The previous example illustrates one important fact in regard to drug supply and provision: the ability of the surgeon in the field to minister to sick and wounded men in the field and hospital was di- rectly dependent on the administrative effectiveness of the supply and provisioning system. Although considerable praise has been heaped on Moore and his Medical Department,31much of which is deserved,
experiences such as those of surgeons Lawton and Harris lowers the estimation of the South’s purveying system.32 Confusion as to the
proper requisitioning of supplies was not uncommon, as demon- strated in this plaintive report to surgeon Joseph P. Logan, medical of- ficer in charge of the Atlanta hospitals:
Sir.—I am entirely out of medicine and made a requisition yes- terday on the Quartermaster for a supply. When he was about to purchase it some one came up and said he was a Medical Pur- veyor and that the Government would not pay for medicines bought by a Qr. Master [sic] when there was a Purveyor near. Is there a Purveyor in Savannah? If there is, why does he keep it a secret from us? I made a requisition on the Purveyor on the 19th Jan. on the Purveyor of this department in Charleston and did not have it filled until the 9th of March, and then there was not one-third of the articles required. If the government has prohib- ited Q. Masters from purchasing please inform me that I may try
the Savannah Purveyor. Be kind enough to give me the name that I may get a supply at once.
Respectfully yours, L. H. Lansar
Asst. Surgeon of Ga. Battalion33
It was not just procedural confusion that plagued the purveying system; there could even be some question as to who exactly was in charge. As mentioned previously, Edward W. Johns assumed the po- sition of “chief purveyor,” and when Prioleau questioned some orders issued therefrom, he was told to comply by the assistant adjutant general, who confirmed both the rank and authority of Johns.34When
Prioleau appealed to the surgeon general, he was told that a chief pur- veyor’s position did not exist and that the final word on all orders were to come from his office.35Six months later Moore would offi-
cially assume this status for himself.36
Sometimes evidence of gross incompetence surfaced, as when as- sistant surgeon and field purveyor John C. Stickney complained to the purveyor in Atlanta,
I assure you it is as disagreeable to me to be compelled to note these differences as it is unpleasant for you to hear of them. I do wish sincerely I could say “All right,” but there will be mistakes with the best. I found the Morphine in 28 gr. bottles, and one tin box (Gray’s Ointment) marked 32 grs. of Morphine. I weighted contents. I found only 16 grs. there was but one box. The ink I found was in (7) seven store bottles, each labled 16 oz. and two vials with 2 oz. in each. I measured two of the store bottles which were full; in one I found 12½ ozs. in the other there were 11½ ozs. so I averaged them 12 ozs.—according to the labels there would have been 116 oz. in all. I tend to these things my- self.37
By late 1863 there are clear indications that serious drug shortages were beginning to be felt. This, coupled with administrative bungling earlier in the war, led Lafayette Guild (1826-1870), the medical di- rector of the Army of Northern Virginia, to adopt a defensive posture with his medical staff:
The supply of medl. [sic] & Hspl. [sic] Stores in the Confed- eracy is very limited. Medical Purveyors fully appreciate the importance of not wastfully using these supplies, and are strictly governed by order and regulations from higher authority as well as by the imperative necessity of economizing and justly appor- tioning the cause.
The present Field Supply Table, chanced to regulate the monthly allowance of medicines to a Regiment [illegible], there- fore, in all cases [must] be rigidly adhered to without great detri- ment to the Public service.
Another great embarrassment under which the Medical Pur- veyor’s Office labors results from the extreme scarcity of proper vessels in which to transmit medical supplies, such as jars, vials & glass stoppered bottles, for lack of which, articles called for are sometimes withheld, although on hand at the Purveying De- pot. Medical Officers are, therefore, directed to turn over to the Medical Purveyor such empty vials, bottles, jars, jugs, etc. in their possession for which they may have no use.
