officer who accompanies them. A proper entry of the disposition of these will be made in the register. The supervision of the Hospital Fund made from the savings devolves upon the Surgeon-in-Charge. He will keep a correct account of it, and authorize the purchase from it of such delicacies as are needed for the comfort of the more serious cases in the hospital. The Surgeon in charge of the hospital is immediately subject to the orders of the Surgeon-in-Chief of the Division, and such other orders as may come through him from higher authority--Medical Director of Corps and Army. His reports should be made through the same channel, also the requisitions for Medical Supplies, requests for details, etc., and in fact all official communications whatever, except property returns, which go directly to the Department of the Surgeon-General. The following is a list of reports, requisitions, etc., made by the Surgeon in charge of the hospital: A Weekly Report, Monthly Report, Report of Sick and Wounded, Certificates of Death, Requisitions for Medical and Hospital Stores, Morning Reports, etc. The following is a list of the books and registers kept on hand: Morning Report Book, Register, Prescription Book, Case Book, Letter and Order Book.

"Duties of the Medical Recorder of a Division Hospital: 1. During a battle the names of all wounded admitted to the hospital are carefully entered in the prescribed forms: Lists of Wounded, giving Rank, Company, Regiment, and Corps; also the nature of the missile or weapon causing the injury, when wounded, its nature (slight or severe) ant. l the treatment pursued in each case. On this form are also entered all amputations and operations and deaths. After the engagement is over a Classified Return of Wounds and Injuries is prepared from this list. 2. At the operating table an assistant prepares all specimens of interest for preservation in a specimen jar. Here, likewise, the name and designation of the patient is noted down, with a full detail of the injury and the operation performed, with the name and rank of the operator. When the specimen is ready to be deposited in the jar it is labelled and the number on the label written opposite the patient's name. As soon as possible afterwards, a complete list is made of all the operations during the engagement, giving, as it were, a history of each case, the number opposite the patient's name corresponding with the number of the specimen in the jar. After a battle a report of aggregate strength of men and names of Medical Officers present for duty is also made out.

"Duties of the Attending or Prescribing Surgeon of a Division Hospital: 1. To visit his ward regularly twice each day, or as often as the condition of his patients may require. 2. To examine and make proper diagnosis of patients as they may be reported to him, either for wounds or disease; to make and keep a correct register of all patients, with their treatment, and daily to report them to the Surgeon in charge of the hospital. 3. To prescribe suitable remedies and to see that they are regularly administered by the attendants. 4. To inspect the diet of the men and see that proper food is given them. 5. To attend strictly to the sanitary condition of his ward and surroundings, and compel those whose duty it may be to remove everything offensive or detrimental to health. 6. To assist in all surgical operations, or operate, as he may be required by the Surgeon assigned to that duty. 7. To see that the men under his care are as comfortable as circumstances will admit.

"Duties of the Operating Surgeon: 1. The Operating Surgeon shall select steady and reliable attendants, give them clear and explicit instructions relative to their respective duties, and assign to each his proper place. 2. He shall see that all the necessary appliances be at hand required in performing operative surgery, that the instruments are in good order and in their proper places, and that a good and sufficient supply of lint, bandages, ligatures, sponges, plaster, etc., be conveniently placed and ready for use. 3. He should take charge of all patients that in the opinion of the Prescribing Surgeon require surgical attention, make a minute and thorough examination of each case and determine whether surgical aid is necessary; judge of the best manner of benefiting the patient, taking into consideration the relation of important organs, vessels, and nerves in proximity to the wound, what bearing they may have in the preservation or loss of the patient's life, and to use every preservative means within the reach of surgical science to save the life of the patient with as little impairment of all his functions as possible. 4. An operation being determined upon, he should have the patient properly placed upon the table and should judge of the practicability of administering anaesthetics, and if their use is found necessary should superintend the administration. 5. The patient being etherized, the Surgeon proceeds with the operation that the case requires in the most expeditious and scientific manner compatible with the nature of the injury, endeavoring to preserve the usefulness of the parts operated upon to the greatest extent--in operations on the extremities preserving as great a length of bone as possible and securing sufficient integument to give a liberal covering to the stump.

