on February 26, 1861, and grew, in historian H. H. Cunningham’s words, into “[a] rather impressive medical organization” that in- cluded a surgeon general’s staff of six officers, eighteen medical di- rectors in the field, eight medical directors of hospitals, seven hospi- tal inspectors, and five medical boards charged with examining candidates for appointments as assistant surgeons and for promotions from assistant to full surgeon.7It has been estimated that 834 sur-
geons and 1,668 assistant surgeons cared for 673 regiments; at sea, the entire Confederate navy had a total of seventy-three medical offi- cers.8When the 154 principal hospitals serving the Confederate army
are added to these numbers in the field, a survey of the United Con- federate Veterans in 1892 determined that the entire medical corps comprised less than 3,000.9Despite the many challenges posed by a
system cobbled together out of necessity on comparatively short no- tice (and the many difficulties of supply and distribution that plagued the department as the war lengthened), the surgeons and assistant sur- geons of the Confederacy, according to one historian, “met the de- mands imposed upon them as courageously and as effectively as could have been expected.”10
In terms of pharmacy, the backbone of supply, distribution, and compounding of medicines resided, as with the U.S. Army, with the purveying department and hospital stewards. Stewards were the foot soldiers of pharmaceutical care, compounding prescriptions and de- livering medicines directly to the men under their charge. They were authorized by act of Confederate Congress on May 16, 1861, to be
employed “as the service may require”11and had comparable rank
and pay to Union stewards. Hospital storekeepers, “not to exceed six,” were established with duties and responsibilities also similar to their Northern counterparts.12It should be pointed out that the struc-
ture, requirements, duties, responsibilities, and character of the Con- federate medical supply and distribution system mirrored that of the North. Just as its Union counterpart, the position of storekeeper never gained much standing or importance in the overall Medical Depart- ment organization. And as for hospital stewards, although they held the rank of sergeant and were expected to have a sound knowledge of the apothecary art just as those of the North, many found themselves in the position merely as the commanding officer’s most expedient choice under the prevailing circumstances.
Whereas the steward provided the most immediate pharmacy care to the men in the field, it was the medical purveyor’s responsibility to acquire and maintain adequate supplies at the depot, from which field and hospital supply tables were filled and replenished. This was no small job. The Medical Department earnestly tried to set down clear guidelines for an efficient purveying system. Circular No. 3 laid out the administrative structure for the medical purveyors.13It consisted
of nine districts, with Edward W. Johns assuming an unofficial role as lead purveyor in Richmond, Virginia. Below these were another nine field purveyors stationed throughout the South (for details, see Ap- pendix D). The “undersigned” signature is absent in the original ho- lographic transcript, but presumably it was issued by Edward W. Johns and endorsed by Samuel Preston Moore.
This circular not only speaks to the general structure of the pur- veyor’s department but also to the urgency felt by the medical leader- ship in terms of drug scarcity and the viability of native plant substi- tutes for medicines increasingly difficult to obtain from foreign sources. Much more about this will be said in Chapter 10, but suffice it to say that at least on paper a working purveying system was put into place.