Various complaints have been made to this office against the Medical Purveyors, which upon investigation have proved ground- less and frivolous in their character. All officers in this army are responsible for any dereliction of duty and there is always a way to punish the delinquent.
Hereafter where complaints are made they should be placed in some tangible form. The officer preferring charges against a brother officer should at the same time recollect that if the charges be frivolous and malicious he himself can be subjected to punishment.
In order to enable the Med. Purveyor to apportion firmly the Medical supplies among the different Regiments, attention is called to the “Letter of Instructions” issued from this office on the 19th of January 1863, a non compliance with which has probably given rise to the disaffection among the complaining Surgeons.
Medical Officers are instructed to economize the Stimulants, Chloroform, Morphine, Dressings, etc. issued to their monthly requisitions in order to avoid encroachment upon the supply re- served for the use of the Field Infirmaries.
The harmonious cooperation of Medical Officers with the Medical Purveyor in his efforts to meet the arduous duties rest- ing upon him will greatly increase the efficiency of his Depart- ment and of our whole Corps.38
Guild was trying to soften the criticism by ascribing the complaint to a single order, but the record shows that problems with filling or- ders in a timely and efficient manner were problematic from the be- ginning. Drug shortages only exacerbated the problem and exasper- ated the surgeons, assistant surgeons, and hospital stewards who had to watch their men suffer for it.
The problems did not entirely reside with the purveyors. Difficulty also came from the nature of the Confederate government itself. The lessons learned by the delegates at Philadelphia’s Constitutional Con- vention about a weak and ineffective confederacy of states were not impressed upon the Southern leadership. As if the South did not have enough handicaps, interstate cooperation that was assumed as a mat- ter of course in the Union war effort was a constant challenge south of the Mason-Dixon. As one recent historian of the Confederacy has pointed out,
the crisis of being a nation at war for its life, especially a new na- tion lacking many of the inertial traditions of custom and habit in federal-state relations, led to one contention after another. . . . Overwhelmingly, the occasions grew out of national military policy, chiefly enlistments and conscription, and procurement of supplies, and they began early and escalated.39
Medical supplies were not immune. Of all the medicinal sub- stances, probably the single most prescribed was alcohol, which was useful not only as a “stimulant” remedy but also as a solvent and sus- pension medium for other drugs. The inability to obtain alcohol could have disastrous results, since no tincture or fluidextract could be compounded without it. Yet the war brought an even more urgent need for alcohol. Our guide to the materia medica, Dr. Alfred Stillé, stated the conventional wisdom of his colleagues when he insisted that alcohol
is frequently required to relieve temporary debility of the sys- tem. This is strikingly the case after grave accidents, particu- larly where the tissues are crushed, and also during severe
surgical operations; under such circumstances these liquors em- inently deserve the name of cordials, and prevent that sinking of the courage which may end in fatal syncope.40
There were a lot of “grave accidents” to attend to in the field. Add to this the general notion that alcohol could serve as a stimulating tonic, and there was in an assortment of liquors a virtual panacea of the medicine chest and supply table.41Imagine, then, the consternation
of T. C. Howard, who found his efforts to obtain the much-needed ar- ticle for Richmond blocked by his very own state of Georgia. Writing in exasperation to George Blackie in Atlanta, Howard stated that he had already informed purveyor Johns in Richmond that the governor and legislature of Georgia
had by the most stringent and occatious [audacious?] hindrances made a compliance on my part with the terms of my contract to deliver the one thousand btls. of Whiskey or any part thereof an utter impossibility. Of this fact I gave the proper department due notice in a letter to Dr. Johns enclosing the Govt. Proclamation and the law of the Gen’l Assembly.42
Howard sent an agent to plead the harm this decision was doing to the Confederacy but was told he could argue his case in court. Howard further stated that the law passed by the Georgia legislature
practically annulled any outstanding contract, changing the pay, etc. It stipulated for an oath on the part of the contractor, that the grain used by him in supplying the Govt. should not be raised
short of 20 miles of a Rail Road [emphasis in the original], be-
sides much foolery of the same sort.43
Howard, in disgust, turned the contract over to E. M. Bruce of Chatta- nooga, Tennessee, apparently giving up all hope of making any profit in the matter.