"Duties of the Regimental Surgeon: The first duty of the day is that of the Morning ' Sick Call,' when the sick and disabled, as well as those who are neither sick nor disabled, present themselves for treatment..The Surgeon is called upon to exercise his judgment in determining the character and gravity of their ailments. If he had none to deal with but those who were really sick, his task would be plain, simple, and easy; but, unfortunately, many of the cases are feigned, and he is required to discover and overcome the means brought into requisition by a skulker's ingenuity to carry out his deception. Presuming that the Surgeon is fortified by skill and experience sufficient to detect these, and has a just sense of responsibility to the United States Government (for he really regulates the strength of the command), his examinations will be made without partiality and regardless of position or prejudice, and in his report he will assign to duty those who are fit for duty, the sick to quarters for treatment, or send them to hospital, and recommend the permanently disabled for discharge or the Veteran Reserve Corps. It may be added that in cases having slight symptoms of diseased action, insufficient to indicate position and unmistakable disease, humanity would dictate, and authority sanctions, that they be placed off duty, and that they may have the benefit of the doubt and time for development of disease. Having concluded his work thus far, the Surgeon will see that a copy of his report is forwarded to the Adjutant, who deducts all excused from duty from the mean strength present in the regiment; and the available strength of the command is obtained, which forms the basis for all details and assignments that may be made in the regiment. Should the regiment be filled up by conscripts, substitutes, or enlisted men, the Surgeon is required to examine each one carefully and report on their fitness for service, rejecting all those who, by reason of infirmity, are unfit, and recommending for reception such as he thinks will be able to discharge the duties of a soldier. That the duties imposed upon the Surgeon are important is obvious to any one, and should be particularly so to an officer who has recorded his obligation to subserve the interest of the United States. If the Surgeon indulges the men and reports them off duty when they are not sick, he imposes additional labor on the faithful men who bear the heat and burden of the day, and virtually offers a reward to the faithless; or in examining recruits admits any who are physically disqualified, he acts in bad faith to all and in the end unwarrantably weakens the command, defrauds the Government, and may be the cause of rendering an important engagement abortive. If he conducts his examinations carelessly, the men will soon avail themselves of the chance to escape duty, and in great numbers report themselves sick; the Surgeon loses his influence for good, and he sinks into disrepute and merited disgrace, which does not terminate with his service in the Army, but will follow him throughout all time. After 'Sick Call' the Surgeon should visit the sick in quarters, prescribe for them, and see that suitable food is provided and their quarters made as comfortable as possible, inspect the camp daily, see that it is well drained by proper ditching through which all superfluous or surface water may be carried off, that all filth or anything likely to produce disease is removed or corrected, that the quarters of the men are swept and aired and their bedding exposed to the sun whenever practicable, that the sinks are covered with dirt or ashes (the latter preferable), that the food of the men is of good quality and sufficient quantity (reporting any error in either), and that the cooking is judiciously done. These duties are essential and should receive daily attention, as the neglect thereof will decidedly increase the sickness of the regiment and consequently impair its efficiency. Should a soldier die in camp or regimental hospital, the Surgeon should notify his Commanding Officer and forward to him an inventory of his effects, with the disease from which he died and the date of death, select a place for burial and see that he is decently buried and his grave carefully marked. The duties thus far pointed out are obligatory, and no excuse can be made for their non-performance in camp. There are many other acts of kindness, more correctly denominated 'favors,' that can be extended by a Surgeon without detriment to himself, that will have a good effect upon the soldier in leading him to believe that his life and comfort command the Surgeon's consideration; these being done willingly will have the effect of improving the morale of the command and usefulness of the Surgeon. When a march is likely to be made the Surgeon is directed to send his sick to General or Division Hospital. Again he is called upon to make a careful and rigid examination to avoid imposition; for the terrifying effect of a prospective battle will cause men to limp who never limped before, and many hitherto good soldiers will make an effort to escape it. The Surgeon completes his list and forwards a copy by name, rank, and company, regiment, and disease, with descriptive lists of each man; when he loads his men, providing sufficient food for the time required to reach the hospital. Having provided the requisite quantity of medicines, etc., to fill the 'hospital knapsack' or 'field companion,' he gives them to his hospital attendants, and when the regiment moves the Surgeon, Hospital Steward, and attendants take their position in the rear. If any of the command take sick or are wounded on the march, the Surgeon is notified and is prepared to prescribe medicines or suitable dressings, and furnishes a pass for ambulance transportation (a duplicate of which he retains), or directs them to walk leisurely in the road, being governed by the severity of the diseases or wounds, and being careful that no deception is practised by men that are not sick, recording each case in his 'Field Register,' with character of disease or wound. Having thus carefully discharged his duties during the day, and though the march has been a long and laborious one, he should, after arriving in camp, visit and prescribe for the sick, and endeavor to make them as comfortable for the night as the means at hand will permit, before his day's work is done. Again, in the morning, before the regiment moves, he should see them and prescribe medicines for the day, select such cases as require wagon transportation, see that they are loaded, and those able to march started before he leaves the carol). From day to day these duties should be performed. Although trying on the strength of the Surgeon he should not fail to do them, as, sooner or later, a day of rest will come and he will be able to recuperate. During an engagement the Surgeon, if not detailed on the operating staff at the hospital, should report with his assistants and attendants to a point selected in the rear of his command, either by brigade or regiment, and notify the sergeant in charge of the stretcher bearers thereof, that the wounded may be carried to said point, to whom he should give such medicines and apply such dressings as their wounds may require, to afford comparatively comfortable transportation to the hospital of their Division, where each case receives minute examination and further attention. Should the Surgeon be placed on the operating staff, his duty, in connection with other members, is to examine carefully every wounded man and determine the extent of his wound, the parts involved, and the necessity for and kind of operation his case may demand. Should he be selected to perform the operation he should endeavor to do it as scientifically and with as much despatch as the nature of the case and safety of the patient will admit, and in all cases apply appropriate dressings in such a manner that they will not become detached in transportation to General Hospital. He may be thus employed for an indefinite length of time; he should therefore feel it incumbent on him to labor as long as there are any cases requiring attention, until all have had the advantage of primary operations and are relieved from the excessive pain of undressed wounds and increased mortality attending secondary operations. The duties of the Surgeon in every position may be summed up in one sentence: He does not rest until everything is done that can contribute to the comfort of the wounded. After a battle the Surgeon will report to his regiment, unless otherwise ordered, and resume the charge thereof, and will perform such duties as are mentioned in describing those in camp, etc., previously procuring the names of the men killed in the action, and of the wounded, the nature of their wounds and character of the missile inflicting them, together with all statistics required in reports he may have to make. The reports required of a Surgeon of a regiment are the 'Morning Report' to the Adjutant, the 'Weekly' to the Surgeon-in. Chief of the Brigade, and the 'Monthly.' It is altogether necessary that a medical officer should so conduct his department that he may secure the confidence of the officer in command of the regiment to which he is attached, that said officer may receive his reports and rely on their correctness. If both military and medical officers are sincerely interested in the health of the regiment and act in concert, much can be done to promote order and discipline. The necessity for this can be discovered when the opposite is experienced. The Surgeon cannot have an order issued or carried into effect without great difficulty, and if the variance should continue the intercourse will be so unpleasant that the command eventually suffers in consequence. The officers are mutually responsible and should be mutually respectful.

"Duties of the Assistant Regimental Surgeon: The duties of an Assistant Surgeon when in charge of a regiment or hospital are identical with those of a Surgeon in the same position. If he be acting under a Surgeon in charge he will perform such share of the Surgeon's duties in the case of the sick as the Surgeon may assign to him. The sick in the ambulances on the march are usually put in charge of an Assistant Surgeon, one or more, whose duty it is to accompany the ambulances and see that such medicines are administered as the patients may require; usually he both prescribes and dispenses. He decides also what patients must be carried, and when they are well enough to walk or to rejoin their companies. Beef stock, tea, and sugar are carried in each ambulance for the use of the sick, subject to the order of the Assistant Surgeon in charge, and to be prepared by the ambulance men belonging to each ambulance. When an action is about to take place the Surgeons with the regiments are usually ordered to the Division Hospital, while the Assistant Surgeons are left to establish regimental field hospitals or depots, where the wounded come or are brought by the stretcher bearers to be dressed. Sometimes a Surgeon is left in charge of the Assistant Surgeons of a Division with orders to select the places for the field hospitals. A depot of this kind should be in some comparatively safe place, but not too far from the regiment, and where the ambulances can have a good chance to come without being in great danger from the enemy's fire; it should also be convenient to good water, which will be needed for dressing the wounded. If the place is too much exposed the stretcher men will not be likely to bring the wounded, nor will wounded men wish to be left where they may get more wounds while being dressed or waiting their turn to be attended to; but will prefer to go farther to the rear. If the ambulances cannot come to the depots where the men are brought to be dressed, a sudden change in the lines may cause some men to be left on the field who were waiting to be attended to, and who might have been carried off in a very few moments if necessary, even though they were not dressed, were the ambulances there. Still, although perfectly safe places can seldom be found near where the fighting is going on, especially where the ground is comparatively even, the Assistant Surgeon should not allow his fears to induce him to remain too far away from his men, and they should be kept advised of his whereabouts; hence, when a regimental field hospital has been established it should not be moved unless it is absolutely necessary to do so. Assistant Surgeons on the battle-field should be furnished with the ordinary Surgeons' dressing case of instruments --operations requiring other instruments than these are usually of too severe a character to be attempted on the field. He should be accompanied by one or two nurses with plenty of lint, bandages, isinglass plaster, water, sponges, and a few of the most frequently required medicines. After dressing the men the Surgeon should see that they are properly placed in the ambulances, and give the direction for their care until they reach the Division Hospital--duties often of great importance to the patient. When it can be done conveniently it is better that the Assistant Surgeons of several regiments or of a Brigade be together on the field, as they will often be enabled to assist and advise each other. An Assistant Surgeon in the field has very little opportunity for observing severe surgical cases; after the first dressing he very rarely sees or hears anything of their further treatment or termination. So far as practicable the Assistant Surgeon in the field should keep a memorandum of the names of the men he dresses, their companies and regiments, also the character and severity of their wounds; this will be of much service in making the required reports and in answering the inquiries.of anxious friends. Of the relative position of an Assistant Surgeon very little is to be said. He seems to be subject to the orders of the commander of his regiment, brigade, etc., whether he be colonel or corporal, and to those of the Surgeon of his regiment, brigade, division, etc., and has command only over those of inferior rank in his own department. So far, however, observation leads to the belief that regimental commanders seldom interfere with the duties of their Assistant Surgeons.

