INTRODUCTION
Anesthetics, chiefly
chloroform, ether and opium/opium derivatives, were widely used during
surgery and for pain relief during the American Civil War. Standard
medical practices of both the United States and Confederate States
called for the use of these anesthetics. The Confederacy also strove
to use indigenous botanical substitutes for medical purposes. The use
of these varied botanical substitutes has left the impression that the
South was bereft of anesthetics, in particular chloroform, and was
forced to use the substitutes on a grand scale. This, however, is not
the truth. Southern hospitals, both field and general, were rarely
without the painkilling drug
chloroform.
A wide variety of
painkillers were available to the Civil War physician but at the top
of this list the surgeon of the times chose from ether, chloroform,
opium and its derivatives laudanum and morphine. Ether and chloroform
were the drugs of choice for the initiation of surgical procedures to
induce “the desired insensibility”1, whereas all but ether were used
to reduce the pain following surgery or as a general pain reliever.2
Surgeon J. Julian Chisholm, M.D., professor of surgery in the Medical
College of South Carolina, stated in his book A Manual of Military
Surgery, “During the performance of capital operations on the
battlefield, death sometimes ensues from nervous exhaustion, produced
by excess
of suffering; the use of chloroform relieves the patient
at least from this risk.”3 He writes further to state, “The universal
use of chloroform to allay the pain of
surgical operations, is a
complete vindication of the utility of the remedy, and proof of its
necessity... We do not hesitate to say, that it should be given to
every patient requiring a serious or painful
operation.”4
INDIGENOUS BOTANICAL SUBSTITUTES
Shortly
after the start of the war, Confederate Surgeon General Samuel Preston
Moore instructed Surgeon (Major) Francis Perye Porcher to prepare a
“treatise on the resources of Southern fields and forests” regarding
the “medicinal, economical and useful properties of the
trees,
plants and shrubs” found in the Confederacy.5 Moore realized
from the beginning of the war that medical supplies would be in short
supply6; this became ever more critical when medical and surgical
appliances were named “contraband of war” by the Union government. So
important was the task of developing indigenous botanical substitutes
for drugs and medicines that he temporarily relieved Porcher of his
duties as surgeon to the Holcombe Legion. Porcher was the obvious
choice for
this task having already written two medico-botanical
texts: one of the flora of South Carolina and the other about the
botanical properties of plants of the United States.7 His new book,
Resources of the Southern Fields and Forests, Medical, Economic and
Agricultural, is credited with saving “the Confederacy for two
years”.8 Published in 1863 and distributed to medical officers, it
offered about 600 pages of information on the use of botanical
substitutes for traditional medications. Moore continually stressed
the necessity of officers to collect and use indigenous botanical
substitutes for the sick and wounded.9 The desire to produce home
grown medical remedies prompted the writing and publishing
of
other, similar texts during the Civil War: The Flora of the
Southern States, Chapman; Plants Growing in the Vicinity of
Charleston, Dr. J. Bachman; and Plants Found in the Vicinity of
Newbern, North Carolina, H. B. Croon.10
Surgeon General Moore
was not alone in his assessment of the need to produce and procure
medical equipment and medical supplies for use by the Confederate
States. While many speculator could be commended for his altruistic,
dedicated patriotic duty, many more were driven by greed and the
ability to buy low and sell high. For instance, Southern traders could
purchase a bag of salt in the North for $1.25 and, in the South,
resell it for $60, a mark up of almost 5000%!11 The activities of
and
problems involved with speculation and medical goods even
caught the attention of the Commander in Chief of the Army of Northern
Virginia, General Robert E. Lee. In September 1862 he wrote to
Secretary of War George W. Randolph:
I desire to call your
attention to a fact reported to me by M. Schriver which cannot be but
injurious to the service. He states that as soon as any place is open
by retreat of the enemy, before the agents of the government can
purchase such medical stores as it requires, numbers of speculators
from Richmond and other places buy up everything at much higher
prices. Mr. Schriver states that at Fredericksburg he had the
knowledge of at least 60 of this class of persons as soon as the
enemy left... I have directed that medical stores found in the
possession of such persons... shall be seized and paid for at their
cost price [and] that measures be taken to put a stop to it and to
prevent persons from coming into places vacated from the enemy with
