The First Hospital Ship & Other Innovations in Federal Naval Medicine During the U.S. Civil War

USS Red Rover (1862–1865), by F. Muller

Periods of conflict are known for forcing the parties involved to change, develop, and evolve. The changes that occurred within the United States armed forces during the U.S. Civil War can be clearly seen in the operations of the Army and Navy medical departments. During the Mexican American War, the medical apparatus of the U.S. armed forces was proved to be completely inadequate, as it allowed more soldiers to perish from diseases than from enemy action. By the end of the Civil War, however, the proportion of Federal Army casualties due to disease was significantly lower than what was achieved during the prior conflict. While the historical literature has documented the professionalization and innovations pursued by the Army medical apparatus during the Civil War, the Navy medical apparatus has been largely ignored. This neglect is entirely unwarranted. Like many other elements of American society, the Federal Navy underwent a multitude of changes between 1861 and 1865.

Navy Medicine at the Start of the War

Before one can fully appreciate and understand the improvements in naval medicine during the Civil War era, one must first understand the problems within the Navy medical apparatus at the start of the war. When Dr. Jonathan Foltz arrived in the fleet of Flag Officer Farragut in early 1862, he immediately realized that the Navy Department Bureau of Medicine and Surgery’s (BUMED) logistical systems were unprepared for the war. The fleet was severely lacking in the medical and surgical supplies that would be needed as combat operations commenced. As a rapid buildup of forces occurred in February of 1862, Foltz wrote, “Not a vessel arrives that does not immediately apply for such necessities as should have been sent with it.”¹ On April 10 of the same year, he writes, “The fleet under command of Flag Officer Farragut consists of more than sixty vessels and is increasing, and there is not, in the whole fleet, more muslin and bandages than would dress a few hundred wounds….”² Throughout these pages, Foltz makes clear his belief that both the medical and combat arms of the Navy were mismanaged and unprofessional.³

This picture of inadequate supplies and poor organization sits in stark contrast to the accounts seen later in the war. Surgeon Brown of the USS Kearsarge, when commenting on an engagement in July of 1864, notes that the crews were trained in basic first aid so that they could help wounded comrades in the absence of a physician. He also explains that “an ample supply” of medical cots and tourniquets were supplied for their use. While he goes on to complain that sailors would often stubbornly refuse to seek treatment while in battle due to their desire to stay in the fight, this testimony suggests that the logistics of the medical apparatus had improved greatly during the war.⁴ A few examples of the decisions, events, and changes which made this improvement possible will be analyzed in the rest of this article.

Navy Medicine Standardization

For centuries standardization has been viewed as a sign of increasing quality and professionalism. Therefore, it is no surprise that the United States Navy medical apparatus moved drastically toward standardization during the American Civil War. In the Instructions for the Government of the Medical Officers of the Navy of the United States, which was published in 1864 by the BUMED, medical staff are instructed to keep detailed records and logs. For example, the instructions state, “Surgeons in charge of sick at stations in the United States, and surgeons of vessels on separate service, shall make to this Bureau a quarterly report, on the 1st of January, April, July, and October, of diseases, wounds, injuries, as well as of the expenses of their respective charge, according to form K.”⁵ The instructions go on to note the adoption of a new standardized system of medical nomenclature, which physicians must adhere to strictly.

In addition to reports on expenses and the prevalence of disease, the instructions also required physicians to carry out comprehensive reporting on medical cases which could result in a claim for pension. This reporting must include the circumstances in which the injury or bodily harm occurred as well as evidence that the injury in question occurred in the line of duty. This section of the instructions goes on to reiterate the fact that, “A simple expression of opinion [from a physician] is no longer recognized by the Commissioner of Pensions; hence much trouble and correspondence will be saved by timely attention to the point here stated.”⁶ Perhaps unsurprisingly, it appears that some of the physicians in the field were annoyed by the increasing amounts of paperwork that they were expected to complete. In his notes, Dr. Foltz wrote, “It is quite impossible that I can make the ‘general abstract’ of the returns for this quarter, or that I can do more than prepare for the approaching battle.”⁷ Nonetheless, these surgeons do appear to have begrudgingly complied with the new instructions.