"Duties of the Commissary of Subsistence of a Division Hospital: The Division Hospital Commissary is under the immediate direction of the Surgeon in charge of the hospital; he makes reports to him and receives his orders. His duties while in camp are to draw at stated intervals from the commissary officer, authorized to issue to the hospital, such stores as are required for the use of the sick and wounded, stewards, and authorized attendants, on provision returns approved by the Surgeon in-Charge. He is required by existing orders to keel) on hand at least one thousand rations of bread, sugar, coffee, tea, pork, and from six to ten head of beef-cattle. He makes a daily inspection of the stores on hand in order to keep up the necessary amount of supplies, so as to be ready at all times for a rapid movement or an engagement. It is also his duty to make out the provision returns, having them agree with the morning report of sick and wounded; the names of all the hospital attendants to be written on the back of each return. He superintends the purchase of such articles as are not furnished by the Government, and which the Surgeon-in-Charge considers necessary for the use of the sick and wounded. He also keeps an account of the savings of the hospital, and makes a monthly report of the state of the hospital fund to the Surgeon-in.Charge. He has, in conjunction with a medical officer, charge of the cooking and preparation of the food, seeing that there is no unnecessary waste, and that the place in which the stores are kept and food prepared is properly policed daily. When orders to move are received he attends to the packing of the supplies in the wagons assigned for that purpose. He also sees that there is a sufficient number of cooking utensils on hand, and that they are kept clean and in good condition. On the march he is required to keep his wagons with the hospital department, or wherever they may be ordered, also to have the beef-cattle up with the wagons, so that if necessary they can be slaughtered and prepared for food in the evening, or whenever a halt is ordered. He selects a proper place for cooking purposes, unloads such stores as are required for the occasion, and, if within reach of the supply train, gets his stock replenished. On the approach of an engagement it is his duty to have hot coffee, tea, beef-soup, and other necessary articles of diet ready for the wounded as soon as they may be brought in from the field. When the wounded are being sent to the depot hospital he furnishes each man with sufficient rations to last him until he reaches his place of destination. When men are returned to duty from the hospital he also furnishes them with rations.

"Duties of the Chief Ambulance Officer of a Corps: In addition to the regular monthly returns of Quartermaster's property the Chief Ambulance Officer of the Corps receives and makes the following reports: 1, Daily Wagon and Forage Report; 2, Weekly Ambulance Report; 3, Monthly Report of Transportation; 4, Monthly Report of Officers in Quartermaster's Department of the Ambulance Train and the time to which they have made their property returns; 5, Monthly Report of all Quartermaster's property received and issued during the month; 6, Monthly Report of Officers serving in the Ambulance Train. When not on the march the Chief Ambulance Officer of the Corps inspects the ambulance train every Sunday morning with the object of correcting all abuses and of promoting the efficiency of the train. Before a move he should give timely notice to the Division Ambulance Officers, so that they may have everything packed up and ready to start at the appointed hour. It is his duty to regulate the order of march of his train, select suitable camping grounds, and see that his train is at all times ready for active service. Before an engagement he informs himself as well as possible about the country, roads, etc., sees that his train is well up and together, so that as soon as the lines of battle are established he can park his whole train in some central position from which to send picket ambulances as near the lines of each Division as possible. An officer is always placed in charge of the main park of ambulances, one in charge of the picket ambulances of each Division, and the remainder of the officers are instructed to take charge of the stretchers, men, and sergeants. It is also necessary to leave an officer in charge of the hospital train of the corps. The Chief Ambulance Officer must personally superintend the working of his train so as to see that every one does his duty, that the drivers do not become stampeded, and that the wounded are transferred to the hospital as quickly and easily as possible. It is also his duty to see that the stretcher men do not carry the wounded farther than is necessary. When in camp, and it is necessary to send off sick or wounded, the chief Ambulance Officer orders the proper number of ambulances and details an officer to take charge of the train; one ambulance officer from each Division superintends the loading of the ambulances at his Division Hospital. When in camp, the stretcher men are used in the hospital when needed. It is also necessary that the Chief Ambulance Officer should see that the ambulances are not improperly used. It being desirable to receive orders as early as possible, the Chief Ambulance Officer finds it best to have his quarters at Corps Headquarters.

"Duties of the Chief Ambulance Officer of a Division: He should be the receipting officer for all Quartermaster's property belonging to his Division, and be responsible for all deficiencies. He should make all necessary returns required by the Quartermaster's Department, Commissary Department, and Ordnance Department, viz: Monthly returns of property to the Quartermaster's Department, Quarterly return of Ordnance, usual Ration return to Commissary Department, also the daily Forage Report, the Weekly report of Ambulance Department, Monthly report to Quartermaster's Department, and Monthly report of Officers. When on the march he should attend to the running of his train, see that forage is drawn from the nearest post, and a sufficient quantity kept constantly on hand; properly park his train at night according to orders from the Chief Ambulance Officer of the Corps; necessary sentries posted so that horses may not stray away or be stolen, and be ready to move at short notice. Before an engagement it is his duty to see that the Brigade Officers are with their Brigades, and that they have the sergeants and stretcher bearers well up with their regiments, have his train so parked that it will be easy of access, and so near that the stretcher men will not have any farther than actually necessary to carry the wounded, and at the same time protect his horses from unnecessary exposure; and after an engagement to assure himself that all the wounded of the Division have been removed from the field; also to assist the Surgeons when a train of sick and wounded is to be sent to Base or General Hospital.