such intentions.12
Major Porcher’s efforts were applauded in
the July 1864 issue of the Confederate States Medical and Surgical
Journal . The editorial wrote that we should not “fail here to notice
the useful and laborious effort of Surgeon Porcher, in bringing before
the public in his work on the Resources of the Southern Fields and
Forests the amount of useful material at hand.”13 In this same issue
is printed a “Standard Supply Table of the Indigenous Remedies for
Field Service and Sick in General Hospital”14, a table listing
botanical names, common names, medical properties, dosage and method
for administration. In the list of 65 plants, however, there is no
mention of a botanical substitute for chloroform and only one for use
as a sedative. A recent historian also notes that “ Generally
speaking, the Medical Corps had good preparations and few
substitutes.”15
Surgeon (Major) E. Burke Haywood, General
Hospital No. 7, Raleigh, North Carolina, references both the early and
mid-war literary works by Porcher’s in the use of Sarracencia Purpura
(Side Saddle of Fly Trap) in the treatment of small pox. Haywood notes
that, although contradictory works appear several praise its effects
writing, “the unmistakable evidence of the efficacy of this remedy in
arresting the progress of small pox has been conspicuously manifested
in many cases.”16 Although Porcher is reported to have tested the
plant on himself and writes of its widespread use in Georgia and South
Carolina, Haywood states that after procuring a supply will fully test
its efficacy and reports
the results.17 Unfortunately, no such
follow up is found in the pages of the Confederate States Medical and
Surgical Journal.
In the June 1864 issue of the Confederate
States Medical and Surgical Journal, Assistant Surgeon (Captain) W. T.
Grant writes an extensive article about Indigenous Medicinal Plants.
He mentions various plants, their successful uses and where they can
be found. Of note, he mentions the poor quality and reliability of a
substitute for quinine, “nearly proved a failure.”18 The concoctions
made up as a quinine substitute were decidedly inferior.19
The
use of indigenous botanical resources is thus well documented by
several independent sources in the Confederate States Medical and
Surgical
Journal and appears to be in use by Southern medical
officers. Surgeon General Moore was dismayed at the failure of some
officers on the regimental level to fully utilize this information20;
he also wrote, “Our
savannahs furnish our meteria medica with a
moderate number of narcotics and sedatives and an abundant number of
tonics, astringents, and demulcents...”21 Diverse discussion is made
of the efficacy of these many
plant substitutes as medicines other
than as anesthetics; dissension is involved in the case of quinine
substitutes.
Perhaps one of the strongest arguments for the
lack of effective botanical substitutes for anesthetics comes from
Porcher himself. In his approximately 600 page long book of over 400
entries,22 Resources of the
Southern Fields and Forests, Medical,
Economic and Agricultural, he makes but four entries for anesthetics
and 28 for narcotics. Listed are topical anesthetics (Schrankia
Augusta and Uncinata)23, cures for
headaches/pain from flatulence
(Solidago Odora - Goldenrod)24, “seeds... said to induce delirium and
partial forgetfulness” (Datura Stramonium - similar to Foxglove)25 and
a powerful local drug that “produced a feeling of numbness... which
lasted a whole day” (Aconitum Uncinatum - Wolfsbane)26. The last was
touted as “no remedy, save chloroform, equals it when applied locally
for the relief of pain.”27 There are 28 different sources of narcotics
including Indian Tobacco, Bush Honey Suckle, Wild Lettuce, Orange
Root, Cannabis Sativa and the Opium Poppy.28 Contradictory
evidence
surrounds the efficacy of the Southern poppy - sources can
be found that laud the Southern white or red poppy as an acceptable
source of opium; other sources report the poor quality of the same.29
As mentioned earlier, the sources of painkillers were
available to the Civil War surgeon were ether, chloroform and
opium/opium by-products. In general, ether was the primary choice of
Northern doctors while chloroform was preferred by Southern doctors.30
Chloroform was a “remedy which the surgeon should never be without.”31
Shortages of chloroform in Southern hospitals, frequently a
matter of feast or famine, produced many ingenious ways to use it as
economically as possible.32 Normal medical practice of the day called
for the application of the chloroform to a piece of folded cloth or
sponge, held in the apex of a funnel or cone and held a distance from
the patient’s nose so the first inhalation was well diluted with fresh
air. Creams or salves could be applied to the nasal area to reduce the
caustic and blistering effects of
the chloroform. As the patient
exhaled the chloroform soaked cloth or sponge was brought closer to
