SEGURO POR CATÁSTROFE

The official duties and responsibilities of hospital stewards were set down by Joseph Janvier Woodward (1833-1884) in The Hospital

Steward’s Manual.22_{Because the hospital steward had, under the di-}

rection of the surgeon, general supervision over all aspects of the en- tire hospital,23 _{the manual covers not only his duties but those for}

whom he was responsible: wardmasters, nurses, female nurses, cooks, and laundresses. Virtually everyone, except physicians, reported to the steward, who served as the hospital’s chief administrator. On the instructions of the senior medical officer, all issues of order and secu- rity, light and ventilation, quality and quantity of food, cleanliness and orderliness of the wards and grounds devolved to the steward. In accordance with the breadth of his responsibilities, he was to receive “obedience from all non-commissioned officers, enlisted men, and citizen nurses in the hospital.”24_{As part of the steward’s regular du-}

hospital under his charge at least twice a day and in the evening he was to “inspect the condition of the lights and fires.”25

The number of hospital stewards was established as one steward per general hospital; but in hospitals that exceeded 150 patients more were allowed.26_{Troops in the field were permitted one steward, one}

cook, and one nurse per company (about one hundred men). That was the “official” allowance. In reality, there were probably no more than two to three medical care personnel per regiment (about 1,000 men).27

The probable reason why the number of hospital stewards never approached the number allotted was the special nature of this posi- tion. As many and as varied as the steward’s duties were, his core function was to serve as pharmacist. Besides having to be between the ages of eighteen and thirty-five, “of honest and upright character” and “temperate habits,” he was also to “have sufficient practical knowledge of pharmacy to enable him to take exclusive charge of the dispensary.”28_{This requirement was emphasized in the manual’s dis-}

cussion on reading of prescriptions. In bemoaning the many ways in which different surgeons may abbreviate “the officinal names for convenience,”29_{Woodward refused to add a list of approved abbrevi-}

ations since

no person shall be enlisted a hospital steward unless he is suffi-

ciently skilled in pharmacy[italics in the original] for the proper performance of his duties, it is presumed that such a list would be unnecessary here. Most of the abbreviations, moreover, at once explain themselves to anyone familiar with the officinal names of the articles, as the steward should certainly be with those on the army supply table.30

Responsible not only for compounding preparations on order of the surgeon or assistant surgeon, the hospital steward was also given explicit instructions on the maintenance of the dispensary. Prepara- tions were to be kept together as to type and dosage form—arranged alphabetically within their groups—with morphine, strychnine, ver- atria, and the other “powerful alkaloids” secured under lock and key.31_{(Details on the precise nature and extent of the steward’s phar-}

maceutical duties, as well as Woodward’s suggestions on the perfor- mance of those activities, are provided in Appendix C.)

The steward’s other primary function was to manage the medical supplies. This included the maintenance of all hospital equipment

and surgical instruments, along with supervising the medicinal stores. Although the manual made it clear that requisitions for all medical supplies (especially drugs, excipients, and liquors) were to be made by the medical officer in charge, the steward was to keep an accurate and up-to-date inventory of medicines on hand and report any short- ages to the surgeon. In actual practice, however, it is most likely that the steward did most of the ordering because the manual states, “it is frequently convenient for the hospital steward to make out the requi- sitions in accordance with the foregoing form, and carry them to the surgeon for his approval and signature.”32

Although the general question of how effective the purveyors were has been deferred to the analysis of drug supply and provision, the same question in terms of hospital stewards may be best answered here, for it will highlight the disparity between the “official” role he played and that which he actually assumed in practice. The adjutant general made hospital steward appointments in the regular army, but the military did not formally recognize the function of pharmacy dur- ing the Civil War. Caswell Mayo, who conducted interviews with many ex-stewards, indicated that the majority who attained this posi- tion were either wholly or partly lacking in the knowledge and skills of pharmacy.33_{In the many volunteer units, the chief surgeon merely}

assigned a man or men to the post. This permitted a great deal of dis- cretion and variation in each individual steward’s particular fitness for his position. Charles Beneulyn Johnson (Figure 4.1), who joined Company E of the Illinois 130th Infantry Volunteers in August 1862 and served for three years, provides an interesting account of his ap- pointment in his memoirs:

Our first Hospital Steward was James M. Miller, of Greenville, Ill., where he had served an apprenticeship in his father’s drug store, and where he now resides [1917] and has the reputation of being the wealthiest man in his county. As Ward Master of the Regimental Hospital I served a sort of apprenticeship under Hos- pital Steward Miller, and later, when he saw fit to become a com- missioned officer in a colored regiment, I succeeded to his posi- tion. This was not because I was as well qualified for the place as I should have been, but because I was the best fitted for it of anyone who was available. I had had a little Latin, a little chemistry, a lit- tle physics, a little higher mathematics before joining the army, and very shortly after I entered I began familiarizing myself with

drugs and chemicals, and with such other duties as might fall to the lot of a hospital attaché. Indeed, I studied so hard that some- times things became confused in my mind. . . .