The number of purveying depots continued to expand as the war prolonged; by November 1864 a total of thirty-two depots and field purveyors stretched from Richmond to San Antonio.14The purveyors
were important not only because they had to purchase and distribute all medical stores but also because they were the men through which virtually all Confederate appropriations for the Medical Department
passed. Purveyors were required to write quarterly, and later monthly, reports indicating the funds necessary for their purchasing activities. Once reviewed and approved by the surgeon general’s office, these reports (essentially requests for funds) went on to the Treasury De- partment.15 That large Treasury warrants were needed for this all-
important medical function can be seen in a sampling of requisitions placed by an assortment of purveyors. Surgeon Potts of Jackson, Mis- sissippi, asked for $300,000 for the third quarter of 1862, and by April 1864 he asked for twice that amount; surgeon Prioleau in Savan- nah asked for $150,000 to cover fourth-quarter expenses in 1862, and, as with Potts, wartime inflation and drug scarcity had him qua- drupling the amount requested in 1864; in Columbia, South Carolina, surgeon J. Julian Chisolm (1830-1903) (Figure 8.1) asked for and re- ceived the single-largest Confederate warrant for medical supplies, over $850,000, issued on April 13, 1864.16Naval records are sketch-
ier, but from July 1861 to September 1863, the Treasury Department issued forty-two warrants totaling about $200,500 for navy medical supplies.17
These sums, coming as they did out of a limited Confederate war chest, speak to the central role of the medical purveyors in the South’s military economy. The entire nation itself could collapse under an in- efficient administration of the Purveyor’s Department, or worse, un-
FIGURE 8.1. Surgeon J. Julian Chisolm ran a Confederate laboratory at Colum- bia, South Carolina, and was one of the South’s most important medical purvey- ors. Photo courtesy of the National Library of Medicine, History of Medicine Division.
der a system prone to corruption and malfeasance. Fortunately, there were few examples of the latter. Although examples of speculation and profiteering can be found, they were not epidemic. A congressio- nal investigation early in the war into the operations of the Medical Department commended the surgeon general and his staff.18 The
committee found “no want of power for its efficiency, and, except in a few particulars, no necessity for a change in the regulations which control it.”19Committee Chair T. N. Waul also noted, however, that
the supply of medical stores were generally “incomplete and insuffi- cient in many of the leading and necessary articles for the prevailing diseases”20but that this was due to the admittedly stifling effects of
the Union blockade and the utter inability of the department to obtain reliable imported medicine supplies.21Nevertheless, the committee’s
findings were not completely glowing. It concluded, “The health, comfort, and efficiency of the Army results less from defects in legis- lation than in the proper enforcement of the Regulations and regular and thorough system of inspection.”22The report serves to show that
the huge and far-flung purveying network was even more than the of- ficious Moore could always handle, and these summary comments probably did little to ameliorate that side of his character. Still, Moore did unquestionably instill and inspire a sense of loyalty and self-sac- rifice to The Cause.
But no amount of honesty and earnestness could satisfy the relent- less need for steady drug supplies or relieve the heavy burden on the public coffers. Table 8.1 illustrates the spiraling inflation that plagued the South as the war continued and the increasing costs of the medical corps, particularly in medicines and the men needed to maintain and dispense them.
These escalating costs brought system-reforming efforts by the Confederate leadership who recognized the importance of the Pur- veyor’s Department. A proposal for the closure of the purveyor’s of- fice caused Jefferson Davis to “fear the unfortunate consequences” of such an act, and on March 7, 1863, he referred his Secretary of War, James A. Seddon, to a more ambitious proposal suggested in an un- signed document that had been sent some months before to the Con- federate president. In outlining the deficiencies of the purveyor’s of- fice as then constructed, it made three main points:23(1) the functions
of the Medical Department and the purveyors were really separate and distinct; (2) a “unity of plan and action” regarding medical sup-
ply is prevented by requiring the surgeon general to be responsible for a function he knows little about; and (3) purveyors at principal de- pots have “but limited control over the other purveyors” and the “in- terference of a third party [i.e., the surgeon general] cannot but lead to confusion.”24The solution was to be found in the establishment of a