the nose. Noisy breathing was the clinical sign that inhalation should
be stopped; the surgical procedure could then commence. Longer
surgeries would require further administration of anaesthetic.33 The
effects as per one of the more famous Southern patients, General
Thomas J. Jackson, was reported as “What an infinite blessing.”34
Ingenious methods were developed to stretch potentially scarce
supplies of chloroform including smaller inhalers that fit into the
nostrils of the patient. Surgeon J. Julian Chisholm, inventor of the
two and one half inch Chisholm inhaler, realized the savings in
chloroform with the increased risk of suffocation of the
patient.35
The necessity for the use of chloroform in surgical
procedures in both the field and general hospitals was well documented
and, in general, agreed upon. The preference of chloroform over ether
has been previously discussed. Southern pharmaceutical companies,
almost nonexistent at the start of the war 36, developed to a point
where in 1864 it was reported that, “A most gratifying progress has
been made in the manufacture of chemicals within our own limits...
Botanical Gardens and farms are flourishing... Manufactories and
laboratories are flourishing at various points.”37 Very specific
reference is made to the various drugs produced, however, no mention
is made of anesthetics. In fact, Charles Theodore Mohair, reportedly
one of the ablest druggists in the Confederacy, describes one of his
tasks as examining the medical supplies smuggled from Europe,
including opium, morphine, quinine and others.38 In all of the
literature
there are no references to the use of indigenous
botanical substitutes for anesthetic purposes. Further, no information
was located in general hospital or regimental sources of the use of
any plant or flora substitute for chloroform. With all of this in
mind, how did the Confederate purveyors, the procurers of medical
supplies for both field and general hospitals, supply the rebel armed
forces with the vital chloroform the surgeons and the wounded
required?
SOURCES OF CONFEDERATE CHLOROFORM
The
Confederate medical organization was supplied of chloroform from three
major sources: 1) through
blockade running, 2) by smuggling through
Union lines and 3) from captured Union supplies. Blockade
running
in the early part of the war was very successful and runners came and
went as they
pleased.39 Purveyors were authorized to barter or
trade cotton for any medical supplies that were
aboard.40
Medicines, medical supplies, medical instruments, drugs and
pharmaceuticals were third to munitions and clothing as contraband
transported by blockade runners. Until the last of the Southern
ports
were captured by Federal troops, this avenue proved a very
lucrative and successful one. Fraser, Trenholm and Company, a Southern
owned trading business, became the premier blockade running business
in the Confederacy. During early 1863 alone, the company’s profits
have been estimated at $20 million dollars.41 The Army of Northern
Virginia was said to have been “dependent for chloroform, morphine,
quinine... almost entirely on the blockade runners” during the last
two years of the war estimated at $170,933 in Confederate currency.42
Smuggling chloroform through Union lines to Confederate
hospitals, although officially declared illegal by both the government
of the United States and Confederate States, did occur. This “internal
trade” provided vast amounts of the much needed medical supplies,
declared contraband of war by the North, to the Confederacy. To make
this trade even more odd was the authorization, by the
Northern
Congress, of Abraham Lincoln to trade with the South “ when it seemed
advantageous.”43 Southern Surgeon General Moore also authorized
Surgeon Richard Potts, a surveyor in the Western theater, to trade
with the North.44 By smuggling, the South was able to maintain
adequate supplies of chloroform, quinine and morphine.45 Perhaps this
was inevitable - the states had traded freely before the war and was a
long established tradition. In exchange for the required munitions,
clothing and medicine, the South could provide, on practically a daily
basis throughout the entire war, the Northern mills with cotton.46
Memphis, Tennessee was central to the “internal trade” that occurred
between the Union and the Confederacy. During the Federal occupation
of the city from 1862 to 1865, vast quantities of supplies passed
through Memphis. Despite the efforts of Union officers to keep this
trade under control, large amounts of drugs were sent “southward” in
exchange for cotton. The Union Congressional Committee on the Conduct
of the War, in July 1864, estimated “that $20 million and $30 million
worth of supplies have passed through this city into the hand of the
Confederacy.”47 Given the need and desire to blockade the Confederacy
by both land and sea, it must have been exceptionally difficult to man
both a 1000 mile long land border and a 3500 mile long sea coastline
effectively.
