Background of USA General Hospitals
Until 1818, the US Army consisted of small regiments without central organization. At that time, Secretary of War, John C. Calhoun, created a national army, which included a separate Medical Department. Medical officers, having no rank and remaining outside the military hierarchy, served under the department head, called the Surgeon General. Medical care was severely limited by the lack of scientific knowledge, and disease prevention and cure were usually impossible. The ill and injured were placed in USA General Hospitals that were tents or local public buildings.
The horrors experienced by the sick and wounded during the first months of the Civil War made the need for change in the Medical Department of the US Army undeniable. The Army extensively studied its earlier experiences in Second Seminole War in Florida (1835-42) and some of the Indian Wars in the West. It also studied European military medical models, particularly those of the English in the Crimean War and the French in eastern Europe. It was apparent many more hospitals, new leadership and new organization were essential.
In the new system, General Hospitals remained under the supervision of the Surgeon General, who was not subject to orders of local commanders. Having a single responsible person, with a separate chain of command of medical officers devoted solely to the care of large numbers of sick and wounded soldiers, was a departure from previous US military practice. The need for a permanent staff, who would not be recalled to their regiments, was recognized as critical to successful and efficient hospital administration.
Army surgeons remained helpless confronting devastating infections, epidemics and wounds because they were ignorant of bacteria. Regardless, they were forced to try to solve the massive problems of shelter, diet, sanitation and other variables of preventable disease. In addition, a more successful treatment of wounds was imperative. Amputation became the common remedy for gunshot wounds to the limbs because the soft lead bullets shattered flesh and bone. Such injuries, combined with unsanitary battlefield conditions, made infection the chief threat to life. Amputation halted the spread of infection.
Through Army systematization and large-scale collection of data, some advances were made. More effective use of the department's increased medical staff, new organizational structure, and the use of volunteer staff contributed in a practical way to the treatment of large numbers of patients. The Medical and Surgical History of the War of the Rebellion, a multi-volume record compiled by the Surgeon General's office, not only recounts the development of the hospital system, but also lists the thousands and thousands of cases of disease and wounds that were treated along with their outcomes.
The principal diseases treated by Army surgeons were those classified as fevers, especially malaria and typhoid. Diarrhea and dysentery were the most frequent symptoms treated. The medical volumes illustrate the severity of the condition by listing 1.6 million cases of diarrhea. Anesthesia, ether and chloroform, was used in 95 percent of the surgical procedures performed on soldiers during the Civil War, and opiates, mainly morphine derivatives, were used to ease the pain afterward. The frequent use of such anesthetics notably advanced medicine's understanding of them. The Circular Orders and Special Orders included in the volumes at the Massachusetts National Guard Archives and Museum make clear the standardization of the Surgical Table. One, written May 4, 1863, reads:
From the reports of the Medical Inspectors and the Sanitary reports to this office, it appears that the administration of calomel has so frequently been pushed to excess by military surgeons as to call for prompt steps by this office to correct this abuse,...it is directed that it be struck from the Supply Table.... The records of this office having conclusively proved that diseases prevalent in the Army may be treated efficiently without tartar emetic....[it] is also struck from the Supply Table of the Army.
Another example, written on June 27, 1864, orders:
...the department to forward to the Surgeon General's office full reports of the Wounded, Surgical operations, Secondary Hemorrhage, tetanus and pyoemia.
And on August 27, 1865:
In all cases either in hospital or in the field, in which death is supposed to result from the employment of anaesthetic agents, a detailed report of the attendant circumstances will be transmitted by the medical office in immediate charge. Together with the report a sample of the anaesthetic agent employed will be forwarded for analysis.
In the early years of the War of the Rebellion, scores of hospitals were established in areas contiguous to the battlefields around Washington and Alexandria. As the war continued and casualties mounted, additional hospitals were built in Philadelphia, New York and other points conveniently accessible by water. In the final years of the war, "with the prolonged struggle for national life with the awful succession of battles and campaigns unremitting, these with their tens of thousands of beds have been inadequate," military hospitals were built further from battle and closer to the homes of the sick and wounded. Dale General in Worcester, Massachusetts, was one of these.
At the Inauguration of the Dale General Hospital in Worcester on February 22, 1865, the keynote speaker, Dr. Warren Webster, said, "In March 1861 there were no Military General Hospitals in the United States. Today there are under orders 195 with a capacity of 129,950 beds bounteously provided with everything which the wisdom of Congress... deem[s] necessary." Twenty-five of these fixed-bed military hospitals were located in the Department of the East, with a total of 17,000 beds.