Examination Procedures

One clear example of the increase in the quality and professionalism of the Navy medical apparatus is the use of examinations and testing to qualify physicians. Records suggest that some form of examination was required to enter the Navy medical apparatus since the 1850s; however, the shortage of medical officers at the beginning of the war put a strain on the testing system.⁸ Considering that the Navy physician core increased nearly six-fold between 1862 and 1864 one might expect that examination standards slackened.⁹ Instead, the BUMED simply had examiners work overtime to keep up with the surge of volunteers seeking to serve as Navy physicians. One of these examiners, Dr. Charles Wheelwright, writes that he is occupied all day by examinations, leaving him very exhausted.¹⁰ According to the editor of Wheelwright’s correspondence, the stress of this task was so severe that it caused many examiners to break down, retire, or perish.¹¹

This stress on the system may explain the BUMED’s decision to rotate some physicians out of active service and into roles as examiners. Indeed, even medical officers as senior as Fleet Surgeons, such as Dr. Foltz, were rotated out of service.¹² This practice may have helped improve the Navy medical apparatus’ responsiveness to the conditions of the war by allowing officers that had been on active duty to be the ultimate arbiters of what knowledge a candidate should possess before being allowed to practice as a Navy physician.

USSC Aid

During the Civil War, the Army medical apparatus was greatly aided in its effort to preserve the health and wellbeing of soldiers through the support provided by the United States Sanitary Commission (USSC). This organization was dedicated to improving the health and overall wellbeing of Union forces. The official plan of the Relief Service of the Sanitary Commission includes “…dispensing supplies wherever most need, to all the service of the Union, without preference of State, arm, rank, army or navy, volunteer or regular.”¹³ Considering this claim to aid both the Army and Navy equally, it is important to examine the activities of the USSC and its interactions with the Navy medical apparatus.

One of the most helpful activities undertaken by the USSC was the publishing of “medical monographs.” These monographs provided military surgeons with information on recent medical developments or public health interventions with which they may have not been familiar. These papers, published with titles such as “Report on the Value of Vaccination in Armies” and “Quinine as a Prophylactic against Malarious Disease,” proved to be very popular with medical personnel.¹⁴ While there is little evidence to suggest that any of this literature was published specifically with the Navy in mind, a majority of these texts would have been useful to any practitioner of military medicine. Despite the difference in environment and duties, the fighting men of both services often suffered from similar diseases, such as malaria, yellow fever, and scurvy. ¹⁵ Additionally, both Navy and Army medical personnel were concerned with issues such as ventilation, water sanitation, and the use of prophylactics and medication.

The USSC also worked to ensure that Army physicians received the supplies needed to efficiently carry out medical procedures and keep soldier’s comfortable.¹⁶ Looking through the accounts of the work of the USSC, one may easily conclude that it did nothing to aid the efforts of Navy physicians. Mentions of the navy are exceptionally sparse in the contemporary literature on the operations of the USSC. Some evidence, however, suggests that the USSC did make financial and material contributions to the Navy medical apparatus throughout the war. For example, Fleet Surgeon Foltz writes in his notes of the “timely contribution of articles so much needed in the fleet” by the USSC in April of 1862. ¹⁷ This is near the time when the Western Gunboat Flotilla was suffering from its most severe supply shortages. In the east, Rear-Admiral Lee of the North Atlantic Blockading Squadron wrote the Chief Inspector of the USSC to thank him for the supplies sent to the vessels under his command in June of 1864.¹⁸

In the official narrative of the USSC’s works, which was both written and published by the USSC, several pages are devoted to refuting the claim that the USSC did not work with the Navy. Considering the nature of the source, it is very possible that the argument presented may be biased, but it is still worth examining. The section notes that members of the USSC were regularly appointed to liaise with the Chief of the Bureau of Medicine and Surgery. In this role, they sought to lend their knowledge, gained from both academic study and, perhaps, personal experience, to the operations of the BUMED. The text goes on to list several instances when the USSC was able to furnish material aid in the form of food or supplies that the logistics apparatus of the Navy had been unable to provide at the time. Interestingly, the author notes that the Navy simply needed less help and that it was better able to provide care for its sailors than the Army could provide for its soldiers.¹⁹ This difference in quality and self-sufficiency was likely due to the innovations developed by the Naval medical apparatus throughout the war.