"Duties of the Chief Ambulance Officer of a Brigade: 1. While in camp one Brigade Officer of each Division train is constantly with the troops, and in case of any movement reports the fact at once to the Chief Ambulance Officer of his Division. He should see that the drivers and stretcher men are at the established posts, and that all orders from Surgeons for ambulances or stretchers for the transportation of sick or wounded men are promptly attended to. 2. When not on duty with the troops he will see that the ambulances are properly parked, and that the drivers attend faithfully to the feeding and grooming of their horses, the cleaning of the harness and ambulances, and to the policing of the stables and grounds of the park; also that the kegs are kept constantly filled with fresh water. Stretcher men will assist in the policing when not on duty at the Division Hospital. 3. A suitable non-commissioned officer will be selected to have the direct supervision of the ambulances of the Brigade, and another of the stretcher men. The rest of the non commissioned officers will have charge of the stretcher men of their respective regiments under the one in charge of the stretcher men of the Brigade. 4. On the march (unless otherwise directed) Brigade Officers remain with the headquarters of their Brigades, and in case of an engagement select a spot as near the line as possible, with a reasonable degree of safety to the horses, and as central to the lines of the Brigade as possible. 5. The Brigade Officer will cause a small number of ambulances to be brought to the spot selected, and others to be sent to fill their places; and as fast as they are filled to send to the place selected for the hospital. The stretcher men will be informed of the position of the ambulances, and will bring to them as fast as possible any man that may be wounded and unable to walk, until all the wounded men are carried from the field. 6. The Brigade Officer should inform himself of the shortest and best roads to the Division Hospital, and see that the drivers take them, driving carefully, and avoiding the bad places as much as possible on an uneven road. A good non-commissioned officer should remain constantly with the advanced ambulances to see that the wounded men are loaded carefully and speedily and the drivers do not get demoralized. 7. No written reports are made by Brigade Officers. They report verbally to the Division Officer any breach of discipline or neglect of duty that may require his attention. 8. He receives only such orders as come through the Chief Ambulance Officer of the Corps or his Division, or some medical officer."

        It is only necessary to point to the manifold functions required of the medical officers in the foregoing reports to see that their duties were arduous and responsible, calling, aside from professional ability, for the exercise of firmness combined with tact and moderation to do justice to the sick and wounded entrusted to their immediate care, and at the same time to avoid complications with clashing interests.

Materia Chirurgica

        At the beginning of the war each regimental Surgeon was furnished with a suitable equipment for his regiment for field service, consisting of medicines, stores, instruments, and dressings, in quantities regulated by the Standard Supply Table.(1) In action he was

(1) See Standard Supply Table for Field Service, in Revised Regulations for the Army of the United States, 1861, p. 304.

Fig. 425  Hospital Knapsack of Wicker-Work, Covered With Enamelled Cloth.


Fig. 426  Regulation Hospital Knapsack of 1862

accompanied by a hospital orderly, who carried a knapsack containing a limited supply of anaesthetics, styptics, stimulants, and anodynes, and material for primary dressings. This hospital knapsack had been recommended for adoption by an army board in 1859; it was made of light wood, 18 inches in height, 15 inches wide, and 7 inches deep, but subsequently wicker-work, covered with canvas or enamelled cloth, was substituted for the wood; its weight when filled was 18 pounds. This knapsack (FIG. 425) was in general use in the first year of the way and served an excellent purpose. In 1862 it was changed for what was known as the new regulation knapsack, in which the arrangement and character of the supplies were modified. The new pattern was 16 inches high, 12 inches wide, and 6 inches deep; the contents were packed in drawers, which were more accessible than in the old style and less liable to become disarranged or broken.(1) The weight when packed was nearly 20 pounds. (FIG. 426). Notwithstanding its convenience and general adaptability it was too heavy and cumbrous to be carried by the Surgeon himself, and, when entrusted to other hands, was liable, in the vicissitudes of battle, to be lost. In the early part of 1863 Medical Inspector R. H. Coolidge, U. S. A.. arranged a field case or companion(2) (FIG. 427) to take the place of the knapsack. It was something after the plan of the one used in the British service, and was intended to be carried by the Surgeon himself, if necessary.

Fig 427  Surgeon's Field Companion.

        The "companion" is a leather case 13 inches long, 6 inches wide, and 7 inches deep; it is supported by a strap passing over the shoulder, and is provided with a waist strap to steady it when carried.
        The hospital medicine chest, mess-chest, and bulky hospital supplies were transported in wagons of the supply train and were often inaccessible when required. To obviate this

(1) The contents of the knapsack were: One piece of white wax, 8 oz. simple cerate, 12 oz. chloroform, 5 yds. adhesive plaster, 2 yds. isinglass plaster, 1 oz. persulphate of iron, 100 compound cathartic pills, 150 blue mass pills, 150 opium pills, 100 opium and camphor pills, 150 quinine pills, 8 oz. aromatic spirit of ammonia, 16 oz. brandy, 4 oz. laudanum, 10 bandages, 10 binder's boards, 4 oz. charpie, 2 medicine glasses, 1 (spirit) lamp, 12 oz. lint, 1 box matches, 1 paper of pins, 1 spool of surgeons' silk, 4 pieces of sponge, 4 (Dunton's) field tourniquets. 2 spiral tourniquets, 1 piece of tape, 1 spool of lead wire, 1 spool of silver wire, and 1 spatula.

(2) The contents of the Surgeon's Companion were; 6 oz. chloroform, 2 oz. fluid extract of ipecacuanha. 2 oz. fluid extract of ginger. 2 oz. solution of persulphate of iron, 24 oz. of whiskey, 2 oz. tincture of opium, 144 compound cathartic pills, 144 colocynth and ipecacuanha pills, 144 sulphate of quinine pills, 144 opium pills, 1 yard isinglass plaster, a medicine cup, scissors, teaspoon, pins, thread, 4 oz. lint, a towel, 2 doz. bandages, muslin, and corks.

Fig. 428  Medicine Pannier
inconvenience panniers were provided containing the most necessary medicines, dressings, and appliances; they were designed to be carried on the backs of pack-animals, but were found to be inconveniently heavy to be transported in this manner, and were more generally carried in one of the ambulance wagons and filled from the medicine chest as required. FIGS. 428, 429 represent the pannier arranged for army use by Dr. Squibb, of Brooklyn, N. Y.; it consists of a wooden box strongly bound with iron, 21 1/8 inches in length, 11 5/8 inches in breadth, and 11 3/8 inches in depth; it weighs, when filled, 88 pounds. The medicines are well packed in japanned tin bottles and boxes, and room is left for an adequate supply of dressing material. The pannier had two compartments.(1)
FIG. 429 Upper Tray of Medicine Pannier.