Another of the chief providers of medical supplies and
chloroform to the Southern armed forces were the Northern armies and
the Northern supply system! Although this method of procurement worked
both ways in the Civil War, the “Southern acquisition by this means
were quite noteworthy.”48 After
victories in battle, the
Confederates would be able to help themselves to the medical supplies
left behind by the Union armies. A North Carolina surgeon, following
the Southern victory at Manassas on 21 July 1861, told of the seizure
of “a large number of cases of fine surgical instruments and a large
stock of medicines... [the medical staff would] not be troubled in
this line of preparation for another action.”49 This,
however, was
only one of two ways the Confederate troops “drew rations” from
Northern suttlers - raiding Union lines proved a frequent and valuable
source from the beginning until the end of the war. During
General
Thomas J. Jackson’s Shenandoah Valley Campaign, May-June 1862, his
troops captured 15,000 cases of chloroform.50 He went on to pillage
Union General John Pope’s supply depot at Manassas Junction on 27
August 1862.51 During September 1862 yet another large haul of
medicines, instruments and other medical supplies was reported from
the Kanawha Valley, estimated at $20,000. One huge cache, appropriated
by General Nathan Bedford Forrest’s cavalry, occurred during a raid in
Western
Tennessee. After requisitioning what his immediate command
needed from the three wagons, Forrest shipped the remainder to
Atlanta. There a medical purveyor appraised the value of the goods at
$150,000 in gold.52 As late as September 1864 found Confederate
raiding parties commandeering
the food and supplies they needed. In
a sortie from their siege lines at Petersburg, Virginia, Confederate
cavalry raided the Union supply, returning with over 2400 cattle and
11 wagons.53 No reference is made of the contents of the wagons and
one must speculate as to the details of the goods captured. If one,
however, recalls the top three items of need: munitions, clothing and
medical
supplies, one may surmise what was considered of value and
what was contained in the wagons.
Reports from Confederate sources
also show that the dearth of the supply of medicines was not entirely
true. The primary consistent complaint of shortages involved medical
instruments.54 The Confederate drug situation may have been slightly
exaggerated. Stewart Brooks writes “some prime sources relating to the
subject are far from emotional, a few going so far as to deny the
problem was ever what might be called desperate - especially in regard
to chloroform.”55 The conclusion of a Master’s Degree thesis by
Charles F. Ballou, II is that Confederate hospitals in and around the
Richmond hospitals were prevented from the acute need of medical
supplies by dedicated purveyors until the end of
the war.56
Accounts from field hospitals report shortages as well as an abundance
of supplies. One description mentions such an overabundance that
surplus medications could be sent to a colleague from home. “I have
more of it than I could use in two years.”57 J. Julian Chisholm, an
outstanding purveyor, brilliant medical author and surgeon and
inventor
of medical equipment, was an outstanding administrator.
Through his pains and tireless efforts, hospitals in the Richmond area
never seemed short of supplies. “In assuring that imported medical
supplies from blockade
runners reached the lines of action, he had
no peer.”58 Another writes “Normally, we were scant of medicines, and
generally, they were the commoner kinds. At times, however, we were
well supplied, and with
excellent preparations,” the latter
following capture of Union supplies or after receiving goods through
purveyors from blockade runners. “Normally we were short [but] at
times we were well supplied.”59 H. H.
