SUBFASE III: INGENIERIA DEFINITIVA Y ESTRUCTURA FINANCIERA DEFINITIVA

The rank of a medical purveyor stemmed not from his position as purveyor but from his position as a physician within the Medical De- partment of the U.S. Army. Physicians’ positions and ranks, estab- lished in 1847, were as follows: surgeons were commissioned as ma- jors, signified by a gold leaf on each shoulder strap; first assistant surgeons were commissioned as first lieutenants, designated by four bars on each shoulder strap; and second assistant surgeons were com- missioned as second lieutenants, shown by wearing two bars on each shoulder strap. As the war went on, the need for a cadre of regular medical inspectors became apparent, and by 1864 some sixteen had been commissioned as lieutenant colonels.49_{That said, the respective}

ranks of military physicians had never been formally clarified, so they were typically referred to by their position rather than rank.50

The hospital steward was a noncommissioned officer holding a rank equivalent to ordnance sergeant and was the immediate superior

of the first sergeant of a company.51_{Hospital stewards were paid $30}

per month, a sizeable increase over the private’s and corporal’s mea- ger salary of $13 a month. Still, such a salary was not that great com- pared with what the steward might make in civilian life. Edwin Witherby Brown, the hospital steward for the 81st Ohio Volunteers, could have expected to make $38 per month as a carpenter. Skilled shoemakers could make as much as $50 per month, and even un- skilled laborers could command more than the steward’s salary.52

Hospital stewards were designated by two green chevrons decorated with yellow piping and caduceus emblems worn on each sleeve. In 1862, about 400 stewards were known to be serving in general hospi- tals, a number that would rise steadily through the course of the war.53

One of the serious problems with the position of hospital steward was that it allowed for no promotion. No higher rung in the steward career ladder existed, unless one transferred out of the medical corps and into a regular line position, and that is just what some did. Caswell Mayo’s postwar survey of stewards notes this preference for those “who were of an active and aspiring nature.”54 _{Not everyone}

avoided the position or saw it as a springboard to line duty. John N. Henry of the 49th New York Infantry started as a nurse, but upon re- ceiving his appointment as hospital steward, he wrote elatedly back home to his wife, “My position is the best for me of any in the Reg. My whole duty is one of assistance to sickly, feeble & suffering men. In many respects my position is more independent than that of a line officer.”55_{Despite Henry’s excitement over his new post, the position}

remained problematic from an organizational standpoint.

The main issue, as mentioned earlier, was that the U.S. Army did not officially recognize pharmacy. Farming out the work of pharma- ceutical care to whomever might seem capable, and consigning the functions of acquisition and distribution to surgeons as purveyors, left no one in the medical corps or elsewhere able to meet basic proficiencies in the things that mattered most in pharmacy—knowl- edge of the materia medica, medicinal chemistry, compounding, and dispensing. Although clearly some individulas performed pharma- ceutical functions for the military (some quite adequately, others not), no one was specifically charged to serve as a pharmacist. This was partly a problem with the status of pharmacy itself. As we have seen, pharmacy in 1861 was only recently emerging as a distinct dis-

cipline; until well into the twentieth century, physicians would per- form many of the routine and ordinary functions of pharmacy.

Yet it did gall members of the emerging profession that pharmacy carried so little status within the military. Toward the war’s end many were calling for a professionalization of pharmacy within the U.S. military. Hospital stewards serving in the U.S. Army forwarded a pe- tition appealing to Congress for an increase in pay and rank for their position.56_{In it they insisted: that their duties required greater skill}

and knowledge than those of other noncommissioned officers, such as ordnance sergeants and quartermasters; that despite their relatively low rank and pay, they were expected to pass an examination as to their qualifications (although this was not always administered when immediate needs demanded otherwise), something required of no other noncommissioned officer; that the army gave tacit admission “of the injustice” by the fact that requests for their resignation would be favorably considered, and regulations prohibited their reduction in rank; that clerks in the quartermaster and ordnance departments were paid “double, treble, and even quadruple” the pay of hospital stew- ards; that in the course of their duties stewards were “compelled to enforce obedience over two noncommissioned ranks above them, a fact contrary to the spirit of regulations”; that despite a ruling from the War Department that enlisted men were to receive extra pay when on detached duty, hospital stewards were routinely denied it; and that there was no opportunity for promotion as a steward.57_{The hospital}

stewards were not without their allies, most notably the Philadelphia College of Pharmacy. The college formed a special committee to in- vestigate and recommend solutions. On March 1, 1864, the Commit- tee on Military Affairs issued the following report:

The Board of Trustees of the Phila[delphia] College of Phar- macy, understanding that a petition from Hospital Stewards has been referred to your honorable committee, would respectfully represent that the care of and dispensing of medical supplies for regimental and hospital purposes can be properly entrusted only to the charge of persons acquainted with medicines and believ- ing that the efficiency of the medical department of the army would be advanced by increasing the qualifications and rank of those placed in such charge, do earnestly recommend—

1st That applications for Pharmaceutical position[s] in the army be subjected to an examination as to qualifications in knowledge of pharmacy, materia medica and chemistry.

2nd That the persons so appointed have assigned to them a rank sufficient to command respect and be eligible to promotion in the same manner as Surgeons as high as the rank of captain. A regulation embodying the above, would, we believe, mate- rially increase the standard of efficiency in that corps, and cor- rect great abuse of the materials necessary to promote the sanitary condition of the soldier.

signed, Robert Bridges, chairman of the Board of Trustees58

Another ally came in the form of an interesting communication from a mysterious “M.” (The speculation that “M” might stand for John Maisch is unconfirmed but is quite plausible given the breadth of his experience with the U.S. Army Laboratory in Philadelphia). M declared

What is needed to supply the wants of the Medical Department of the Army in this respect is a corps of thoroughly educated apothecaries—not drug clerks, whose whole knowledge con- sists in knowing how to “make a bundle.” A thoroughly educated apothecary will know how to keep accounts, and experience will teach him how a hospital should be conducted. Constitute them as a separate corps under an apothecary-general, instead of purveyor-general, with two deputy-apothecary generals.59

M went on to detail the structure of an apothecary corps, noting, “The corps would prove less expensive then [sic] the present system of as- signing medical officers as purveyors, who are often very much de- pendent on their clerks in the discharge of their duties, living, natu- rally enough, ignorant of the drug business.”60

Despite the cogency of their arguments, Congress (always inter- ested in not rocking the ever-sensitive military administrative boat) chose to do nothing. Interestingly, some forty years later Caswell Mayo used the egregiously low pay and rank of hospital stewards during the Civil War to issue a renewed call for improvement in their status through the establishment of a corps very similar to that of M’s. As in the Civil War, Mayo’s call went unheeded. Though the surgeon general’s assistant, Major J. R. Kean, admitted the U.S. Army might

find the services of a half-dozen pharmaceutical chemists useful, he objected to the establishment of an elaborate corps.61_{The title “phar-}

macist” over the old “hospital steward” designation was not recog- nized until 1902, and a pharmacy corps would not be created until World War II (by an act of Congress in 1943).62_{In the military, old}

Chapter 5

The Supplies: Drug Distribution and Manufacturing

The Supplies: Drug Distribution