        In the early part of the war medical supplies and instruments had been carried in heavy army wagons. In March, 1862, a medicine wagon was constructed by E. Hayes & Co., of Wheeling, Virginia, in accordance with plans and instructions of Surgeon Jonathan Letterman, U.S.A. Details of the internal arrangement of this wagon, could not be obtained. A Board, consisting of Brigade Surgeon William Hayes and Assistant Surgeons Hammond and Dunster, U. S. A., on April 17, 1862, examined the wagon and reported as follows: "The merits of this dispensary wagon are so apparent, when compared with the old method of packing medicines and instruments in unwieldy boxes and transporting them in the heavy army wagons, that the Board unanimously approves of the same, and recommend that it at once be sent into the field where it can be practically tested. The adoption of a vehicle of this or some similar construction for the transporting of medicines, etc., in the field would be an actual saving in transportation over the present plan, as a three months' regimental supply can be carried with case in a single wagon dispensary. The advantage accruing from the prevention of loss by wastage and breakage, the convenience of having the whole together and unencumbered by other baggage, and the readiness of access to medicines, instruments, and dressings in case of an emergency, are so palpable that it is only a matter of surprise that some such plan has not been previously adopted."
        In November, 1862, Mr. J. Dunton proposed a medicine wagon, a drawing of which is shown in FIG. 430. It was examined by Medical Inspectors T. F. Perley and J. M. Cuyler and Surgeons J. Simpson and J. H. Brinton, who reported, on November 3, 1862, that it was questionable whether it would answer the purpose for which it was designed, as it was faulty in construction, and its capacity insufficient to accommodate the entire hospital

(1) The upper compartment contained 24 roller bandages, 1 yd. of isinglass plaster, 1 paper of pins, 2 yds. bleached muslin, and 1 pair of scissors. In the lower compartment were 6 oz. purified chloroform, 2 oz. fluid extract of ipecacuanha, 2 oz. fluid extract of ginger, 2 oz. liquor of persulphate of iron, 12 doz. compound cathartic pills, 12 doz. quinine pills (3 grs. each), 12 doz. opium pills, 12 doz. pills of compound extract colocynth (3 grains) and ipecacuanha ( grain), 24 oz. whiskey, 2 oz. tincture of opium, lb. patent lint, 1 medicine glass, 1 tinned iron teaspoon, 1 small piece fine sponge, oz. silk for ligatures, 1 towel, and 6 corks.

FIG. 430  "DUNTON'S" Regimental Medicine Wagon

supplies for a regiment for three months." The wagon could be elongated at both ends, or closed, as was desired, and was arranged so as to be opened on the side.(1) As the organization of the medical staff was perfected, the cumbrous regimental supplies were curtailed and the brigade supplies augmented. Each brigade was provided with a "medicine wagon," which was furnished not only with drugs but with ample provision of stores, dressings, furniture and appliances, an amputating table, and a limited amount of bedding. The contents of the medicine wagon were constantly replenished from the stores of the medical purveyors who accompanied each army. FIGURE 431 represents the medicine wagon of Perot.(2) While the internal fixtures and arrangements for transporting supplies in this wagon were excellent and convenient, the cost of furnishing it was very great, and on the recommendation of a Medical Board consisting of Surgeons C. H. Crane, R. O.

FIG. 431  "PEROT'S" Medicine Wagon

(1) This medicine wagon is erroneously designated by Professor T. LONGMORE (A Treatise on the Transport of Sick and Wounded Troops, London, 1869, page 386) as a United States Sick Transport Wagon with side and end openings.

(2) CONTENTS OF PEROT'S MEDICINE WAGON.--Drawer 1 contained an oval keg for 6 galls, of whiskey, with a cock on top and bottom, one to let in air, the other to draw from. This keg is on a skid and can be drawn out and filled at the bung. Drawer 2: Stronger ether for anaesthesia, 32 oz.; sweet spirit of nitre, 32 oz.; solution of ammonia, 32 oz.; turpentine, 1 qt.; castor oil, 4 qts.; brandy, 6 qts.; olive oil, 2 qts.; purified chloroform, 32 oz.; copaiba, 32 oz.; sulphate of quinia, 10 oz.; syrup of squill, 4 lbs. (part in Drawer 9). Drawer 3: 1 sponge-holder for throat, 12 probangs, 1 hinged tongue depressor, 4 single trusses, 2 bottles ink, 1 bottle mucilage, 1 U. S. Dispensatory, 1 portfolio (cap size), 2 quarto blank books, 1 order and letter book, 4 quires writing paper, 1 register of patients, 1 Gray's Anatomy, 1 Erichsen's Surgery, 1 Packard's Minor Surgery, 1 Longmore on Gunshot Wounds, 1 tooth-extracting case (army pattern), 1 8-oz. hard-rubber syringe, 1 self-injecting rubber syringe, 2 thumb lancets, 12 hair pencils, 2 scarificators. Drawer 4: Closet for 3 gall. can of alcohol, and a vacant drawer for any articles desired. Drawer 5: 1 set splints (6 forearm, 4 leg, 6 large coaptation, 4 small coaptation), 2 papers pill boxes (turned wood), 1 pair pliers, 1 gimlet, 1 tape measure, 8 pieces binder's board (4 x 17 inches), 8 pieces binder's board (2 x 12 inches), razor strop in case, 1 file, 6 glass penis syringes, 1 corkscrew, 1 set Aiken's tool pad, 8 oz twine ( coarse), 1 bone, 1 razor. Drawer 6: 2 quires wrapping paper (white and blue), 2 oz. ligature silk, 1 oz. linen thread (unbleached), 2 papers pins, 4 pieces cotton tape, case containing 25 needles, 1 spool cotton and thimble, 1 yard gray silk for shades, 8 field tourniquets, 2 screw tourniquets with pad, 12 cupping tins, 2 scissors (large and small), 1 pocket case, 1 box for sundries, 100 printed envelopes, 1 traveller's inkstand, 24 steel pens, 2 pen-holders, 6 lead-pencils No. 2, 1 stick sealing wax, 1 sheep-skin (dressed). Drawer 7, Dispensing Case: Wedgewood mortar 2 doz. vials (6 6-oz. 12 4-oz., 3 2-oz. 3 1-oz.) 1 pill tile (6x8 inches), 8 oz. fine sponge (small pieces), 1 tin funnel (pint), 5 yds. adhesive plaster, 4 lbs. patent lint, pestle for mortar, 4 yds. red flannel (all wool), 2 medicine measuring glasses, 2 yds. gutta-percha cloth, 5 yds. isinglass plaster, 8 doz. assorted corks, 1 glass graduated measure (4 oz.), 1 minim measure, 10 yds. bleached muslin, 2 cotton bats, 1 sheet cotton wadding, 1 set prescription scales and weights, 2 spatulas (3 and 6-inch), 2 glass urinals, 8 suspensory bandages, 2 lbs. scraped or picked lint, 2 yds. oiled silk, 2 yds. oiled muslin, 16 doz. roller bandages, assorted (2 doz. 1 inch by 1 yd., 4 doz. 2 ins. by 3 yds., 4 doz. 2 ins. by 3 yds., 2 doz. 3 ins. by 4 yds., 2 doz. 3 ins. by 5 yds., 1 doz. 4 ins by 6 yds., 1 doz. 4 ins. by 8 yds.), 10 lbs. pressed tow, 1 doz. towels, aromatic sulphuric acid, tannic acid, spirit of nitrous ether, stronger ether (for anaesthesia), strong alcohol, alum, aromatic spirit of ammonia, purified chloroform, Dover's powder, sulphate of morphia, olive oil, castor oil, laudanum, paregoric, acetate of lead, bicarbonate of potassa, creasote, fluid extract of colchi-cum seed, fluid extract of aconite root, fluid extract of ipecac, fluid extract of seneka, tincture of chloride of iron, solution subsulphate of iron, pure glycerin, chlorate of potassa, iodide of potassium, bicarbonate of soda, whiskey, syrup of squill, blue mass, citrine ointment, powdered squill, Hoffman's anodyne, carbonate of ammonia, solution of ammonia, camphor, collodion, copaiba, sulphate of copper, alcoholic extract of belladonna, fluid extract cinchona (aromatic), fluid extract ginger, mercury with chalk, oil of turpentine, croton oil, permanganate of potassa, Fowler's solution, chlorinated solution soda, solution chloride zinc, resin cerate, simple cerate, powdered gum arabic, nitrate of silver (crystals), fused nitrate silver, sulphate cinchona, citrate iron and quinia, powdered subsulphate iron, iodide of iron, powdered ipecac, powdered opium, pills of camphor (2 grains) and opium (1 grain), compound cathartic pills, opium pills, pills of sulphate of quinia (3 grains), sulphate of quinin, powdered Rochelle salts, sulphate zinc, blistering cerate, powdered compound extract colcoynth. Drawer 8: 8 oz. Fowler's solution, 8 oz. aromatic sulphuric acid, 8 oz. fluid extract ipecac, 8 oz. fluid extract seneka, 8 oz. tincture chloride of iron, 8 oz. pure glycerin, blue mass, empty bottles, 8 lbs. sulphate magnesia, 8 lbs. flaxseed meal, 10 lbs. farina, 12 lbs. white crushed sugar. Drawer 9: 16 oz. Hoffman's anodyne, 16 oz. fluid extract ginger, 16 oz. laudanum, 16 oz. paregoric, 16 oz. chlorinated solution of soda, 16 oz. solution chloride zinc, 4 lbs. syrup of squill (part in Drawer No. 2), 8 oz. powdered tartaric acid, 16 oz. subnitrate bismuth, 8 oz. ground cayenne pepper, 16 oz. powdered Rochelle salt, 8 oz. alum, 8 oz. mercury with chalk, 8 oz. powdered ipecac, 8 oz. Dover's powder, 8 oz. acetate lead, 8 oz. bicarbonate potassa, 8 oz. chlorate potassa, 8 oz. iodide polassium, 8 oz. bicarbonate soda, 8 oz. nutmegs, 8 oz. powdered gum arabic, 8 oz. carbonate ammonia, 8 oz. camphor, 8 oz. powdered opium, empty bottles, 8 lbs. castile soap. Drawer 10: 2 tin basins (small, for dressers), 3 wash-hand basins, 2 vacant boxes for sundries, 1 metal bed-pan. Drawer 11:3 lbs. simple cerate, 24 oz. sulphate cinchona, 16 oz. mercurial ointment, 1 smoothing plane, 1 saw, 1 hatchet, 1 nutmeg grater, 4 oz. white wax, 6 lbs. ground black mustard seed, 5 lbs. black tea, 1 box for sundries, 2 lbs. candles (half length). Drawer 12: 2 doz. planed splints, 20 gray blankets, 2 blanket cases (canvas), 8 gutta-percha bed-covers, 15 bed sacks, 15 pillow cases (white), 2 leather buckets, 1 coffee mill. The wagon also contained an amputating table, 3 box lanterns, and 2 camp stools, and four hand litters were attached outside.