Cunningham writes “... some
Confederate medical officers have gone so far as to state that at no
time during the struggle did they fail to have a sufficient quantity
of the essential needed.” Surgeon Deering J. Roberts found many
Southern doctors “always had an abundant supply of quinine, morphine
and
chloroform - the most important drugs of all.” The sick and
wounded of Petersburg, site of a 10 month siege at the very end of the
war, “did not suffer for anything necessary to their comfort.” Surgeon
General
Moore, in a report to the Secretary of War, dated February
1865, stated that his department had a limited amount of some supplies
and over a year’s worth of others. Moore believed that if the
department were allowed to retain the skilled staff they currently
possessed at the various laboratories and purveying depots and were
allowed to import medicines through the lines in Mississippi and
Alabama, the sick and wounded would not suffer for want of the
essential medical supplies.60 The appearance of shortages
began in
early 1864. A memorandum to the Surgeon General, in March 1864,
reported a list of 39 medicines removed from the supply table.
Chloroform and opiates, significantly, were not on this list.61
Shortage notices also increased as the Confederate transportation
system collapsed near the end of the war. Needed supplies arrived
“tardily at their destination. Until near the end of the war, however,
the Medical
Department was reasonably successful in supplying its
patients with the necessary medical supplies, assisted in these
undertakings by state and private
efforts.62
CONCLUSION
If, in the end, the doctors in
gray and butternut were reasonably well stocked with medical supplies
and in particular, chloroform, why was there such a great push so
early in the war for the search for indigenous
alternatives? Very
few people on either side believed the war would last long; in 1861
both North and South thought the other would back down from their
respective positions and the fighting would cease with the
successful conclusion for their side. Most experts could not conceive
that the war would last four long years. The drive to explore the use
of home grown plant substitutes for traditional medicines and drugs
seems to be part of a general movement to establish self sufficiency.
Southern self-sufficiency meant just that - independent means for an
independent sovereign nation. In this respect they proved successful
thanks, in part, to the writings of Surgeon Francis Perye Porcher.
Although indigenous botanical substitutes were used by the South, they
were primarily used for purposes other than anesthesia. The Southern
pharmaceutical industry, nonexistent at the start of the war, became
an adequately proficient part of the Confederate medicinal supply
system. Blockade running, until the final ports were closed, furnished
the South with quantities of European medicines. The thriving
“internal trade,” although officially banned bilaterally, provided the
Confederate armies with another source of medical supplies. Lastly,
the Federal army itself contributed vast amounts of medical supplies
and medicines to the Southern cause. In spite
of the eventual
collapse of the Confederate transportation system, field and general
hospitals generally possessed adequate amounts of the medicine that
they considered essential: chloroform, quinine and opium. The only
genuine shortage for which there was a universal complaint was the
lack
of medical and surgical equipment. The Southern medical cause
was fortunate for they enjoyed the exertions of men like Surgeon
General Samuel Preston Moore,
Surgeon J. J Chisholm and Samuel
Hollingsworth Stout63 whose innovative techniques and administrative
efforts kept both the field and general hospitals stocked with the
medicines that were considered essential at
that time. Thanks to
their combined efforts the Southern military hospitals were not
dependent on indigenous botanical substitutes for anesthesia nor did
they go without essential basic medical supplies.
Compared to the
ability of the other aspects of the Southern supply system to supply
munitions, clothing and forage - from the beginning to the end of the
American Civil War the Confederate States Medical
Department
provided outstanding medical support for her fighting
soldiers.
ENDNOTES
1.
J. Julian Chisholm, A Manual of Military Surgery for the Use of
Surgeons of the Confederate States Army, Columbia, Evans and Cogswell,
3rd edition, 1864,
p. 426.
2. Ibid., pp. 221-225, p. 416,
pp.426-430. Confederate States Medical and Surgical Journal,
January 1864 - February 1865, as noted by a variety of
assorted
case studies throughout the Journal.
3. Chisholm,
(n.1) Manual of Military Surgery, p. 427.
4. Ibid., p.
427.
5. H. H. Cunningham, Doctors in Gray: The Confederate
Medical Service, Gloucester, Massachusetts, Peter Smith, 1970,
pp. 148-149. Reprinted from 1958
edition, Louisiana State
University Press.
