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The Confederate Navy's Office of Medicine and Surgery was a small organization within the Confederate Navy Department. The physicians, surgeon's stewards, and nurses provided medical care to sick and injured sailors from both sides of the conflict. The provision of health care often took place under trying circumstances, including shortages of medicines, money, and food. Members of the medical department served in all major and many minor naval engagements and worked long hours treating the wounded after battle. Many of the physicians served in the U.S. Navy before the Civil War. Their sacrifices and achievements are lost in the maelstrom of the larger conflict on land. This article is an effort to call attention to their story.

Introduction

I common misperception is that during the American Civil War the two combatant navies played only a subordinate role to the greater conflict on land. In fact, the Federal and Confederate navies greatly affected the war at the operational and strategic levels. General George McClellan's 1862 peninsular campaign and Benjamin Butler's Army of the James 1864 Virginian peninsula operations would have been impossible without the support of the U.S. Navy. The Union's Mississippi Squadron was key to denying the Mississippi River to the Confederacy and to the eventual capture of Vicksburg. The naval blockade of the southern coastline seriously hampered Confederate importation of war materiel and export of "king cotton," which, of course, affected the Confederacy both militarily and financially. The Confederate Navy also affected the operational and strategic course of the war. Confederate Navy ironclads, such as the Virginia and the Albemarle, kept Southern ports and rivers safe from capture and open for blockade runners. One major contribution to the war effort by the Confederate Navy was its handful of commerce raiders. These ships, the most famous being the CSS Alabama, destroyed the U.S. maritime industry by sinking merchant ships, driving up insurance costs to prohibitive levels, and finally forcing American cargoes into neutral ships. The U.S. merchant marine did not recover from Confederate Navy depredations until the 20th century, Historians primarily focus their attention on these raiders and the ironclads. As a result, few people today know anything about the Confederate Navy's Office of Medicine and Surgery. This article, then, is designed to shed light on this overlooked chapter in the history of military medicine, Organization, Staffing, and Budget of the Office of Medicine and Surgery The Confederate Navy's Office of Medicine and Surgery (OMS) was formally instituted on March 16, 1861, when Confederate President Jefferson Davis signed the Navy Bill into law. OMS was one of four naval bureaus. The other three were the Office of Orders and Details (the senior bureau and essentially an office of personnel with military judicial duties), the Office of Ordnance and Hydrography (which dealt with weapons, ammunition, and navigational equipment), and the Office of Provisions and Clothing (logistics).',' OMS was tasked with establishing and operating naval hospitals, acquiring and producing medicines, and obtaining or fabricating medical and surgical supplies It directed medical personnel and provided physicians for Confederate naval vessels and facilities. OMS was a small office that supported a small navy. (The Confederate Navy's highest personnel level was 753 commissioned officers and 4,450 enlisted men in 1864.1) Its early physician staff was mostly drawn from former U.S. Navy physicians. In 1860, there were 69 surgeons, 43 passed assistant surgeons, and 36 assistant surgeons in the U.S. Navy. Thirty-eight of these men resigned or were dismissed, representing a loss of 26% of the Federal Navy's physicians. At least 35 of these former U.S. Navy physicians eventually served in the Confederate Navy.' In contrast, in 1860 the U.S. Army had 30 surgeons and 83 assistant surgeons. Three surgeons and 21 assistant surgeons resigned from the Army for the Confederacy, representing a loss of 21% of the Army's medical officers.3 The OMS grew during the war in response to increasing demands for medical support. The original March 16, 1861, legislation authorized OMS to have 5 surgeons and 5 assistant surgeons. In December 1861, 30 "temporary" physicians were authorized. The demand for additional naval medical officers was such that the Confederate Congress passed legislation in April 1862 that increased OMS physician levels to the following: I surgeon general, 20 surgeons, 15 passed assistant surgeons, and 30 assistant surgeons. Demand increased further, and in 1863 President Davis was authorized to appoint as many naval officers he deemed necessary.4 Fiftyone years after the Confederate surrender, the Association of Medical Officers of the Army and Navy of the Confederacy determined that there were 107 naval medical officers who served at one time or another during the war. The 107 physicians included 26 surgeons, 13 passed assistant surgeons, 63 assistant surgeons, and 5 assistant surgeons for the war.' In addition to physicians, OMS employed surgeon's stewards (a noncommissioned officer rank) who aided the physicians and were required to have a working knowledge of pharmacy and bandaging techniques and to be able to perform minor surgery.' Nurses were also employed or detailed as needed. Appropriations for the Confederate Navy were insignificant compared with that for the Confederate Army. Approximately $107,000,000 (Confederate) was appropriated for the Confederate Navy during the entire War. The Confederate War Department, in contrast, had a total appropriation of $2,180,700,000.4 Approximately $1,716,500 (2% of the naval appropriations) was budgeted for the Navy's Medical Department during the nearly 5 years of conflict. The Confederate Navy's medical appropriations were as follows: 1861, $20,000; 1862, $61,500; 1863, $250,000; 1864, $1,010,000; and 1865, $375,000. IA

The Chief of the Office of Medicine and Surgery for the entire war was Dr. William Augustine Washington Spotswood. 1,5 Spotswood, like many contemporary American physicians, did not have a formal medical degree. He did attend the University of Virginia's medical school but left in 1828 after completing the first year of its 2-year program. He was commissioned as an assistant surgeon in the U.S. Navy in December 1828. Spotswood resigned from the U.S. Navy on January 19, 1861, while assigned to the Pensacola Navy Yard.'-' Service Life for a Confederate Navy Medical Officer In general terms, the Confederate Navy physician faced less physical hardship than his Army counterpart. Many naval physicians lived in metropolitan areas, whereas Army physicians often slept under tents. Battle hazards were less for the naval physicians, because the ships were idled by blockade or, if in battle, they were protected by their duty stations being below the waterline or by ironclad bulwarks. The risk of contracting disease was high for the Navy physician. Poorly cooked or contaminated food could lead to diarrhea. Medical officers in ships anchored near marshland often contracted malaria. Only four physicians died while in service: David Llewellyn drowned in the immediate aftermath of battle; Joseph Grafton gave his life so another could five during a boating accident off the Brazilian coast; and George Blacknall and Daniel Green died from natural causes or disease.4,8-10 OMS physicians, as a result of their specialized training, were classed as limited duty officers by the Confederate Navy Department. I This meant that they could not be used in line officer positions. Naval medical officers were assigned to one of several general areas: land installations, riverine or harbor defense vessels, or cruisers.