purveyor general and an assistant to oversee all purveying opera- tions.25Because the vast majority of medical stores in both quantity
and value had to deal with pharmaceuticals, the proposal is not unlike one suggested after the war in the North for an apothecary general. The idea, intriguing as it seems, was apparently never adopted. As difficulties in procuring supplies and transporting them became in- creasingly severe and the resources of the Confederacy strained, ad- ministrative experiments no matter how justifiable were just too im- practical and costly to implement. Besides, the suggestion was very
TABLE 8.1. Confederate Appropriations for Medical Supplies and Pharmacy Personnel
Appropriation 1862 1863 1864 1865
Hospital Stewards
Fiscal year ending February 18, 1862 $350,000 – – – – February 18 to April 1, 1862 $120,000 – – – – April 1 to November 30, 1862 $2,400,000 – – – – December 1 to December 31, 1862 $400,000 – – – – January 1 to January 31, 1863 – $400,000 – – $12,000 February 1 to June 30, 1863 – $3,500,000 – – $60,000 Fiscal year ending June 30, 1864 – $15,420,000 – – $100,000 July 1 to December 31, 1864 – – $14,820,000 – $100,000 Estimates of funds required for 1865 – – – $16,000,000 $200,000
Totals $3,270,000 $19,320,000 $14,820,000 $16,000,000 $472,000
Grand total – – – – $53,882,000
Source: The War of the Rebellion: A Compilation of the Official Records of the Union and Confederate Armies
(Washington: GPO, 1900), Series 4, Volume 1: pp. 339, 939, 1045; Series 4, Volume 2: pp. 112, 120, 392; Series 4, Volume 3: pp. 139, 480, 1111.Note:Changes in reporting methods make much of the data incomplete. Hospital steward allocations, for example, are probably included in the report for April-November 1862, and the figure (though not stated) for the month of December 1862 was likely $12,000 as in the following month. Although these figures undoubtedly include some nonpharmaceutical items (e.g., hospital bedding, surgical equipment, etc.), much of these reflect the manufacture and procurement costs of the materia medica. Figures are exclusive of funds for the establishment and maintenance of hospitals, physician’s salaries, and ancillary personnel (e.g., laundresses, cooks, nurses, etc.).
likely to incur the wrath of Moore, who would certainly have viewed the new position as an unwelcome intrusion over areas of his admin- istrative domain.
It is not that some such or similar position was not needed. The ad- ministrative structure of the purveyor’s office could be rigid and counterproductive. Surgeons were required to order their drug sup- plies on forms designed for that purpose and then submit them in duplicate—one copy going to the purveyor and the other to the sur- geon general’s office—and woe to the surgeon who failed to comply or properly fill out the requisite paperwork.26
Problems could particularly arise when rules were changed. For example, when Surgeon General Moore issued an order in March 1862 requiring that medical supplies be requisitioned in one-month instead of three-month quantities, confusion reigned and real suffer- ing ensued.27Writing desperately to William H. Prioleau in Savan-
nah, surgeon W. S. Lawton of the 2nd Georgia Cavalry called the pur- veyor’s attention to
a requisition for medicines sent in by me nearly a month ago and recently corrected and returned to you. The supply of medicines at the post is almost gone on account of this delay and I must ur- gently call your attention to the matter as my patients have al- ready suffered for the want of medicines. Lt. Moore, our quarter master, will take charge of the transportation of these supplies.28
Four months later things had not improved. Surgeon I. L. Harris Jr. of the 55th Georgia Volunteers complained on August 7, 1862, that for a whole week he had “not a grain” of quinine because his supply form was returned to him unfilled. The reason stated on the returned form was that Harris requisitioned a three-month quantity instead of the one- month quantity mandated back in March. The purveyor also noted that there was no accompanying duplicate. But forms distribution ap- parently did not keep pace with the surgeon general’s new orders. Harris, obviously angered over an incident that could have easily been corrected by the purveyor’s adjusting the quantity and pointing out the procedure to be followed in the future, pleaded his case:
I sent the duplicate. I sent the duplicate as I have been directed heretofore by the next mail. . . . Had I been furnished with a sup- ply table for one month or been notified that I could obtain only
a month’s supply I would have used it, instead of the three month’s furnished me and the sick would not have been suffer- ing for want of some of the articles.29
These were not the only ones to complain. Even Samuel H. Stout, medical director of the Army of the Tennessee, admitted, “that [be- cause of] the want of prompt action by purveyors, quartermasters, and commissaries unnecessary suffering was experienced by the sol- diers in consequence of their rigid adherence to the red tape routine of the regulations.”30
ADMINISTRATIVE ASPECTS