We had a few medical books, among which I recall “Pareria’s Materia Medica,” “Mendenhall’s Vade Mecum,” a work on chem- istry; “Parish’s Pharmacy,” and “Gray’s Anatomy,” then a new work just out.34

In similar fashion Jonathan Wood, of the 14th Regiment Ohio Vol- unteer Infantry, was clearly serving in the capacity of a hospital stew- ard, though listed officially on the rolls as a private.35 _{Wood’s unit}

had extensive duty throughout the South, seeing action in Kentucky,

FIGURE 4.1. The hospital steward served as the military pharmacist during the Civil War in Union and Confederate armies. This photograph of Charles Ben- eulyn Johnson, who served with the 130th Illinois Infantry Volunteers, shows the distinctive chevrons worn by stewards. Johnson’s published workMuskets and Medicine is one of the most detailed accounts of a hospital steward’s duties and

life with the U.S. Army. Photo courtesy of the Reynolds Historical Library, Lister Hill Library of the Health Sciences, University of Alabama at Birmingham.

Tennessee, Mississippi, Georgia, and North Carolina. When he was finally detailed as a hospital steward to a general hospital, he was too ill to assume the position he had unofficially served for so long and was discharged at Chattanooga with a surgeon’s disability certifi- cate.36

Such irregularities naturally led to some stewards who were clearly unfit for the position. Sometimes the volunteer units gave evidence of wholly incompetent stewards. George E. Cooper, medical purveyor of a depot “with supplies enough for 30,000 men,” wrote plaintively to his superior:

I have had turned over to me the debris of Medical Stores of the three months [volunteer] troops. And each a mess. Had Dr. Lawson [probably a reference to Surgeon General Thomas Lawson, who had died some four months earlier] been about & come in when I was unpacking he would have caused a hole in the ground. The medicine chests are in the finest condition of all. The stoppers have come out of many of the bottles and ipe- cac, quinine, tartar emetic . . . have made a most strange and cu- rious compound. In truth none of them, save one, which has never been opened, are in condition to use again without send- ing them back to N. York to be re-filled.37

Although such slovenly goods were ultimately the responsibility of the unnamed unit surgeon, some grossly incompetent steward was probably the most directly culpable party.

Sometimes incompetence bred dishonesty. Disreputable, drunk, and ignorant contract surgeons, of which there were more than a few early in the war,38_{not infrequently permitted gross abuses of stew-}

ards through lack of interest or oversight. Such instances usually caught the vigilance of an attending nurse. A. H. Hoge, associate manager of the northwestern branch of the U.S. Sanitary Commis- sion, noted the problems that “incompetency, unfaithfulness, and fre- quent change of . . . medical men” created for hospitals.39_{The matron}

in charge at Union Hospital found the situation so bad that the hospi- tal steward there was openly profiteering in goods and supplies at the expense of the patients, spurring her to notify Secretary of War Stanton, who launched a full investigation leading to the imprison- ment of both the steward and chief surgeon.40_{Similarly, assistant sur-}

pitalized men of the 149th Illinois Volunteers were being fed only “crackers, coffee, and sugar” and when presenting his complaint, “[c]ould get nothing but imputance [sic].”41

Of course these were exceptions to the rule. Katharine Wormeley noted that both the government boats she worked on, the Louisiana and the State of Maine, had “excellent hospital stewards.”42_Although

a great many hospital stewards had been pharmacists, apprentices, or pharmacy clerks in civilian life, some became quick studies. Edwin Witherby Brown of the 81st Ohio Volunteer Infantry described him- self as a “journeyman carpenter” who found himself first wardmaster and later hospital steward for the men of his unit.43_{Brown’s two-vol-}

ume account of his experiences during the war shows diligence and care in his concern for the sick and wounded, characteristics that sent extra responsibilities his way. Brown recalled

The officer in charge of the camp was so overwhelmed with work that he was compelled to use everybody that he could trust to help, and so I got all sorts of jobs—acted the doctor and got into all sorts of trying positions. . . . How many, many of these poor people I cupped and mustard plastered I can never tell. I did my very best to help them.44

At one point he was detailed to assist with the examination of ex- slave enlistees before they were to be mustered into service. Brown took this duty particularly seriously.

They were brought perfectly nude, three at a time, into a room for examination: So that I had an unusual chance to see and know for myself the exact condition they were in. And I want to testify here that three-fourths of them had by lash or brand been brutally treated.45

Spencer Bonsall, hospital steward for his 81st Pennsylvania Volun- teers, also demonstrated concern for his comrades.46_{Bonsall’s letters}

to his wife Ellen give an interesting account of his unit’s activities during the Peninsular Campaign and the bloody Battle of Fred- ericksburg. Bonsall’s descriptions are also punctuated with com- ments on his daily activities. With stoic diligence, he writes, “I have been busy all day getting our books, etc. all up, compounding pre-

scriptions, making pills, powders and potions, and attending to vari- ous other matters.”47

Not a few hospital stewards were physicians who were either wait- ing to take their examinations before the medical board or had taken them unsuccessfully. Once passed, these stewards could become as- sistant surgeons. Other likely candidates were medical students, who welcomed the opportunity for some practical experience, something their didactic medical school curricula typically failed to provide.

Besides hospital stewards there was one other group designated to provide pharmacy care. These were the variously titled “stewards, chemists, apothecaries, and purveyors” of the Marine Hospital Ser- vice, predecessor to the U.S. Public Health Service.48 _{Dating from}

1798, the Marine Hospital Service was the largest military health care system prior to the Civil War. In twenty-seven hospitals located at major seaports such as Boston, Baltimore, Charleston, and Staten Island as well as major inland waterways in Cincinnati, Chicago, Louisville, and Memphis, each hospital had someone assigned to ad- ministering the hospital, managing its supplies, and providing phar- macy services to its patients. These hospitals provided care for sol- diers and sailors stationed along inland and coastal waterways.

RANK AND STATUS OF MEDICAL PURVEYORS