Fig. 432  "AUTENRIETH" Medicine Wagon.

        Abbott, and Charles Sutherland, U. S. A., in June, 1864, the Autenrieth pattern(1) (FIGS. 432, 433) was furnished to the army. An improved wagon, recommended by the Medical Department and constructed at the Government shops, was adopted during the last year of the war. Surgical instruments were furnished by the Government, each medical officer making requisition for his equipment, receipting for it, and becoming responsible for its condition while in his possession; no transfers wore allowed, and an annual return was required to be made to the Surgeon General. On leaving the service it was turned in to the nearest medical purveyor, who receipted for the same. The instruments intended for surgeons and assistant surgeons of the regular and volunteer staff were comprised in three cases--one for capital operations, containing amputating, trephining, and

(1) CONTENTS OF THE AUTENRIETH MEDICINE WAGON.--First Case: Tannic acid, 1 oz.; aromatic sulphuric acid, 8 oz.; powdered gum arabic, 8 oz.; stronger ether, 2 lbs.; Hoffman's anodyne, 1 lb.; alcohol, 64 oz.; alum, 8 oz.; solution of ammonia, 32 oz.; carbonate of ammonia, 8 oz.; aromatic spirit of ammonia, 4 oz.; tartar emetic, 1 oz.; nitrate of silver, 1 oz.; fused nitrate of silver, 1 oz.; subcarbonate of bismuth, 4 oz.; camphor, 8 oz.; simple cerate, 2 lbs.; cerate of cantharides, 8 oz.; resin cerate, 1 lb.; pure chloroform, 32 oz.; collodion, 4 oz.; copaiba, 16 oz.; creasote, 4 oz.; sulphate of copper, 2 oz.; fluid extract of aconite root, 4 oz.; extract of belladonna, 1 oz.; fluid extract of cinchona, aromatic, 16 oz.; fluid extract of colchicum seed, 4 oz.; compound extract of colocynth, 8 oz.; fluid extract of ipecac, 8 oz.; fluid extract of ginger, 8 oz.; tincture of chloride of iron, 8 oz.; citrate of iron and quinine, 2 oz.; solution of persulphate of iron, 4 oz.; powdered subsulphate of iron, 2 oz.; glycerin, 8 oz.; calomel, 8 oz.; blue mass, 8 oz.; mercurial ointment, 16 oz.; citrine ointment, 4 oz.; Dover's powder, 8 oz.; flaxseed, 6 lbs.; flaxseed meal, 12 lbs.; morphia, oz.; olive oil, 2 qts.; castor oil, 4 qts.; oil of turpentine, 1 qt.; croton oil, 1 oz.; powdered opium, 8 oz.; tincture of opium, 16 oz.; paregoric, 16 oz.; pills of camphor (2 gr.) and opium (1 gr.), 12 doz.; compound cathartic pills, 16 doz.; pills of compound extract of colocynth (3 gr.) and ipecac ( gr.), 16 doz.; opium pills, 10 doz.; sulphate of quinine (3 gr.) pills, 12 doz.; chlorate of potassa, 8 oz.; acetate of lead, 8 oz.; bicarbonate of potassa, 8 oz.; permanganate of potassa, 32 oz.; iodide of potassium, 8 oz.; sulphate of quinine, 8 oz.; soap, 8 lbs.; syrup of squill, 3 lbs.; powdered black mustard, 9 lbs.; bicarbonate of soda, 8 oz.; solution of chlorinate of soda, 32 oz.; Rochelle salt, 16 oz.; sweet spirit of nitre, 2 lbs.; solution of chloride of zinc, 1 lb.; sulphate zinc, 1 oz.; sulphate cinchona, 2 oz.; arrow root, 10 lbs.; extract of beef, 16 lbs.; brandy, 6 qts.; farina, 10 lbs.; nutmegs, 4 oz.; sugar (white, crushed), 15 lbs.; extract of coffee; black tea, 10 lbs.: whiskey, 6 qts.; patent lint, 6 lbs.; scraped lint, 2 lbs.; roller bandages (assorted), 32 doz.; suspensory bandages, 8. The wagon also contained surgical instruments, books, and stationery, prescription furniture and utensils, bed-pans, urinals, tow, coffee mill, rubber buckets, tin basins, wash-hand basins, blankets, gutta percha bed-covers, lanterns, and a hatchet. The medicines were arranged in slides; the hospital stores, dressings, furniture, utensils, etc., were arranged in drawers or on shelves.