6. Charles F. Ballou II, Hospital Medicine in
Richmond, Virginia During the Civil War: A Study of Hospital No. 21,
Howard’s Grove and Winder Hospitals, Blacksburg, 1992, p.
96.
7. Francis Perye Porcher, A Sketch of the Medical Botany of
South Carolina, Philadelphia, T.K. and P.G. Collins, 1849 and The
Medicinal, Poisonous, and Dietetic
Properties, of the Cryptogamic
Plants of the United States, New York, Baker, Godwin, and Co.
1854.
8. Cunningham, (n. 5) Doctors in Gray, p. 149.
9.
U.S. War Department (comp.) War of the Rebellion: A Compilation of the
Union and Confederate Armies, Washington, D.C., 1880-1902 Ser.
IV, Vol. II, 13,
quoted in Ballou, Hospital Medicine, p.
97.
10. Francis Perye Porcher, Resources of the Southern Fields
and Forests, Medical, Economic and Agricultural, Charleston,
Steampower Press of Evans and
Cogswell, and Richmond, Virginia,
West and Johnston, 1863, as reported in the preface during a 1950s
reprint of the book. Subsequent searches have failed to locate any of
the books exactly as listed, however, a text of
similar title was
located and may be one to which the writer referred: John Bachman, An
Inquiry into the Nature and Benefits of an Agricultural Survey of the
State of South Carolina, Charleston, Miller and Brown,
1843.
11. Time-Life Books, The Civil War Series, Twenty Million
Yankees, Alexandria, Virginia, 1986, p. 73.
12. War of the
Rebellion, (n. 9) Ser. I, XIX, II, 614, quoted in Ballou, (n.6)
Hospital Medicine, p. 99. Cunningham, (n. 5) Doctors in Gray, p.
158.
13. Medical and Surgical Journal, (n.2) Vol. I, No. 7,
107.
14. Ibid., pp. 107-108.
15. Dr. Bartholomew Egan
held that opium from white poppies was equally as good as the
commercial product. Porcher asserted that there were no fatalities
from the use of locally produced chloroform. Quoted
from
Cunningham, (n. 5) Doctors in Gray, pp.150-151.
16.
Medical and Surgical Journal, (n. 2) Vol. I, No.3, 38.
17.
Ibid., Vol. I, No. 7, 38.
18. Ibid., Vol. I, No. 6,
84-86.
19. Cunningham, (n. 5) Doctors in Gray, p.
150.
20. Ibid., p. 150.
21. Stewart Brooks, Civil War
Medicine, Springfield, Illinois, Charles C. Thomas, 1966, p.
70.
22. Time-Life Books, The Civil War Series, Sherman’s March,
Alexandria, Virginia, 1986, page 108. Porcher, Southern Fields. There
appear to be two editions
of this book, one of 601 pages and the
other of 594 pages.
23. Porcher, (n. 7) Southern Fields, p.
197.
24. Ibid., p. 417.
25. Ibid., p. 475.
26.
Ibid., p. 44. In order to evaluate the efficacy and action of the
drug, Porcher frequently perfomed tests of the plant substitute on
himself.
27. Ibid., p. 44.
28. Ibid., several listings
throughout the text.
29. Cunningham, (n. 5) Doctors in Gray, p.
150. Medical and Surgical Journal, (n. 2) Vol. I, No. 6,
84-86.
30. Wyndham B. Blanton, M.D., Medicine in Virginia in
the Nineteenth Century, Richmond, Virginia, Grant and Massie,
Inc.,1933, page 286.
31. Chisholm, (n. 1) Manual of Military
Surgery, p. 426.
32. Ballou, (n. 6) Hospital Medicine, p.
100.
33. Chisholm, (n. 1) Manual of Military Surgery, pp.
427-428.
34. Hunter McGuire, M.D., “Account of the Wounding and
Death of Stonewall Jackson,” The Virginia Medical Monthly, 1961,
Vol. 88, No. 10, 5, originally
printed in the Richmond Medical
Journal, 1:403 May, 1866.
35. Chisholm, (n. 1) Manual of
Military Surgery, pp. 428-429. Susan Provost Beller, Medical Practices
in the Civil War, Cincinnati, Ohio, Betterway Books,1992 page 72. A
scale illustration of the inhaler is on page 74.