Problems with state governments and the procurement of alcohol for medicinal purposes reared up again early in 1864, when Moore had to remind Governor Vance of North Carolina that the distillery operating in that state belonged not to the Governor but to the Con- federate Medical Department. Vance’s insistence that North Carolina
could provide liquor to Moore’s office under contract brought an angry reply of clarification to the secretary of war:
[T]he Medical Department has no contract for alcoholic stimu- lants in the State of North Carolina. The distillery at Salisbury referred to by Governor Vance is owned by the Medical Depart- ment and is engaged in the manufacture of whisky and alcohol for the sole use of the sick and wounded of the Army. This dis- tillery was purchased by this department for the purpose of dis- pensing with the system of contracting for alcoholic stimulants, as it has been found that a large quantity of whisky manufac- tured by contractors is of an inferior quality, and their contracts were not in other respects faithfully complied with. It is also be- lieved that a large quantity of the whisky made by contractors has been sold to private parties when it should have been deliv- ered to the Government. . . .
The Attorney-General has decided that the Confederate Gov- ernment has the express power to support armies; that any means may be used which are necessary and proper to obtain supplies for that support. . . . In conclusion I would state that it is absolutely necessary for the comfort and welfare of the sick and wounded of our Army that the Government distillery at Salis- bury should not be interfered with or the supply of grain cut off.44
These incidents show a fatal flaw in the Confederacy itself. States, concerned for their own supplies, could essentially legislate away any national need, no matter how pressing. The law described by Howard was clearly designed to do precisely what it did, namely, “annul any outstanding contract.” The administrative battle between Governor Vance and Surgeon General Moore shows that state interests were not always one with national requirements. In a bitter twist of irony that echoed Lincoln’s 1858 speech, the South had become its own “house divided against itself,” and it was most apparent in its procurement of medical supplies.
Lacking funds, a manufacturing infrastructure, reliable outlets for procurement, even a unified government through which they could operate, the accomplishments of the purveyors were remarkable and, at times, ingenious. The operations of the Confederate laboratories will be examined in Chapter 9, but it should be stated here that the
purveyors’ skills were most noteworthy in their efforts at manufactur- ing certain medicinal items. On the eve of Gettysburg, for example, the surgeon general announced that J. Julian Chisolm had com- menced the manufacture of blue mass, mercurial ointment, and sweet spirit of nitre at his purveying depot in Columbia, South Carolina.45
Dr. Milo Smith of Chattanooga made up his own Epsom salts and told the War Department that a supply “ample for the needs of the army can readily be manufactured and at very little cost.”46George Blackie
reported that he had discovered a large deposit of black oxide of man- ganese (dioxide of manganese, a popular tonic and alterative usually given in three to twenty grains in pill form) “of extreme purity” in a nearby Georgia County.47In these and many other ways, purveyors
attempted to provide for a beleaguered Confederate Medical Depart- ment. That they had difficulties is to be expected; that they succeeded as well as they did is a testimony to their diligence and ability to inno- vate.
But, as in the North, the heart of pharmacy lay not in its adminis- tration but rather in its materia medica and the ability of hospital stewards in the field and in hospitals to provide care. From the drug supply table to the drug manufacturing laboratories to the men who prescribed and dispensed the drugs, the materia medica was the foun- dation of all nonsurgical and postoperative care in the Civil War. In the South, however, all of this took place under conditions of serious disease and severe drug shortages caused by a steadily tightening Un- ion blockade. Indeed, before the Confederate materia medica can be understood, the conditions of privation under which it labored must be explained. The story of how precisely the South managed to pro- vide pharmacy care amidst these obstacles rivals even the most quint- essential Yankee ingenuity.