Fig. 433  AUTENRIETH Medicine Wagon Side View

resecting instruments;(1) one for general and minor operations,(2) composed of knives, forceps, catheters, etc.; and a pocket case.(3) For regimental surgeons and assistant surgeons the field case(4) was issued; this contained much the same assortment of instruments as those already mentioned, but were somewhat more closely packed and more easily transported. Teeth-extracting instruments and dissecting cases were also furnished to regimental and general hospitals. Great liberality was shown in providing special instruments and appliances, and every effort was made to render the surgical equipment as perfect as possible.
        At the beginning of the war it was the general custom to secure possession of buildings, such as churches, mills, and dwelling houses, for hospital accommodations; but the hygienic evils growing out, of such occupancy soon led to the use of tent hospitals for the wounded, and finally, under the excellent organization of the field hospitals, tents were almost universally used by our armies in campaigns as well as in periods of inactivity. The principal tents used were the Hospital and the Sibley tent.

(1) The Capital Operating Case contained: 2 amputating knives (one long, one medium), 2 catlings (one long, one medium), 4 scalpels, 1 cartilage knife, 1 capital saw (long, bow, two blades), 1 metacarpal saw, 1 chain saw, 1 Hey's saw, 1 trephine (conical), 1 trephine (small crown), 1 bone forceps (Liston's long, sharp, spring handle), 1 bone forceps (broad edged, slightly carved, spring handle), 1 bone forceps (gnawing, spring handle), 1 bone forceps (sequestrum, spring handle), 1 artery forceps, 1 artery needle, 1 artery needle key, 12 surgeon's needles, 1 tourniquet screw with pad, 1 tenaculum, 1 scissors, 1 chisel, 1 gouge, 1 mallet, 4 drills (with one handle), 2 retractors, 1 raspatory, 1 elevator, 1 brush, 12 yards suture wire (iron), oz. ligature silk. 1/8 oz. wax, 1 mahogany case (brass bound, slide catch), 1 leather pouch.

(2) The Minor Operating Case contained: 1 amputating knife, 3 scalpels, 2 bistouries, 1 hernia knife, 1 finger knife, 1 artery forceps, 1 ball forceps, 1 gullet forceps, 1 dressing forceps, 1 dissection forceps, 1 artery needle, 1 artery needle key, 12 surgeon's needles, 1 tenaculum, 2 scissors, 1 trocar and canula. 1 Belloc's canula, 1 bullet probe, 1 director, 1 cutting pliers (small), 6 steel bougies (silvered, double curve, Nos. 1 and 2, 3 and 4, 5 and 6, 7 and 8, 9 and 10, 11 and 12), 3 silver catheters (Nos. 3, 6, and 9), 6 gum-elastic catheters (Nos. 1, 3, 5, 7, 9, and 11), 24 suture pins (silvered), 6 yards suture wire (iron), oz. ligature silk, 1/8 oz. wax, 1 mahogany case (brass bound, slide catch), 1 leather pouch.

(3) The Pocket Case contained: 1 scalpel, 3 bistouries, 1 tenotome, 1 gum lancet, 2 thumb lancets, 1 razor (small), 1 artery forceps, 1 dressing forceps, 1 artery needle, 6 surgeon's needles, 1 exploring needle, 1 tenaculum, 1 scissors, 1 director, 3 probes, 1 caustic holder, 1 silver catheter (compound), 6 yards suture wire (iron), oz. ligature silk, 1/8 oz. wax, 1 Russia leather case.

(4) The Field Case contained: 2 amputating knives (one long, one medium), 2 catlings (one long, one medium), 3 scalpels, 2 bistouries, 1 hernia knife, 1 finger knife, 1 capital saw (long, bow, two blades), 1 metacarpal saw, 1 Hey's saw, 1 trephine (conical), I bone forceps (broad edged, slightly curved, spring handle), 1 bone forceps (sequestrum, spring handle), 1 artery forceps, 1 ball forceps, 1 dressing forceps, 1 dissection forceps, 1 artery needle, 1 artery needle key, 12 surgeon's needles, I tourniquet screw with pad, 1 tenaculum, 2 scissors, 2 retractors, 1 trocar and canula, 1 raspatory, 1 elevator, 1 brush, 1 bullet probe, 1 director, 6 steel bougies, silvered, double curve (Nos. 1 and 2, 3 and 4, 5 and 6, 7 and 8, 9 and 10, 11 and 12), 3 silver catheters (Nos. 3, 6, and 9), 6 gum-elastic catheters (Nos. 1, 3, 5, 7, 9, 11), 12 yards suture wire (iron), oz. ligature silk, oz. wax, 1 mahogany case (brass bound, slide catch), 1 leather pinch; pocket case the same as allowed to staff surgeons.

Fig. 434 Regulation Hospital Tent


Fig 435  Sibley tent.

        The hospital tent(1) in use previous to the war was 24 feet in length, 14 feet 6 inches in breadth, and 11 feet 6 inches high; it was bulky, heavy, and difficult to pitch in windy weather. By the action of an army board in 1860 its size was reduced, the general form being retained. Its general appearance will be seen in FIG. 434, and its dimensions were: length 14 feet, breadth 14 feet 6 inches, height 11 feet (centre), with a wall 4 feet, the whole covered with a "fly" 21 feet 6 inches by 14 feet. The weight of this tent, including its poles and pins, was 217 pounds. Each tent had at one end a lapel to admit of two or more tents being joined and thrown into one ward. Each hospital tent was designed to accommodate comfortably eight patients. This tent has been found in practice to answer every necessary purpose. By the Army Regulations three hospital tents were assigned to each regiment, also one Sibley tent and one common wedge tent. The Sibley tent (FIG. 435) is conical in shape, 18 feet in diameter at base and 12 feet high, with an opening at the apex, to which is fitted a hood which may be closely fitted or removed at pleasure. The absence of any wall renders it inconvenient and illy adopted to hospital purposes, and the want of a fly renders it almost intolerable on account of heat in midsummer, while the centre pole curtails the available space and interferes with the free movements of the medical officers and attendants. It was not used to any very great extent for hospital purposes. The wedge tent was still less adapted to hospital purposes though found convenient as an adjunct to field hospitals. The hospital tent "fly" alone was found to answer an admirable purpose in sheltering the wounded in mild weather or when it was inconvenient or impracticable to pitch the entire tent.
        Surgeon A. P. Meylert, U. S. V., treated about eighteen hundred (1,800) patients in a field hospital of the Army of the Ohio constructed of tarpauling, such as was used by the Quartermaster's Department for covering stores and forage, and remarks: "The chief cause of success in this hospital, I believe, was in the mode of shelter adopted. The difficulty in obtaining quarters for the sick and wounded, which in the outset I regarded as the greatest possible calamity, was no doubt of the utmost advantage, since it led to the adoption of those cool, clean, and airy wards, in which I am satisfied the patients improved more rapidly and surely than in either wall or hospital tent or in ordinary buildings. Whenever it was practicable, board floors were placed in the tents, resting on sleepers placed directly on the ground. A trench from 6 to 8 inches in depth, dug around the base, and loose earth thrown around the lower edge of the tent wall in cold weather, completed the arrangement."