36. Ballou,
(n. 6) Hospital Medicine, p. 96. Brooks, (n. 21) Medicine, p.69.
Time-Life, (n. 22) Sherman, p. 108.
37. Cunningham, (n. 5)
Doctors in Gray, p. 148. Norman H. Franke, an able student of
Confederate pharmacy, feels that the military failed to make full
use of the skilled druggists in the South.
38. Cunningham, (n.
5) Doctors in Gray, p. 147. Taken from a direct quote of
Mohr.
39. Beller, (n. 35) Medical Practices, p. 67. Time-Life
Books, The Civil War Series, The Blockade, Alexandria, Virginia, 1986,
pages 86-101.
40. Ballou, (n. 6) Hospital Medicine, p. 98.
Frank Reed Freemon, Medical Care During the American Civil War, Ann
Arbor, Michigan, U.M.I, 1992, pp. 107-108.
Glenna Ruth
Shroeder-Lein, Waging a War Behind the Lines: Samuel Hollingsworth
Stout and Confederate Hospital Administration in the Army of
Tennessee, Ann Arbor,Michigan, U.M.I, 1991, pp. 76-77.
41.
Time-Life, (n.39) Blockade, p. 98.
42. Cunningham, (n. 5)
Doctors in Gray, p. 135.
43. Brooks, (n. 21) Medicine, pp.
67-68.
44. Cunningham, (n. 5) Doctors in Gray, pp. 136-137.
From a direct communication from Moore to the Confederate Secretary of
War.
45. Beller, (n. 35) Medical Practices, p. 78.
46.
Time-Life Books, (n. 11) Yankees, pp. 73-75. 34. Cunningham, (n. 5)
Doctors in Gray, p. 137.
47. Cunningham, (n. 5) Doctors in
Gray, pp.136-138.
48. Ibid., page 139.
49. Ibid., page
139.
50. James M. McPherson, Battle Cry of Freedom, New York,
New York, Balantine Books, 1988, page 487. Cunningham, (n. 5) Doctors
in Gray, p. 139.
51. Time-Life Books, The Civil War Series, Lee
Takes Command, Alexandria,Virginia, 1986, pp. 129-130.
52.
Cunningham, (n. 5) Doctors in Gray, p. 139.
53. Time-Life
Books, The Civil War Series, Death in the Trenches, Alexandria,
Virginia, 1986, pp. 111-115.
54. Cunningham, (n. 5) Doctors in
Gray, pp. 156-159. Ballou, (n. 6) Hospital Medicine, pp.
96-98.
55. Brooks, (n. 21) Civil War, page 67.
56.
Ballou, (n. 6) Hospital Medicine, pp. 96-108.
57. Spencer G.
Weich, A Confederate Surgeon’s Letters to His Wife, New York, 1911, p.
131, quoted in Ballou, (n. 6) Hospital Medicine, p. 100.
58.
F. Terry Hambrecht, “The Missing Letters, Insights into the
Confederate Medical Department,” The Maryland Line, Baltimore,
Maryland, 1991, II, 2, quoted in Ballou,
(n. 6) Hospital Medicine,
p. 98.
59. Taylor: De Quibus: pp. 302, 316, 318, 319, 320,
330, quoted in Blanton, Medicine in Virginia, (n. 30) pp.
278-279.
60. Cunningham, (n. 5) Doctors in Gray, pp.
159-160.
61. National Archives, DXLVII, 182, quoted in Ballou,
(n. 6) Hospital Medicine, pp. 106-107.
62. Cunningham, (n. 5)
Doctors in Gray, pp. 161-162.
63. Shroeder-Lein, (n. 40) Stout,
iii. Surgeon Stout was by 1863 the Medical Director of Hospitals for
the Confederate Army of Tennessee, supervising as many as
60
hospitals in Tennessee, Georgia, Alabama and Mississippi. Proficient
at personnel management, he oversaw all aspects of medical care in
this vast area, made more difficult during the later years of the war
with
Union advances and a crumbling Confederate transportation
system.