(1) In October, 1859, a board of medical officers, consisting of Surgeons C. A. Finley, R. S. Satterlee, C. S. Tripler, J. M. Cuyler, and Assistant Surgeon R. H. Coolidge, had recommended for the army the following allowance of tents for the sick and wounded and their attendants: For one company, 1 Sibley tent and 1 common tent; for three companies, 1 hospital tent, 1 Sibley tent, and 1 common tent; for five companies, 2 hospital tents, 1 Sibley tent, and 1 common tent; for ten companies, 3 hospital tents, 1 Sibley tent, and 1 common tent.

        The bedsteads used in the hospital tents were cots of a light frame-work of stout wood, provided with four folding legs and furnished with a jointed support near the head. The whole frame-work was covered with sacking, and throughout the war proved a most useful and satisfactory hospital cot. It was light, strong, easily transported, and was comfortable to the patient.
        Various modes were employed for heating hospital tents in the field. Wood-burning stoves were largely used, their chief objection being the difficulty of transportation. The plan which was most generally in vogue, particularly in the Army of the Potomac, and which gave the utmost satisfaction, was that known as the California plan. A pit was dug about two-and-a-half feet deep outside the door of the hospital tent; from this a trench passed longitudinally through the tent, terminating outside its farther or closed extremity. At this point, a chimney was formed by barrels placed one upon the other, or by some other simple plan. The joints and crevices of this chimney were cemented with clay. The trench in the interior of the tent was roofed over with plates of sheet-iron issued for that purpose by the Quartermaster's Department. A fire was built in the pit, and the resulting heat, radiating from the sheet-iron plates, kept the interior of the tent warm and comfortable even in the coldest weather. In the western armies, in the trench in the interior of the tent, railroad iron was placed in regular layers and covered with iron plates when possible to procure them, or with stone slabs. Occasionally funnel-shaped stoves, open at the bottom, resting upon the ground, and provided with a short pipe, were used. These were, however, objectionable. The wood fire burned out rapidly, and although an intense heat was created while it lasted, after its extinguishment the atmosphere soon chilled, exposing the men to rapid' and uncomfortable changes of temperature.
        From an examination of the records and reports in this office it would appear that the first regular tent field hospital was organized during the battle of Shiloh, April, 1862, by Dr. B. J. D. Irwin, U. S. A., Medical Inspector of the 4th Division, Army of the Ohio. His interesting description is here given: "During the military movements of troops during the battle of Shiloh," Dr. Irwin says, "one of the operating hospitals was moved forward to a deserted farm-house situated on an open level piece of unbroken ground. The presence of a spring of cool potable water and the nearness of the building to a branch of the creek were advantages that were promptly recognized, and but a short time elapsed ere these valuable desiderata were utilized in providing shelter and other comforts for the large number of wounded of our own division and those disabled on that part of the field in the preceding day's conflict, pertaining to both of the contending parties, left on the field without assistance some twenty-four to thirty-six hours. The proximity of this field hospital to the recaptured camp of a division of our troops defeated and made prisoners the preceding day, suggested the utilization of the abandoned tents for the benefit of the wounded; and as soon as the battle ceased the hospital tents, commissary tents, and wall tents pertaining thereto were accordingly taken possession of, and in a short space of time were removed to and pitched in regular order on the level ground by which the house was surrounded. The building afforded an operating room, dispensary, office, kitchen, and dining-room. Long into the night the ambulances continued to bring in the wounded, who, after receiving the necessary professional attendance, were made as comfortable as possible by being supplied with an abundance of warm food, good bedding, and shelter from the inclement weather. Next day the hospital camp was enlarged so as to accommodate some 300 patients, and the tents were systematically arranged; all bedsteads, cots, bedding, cooking and messing utensils, hay and straw found in the abandoned camp were taken possession of, and on the evening of the 8th the Division Medical Purveyor reached us with our medical supplies and hospital stores. By this time the hospital had assumed the proportions and discipline of a well regulated army camp, arranged with a view to meet the special wants of those for whom it had been established. Some mattresses were secured, and the bed-sacks, filled with hay and straw, were placed on cots, bedsteads, or improvised bunks, so that almost every patient was provided with comfortable sleeping accommodations. A suitable number of attendants of each class was detailed for duty in the establishment, which was placed under the charge of Surgeon Menzies, 1st Kentucky Volunteer Infantry, so that the invalids were promptly and regularly supplied with abundance of properly prepared nutritious food, and even a fair supply of extra diet and delicacies were served to the inmates requiring special attention. It soon became manifest that the wounded in this improvised field hospital were better provided for and more comfortable in every way than those who were moved aboard the hospital transports. In illustration of how the efforts made to ameliorate the condition of the wounded were appreciated the following official communication was published, viz:

"'HEADQUARTERS FOURTH DIVISION, ARMY OF THE OHIO,
FIELD OF SHILOH, April 12, 1862.

"Col. J. B. FRY,
Assistant Adjutant General, Chief of Staff.

"'SIR: I desire to call the especial attention of the General commanding this Army to the admirable hospital accommodations adopted by Dr. Irwin, U. S. A., Medical Inspector of the Division, during the battle of the 7th inst. They will be found as nearly perfect as the circumstances would allow. The wounded in the Division did not suffer from the inclement weather; they were all promptly sheltered and cared for. I beg to recommend Dr. Irwin to the favorable consideration of his superiors.

"'Very respectfully,
(Signed) 'W. NELSON,

"'Brigadier General.'

"Thus was established the first tent field hospital of any magnitude for the reception and treatment of the wounded on the field of battle. In the movements of the army following Shiloh and culminating in the siege of Corinth, Miss., the utility of large field hospitals was recognized, and soon developed into a system which became general in the combined armies engaged in the investment of that place. Further experience in the treatment of the sick and wounded under canvas demonstrated the many great advantages possessed by such hospitals over those established in churches, houses, and other structures temporarily used as hospitals, such as the wooden and iron huts used by the allied armies in the Crimea, or those established in large buildings, especially when not constructed in accordance with modern sanitary science. Numerous tent hospitals of much greater capacity were established and kept in successful operation during the last two years of the war, it having been satisfactorily shown that the wounded who were treated under canvas did better in every way, and recovered sooner than those treated in the large permanent hospitals."

        The consideration of the construction, organization, and administration of permanent or general hospitals is deferred to the Third Medical Volume of the Medical and Surgical History of the War.

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