Hospital Ships

Another clear example of the development of naval medicine during the Civil War is the invention of the hospital ship. The USS Red Rover, which was ready for service on 10 June 1862, was the first Navy hospital ship during this period.²⁰ The concept of a hospital ship was more of an evolution than an innovation. In other words, the notion of a dedicated medical vessel was new, but the principle of using ships to transport and house sick soldiers was not. As early as 1862, the USSC and the Medical Bureaus of the Army and Navy were using ships for medical purposes. When battlefield injuries and diseases like typhoid began to flourish in the Army of the Potomac during the Peninsular Campaign, the established medical hospital system was quickly overwhelmed. To combat this, the USSC began using everything from shallow-draft riverboats to larger seafaring vessels to transport supplies, physicians, and sick soldiers around the coasts and rivers of Virginia.²¹

While this idea was quite clever, it had several major flaws. The most glaring issue is the fact that there were many opportunities for miscommunication between the USSC, the military officers in the field, and the Medical Bureau. Additionally, it may have been difficult for civilian staff on these ships to control and corral soldiers on board. Since these ships were privately owned and independently operated, they could not be fully integrated into the military command and logistics structure.²² It was clear to all involved that this state of affairs was suboptimal.

As these early hospital ships were moving around the coasts of Virginia, a similar situation was unfolding along the Mississippi River. Even in this theatre of war, the Navy encountered huge problems when attempting to transport wounded army soldiers and take care of the Navy’s own injured seamen. The solutions, up to this point, were largely hodgepodge an impromptu. Sick soldiers were often housed in assorted barges, ships, or even active fighting vessels. Since these boats were not designed for this purpose, they often had major problems with ventilation and accommodations, thus greatly limiting their usefulness and efficacy.²³ One letter notes that injured soldiers who were unfortunate enough to be stuck on a fighting vessel often had to be rapidly moved about the ship, as the needs of combat dictated. The author notes, “This must always have been attended with pain and distress, if not positive injury.”²⁴

Fortunately, there were people thinking about solutions to this problem. Sometime in early 1862, Quartermaster George D. Wise received 3500 dollars from the Western Sanitary Commission to refit a captured Confederate steamer. This refit created the ship that would become the USS Red Rover. When describing the layout of the ship, Wise states:

The ice box of the steamer holds 300 tons. She has bathrooms, laundry, elevator for the sick from the lower to the upper deck, amputating room, nine different water-closets, gauze blinds to the windows to keep the cinders and smoke from annoying the sick, two separate kitchens for sick and well, a regular corps of nurses, and two water closets on every deck.²⁵

These facilities were immediately put to good use, receiving its first patient, a cholera victim, on 11 June 1862. Shortly thereafter, Red Roverassisted with medical treatment and transport of soldiers and seamen injured in the Battle of Saint Charles and the First Battle of Memphis.²⁶ Unlike regular fighting or trade ships, the Red Rover’s interior was specifically designed to promote the health and well-being of the soldiers and seamen onboard. Special attention was paid to ventilation, the lack of which was known to be a major contributor to disease prevalence in the minds of the medical experts of the era.²⁷

In addition to providing medical services and a hygienic environment, the ships large ice box and ample cargo space made it ideal for supply transport and storage.²⁸ The correspondence of various U.S. Navy officers reveals that meat and vegetables were commonly relocated from dedicated supply vessels to the cargo hold of the Red Rover.²⁹ This is a very logical use of the vessel, considering that it would often be kept away from enemy fire and was not likely to be sunk or destroyed. Furthermore, separating vital food and supplies from the sailors eliminates the risk of these supplies being pillaged in a moment when discipline lapses. Some evidence suggests that, in the moments of chaos following a defeat or major losses, sailors would even go so far as to loot their fallen and wounded comrades.³⁰

Up to this point, the entire Western Gunboat Flotilla, of which Red Rover was a part, had technically been operating under the jurisdiction of the Army, even though the officers of the flotilla were naval officers and the force was mostly supplied by the Navy. Inevitably, this unusual command structure resulted in mishaps, confusion, and conflict.³¹ Thus, the Western Gunboat Flotilla was transferred to the Navy’s jurisdiction on 1 October 1862 and became the Mississippi River Squadron.³²

With this reorganization came another step in the development and homogenization of the Navy medical apparatus. This reorganization of structure allowed the flotilla commander to bring all the navy medical staff operating on ships, on land, and at the soon to be created Mound City Naval Hospital, under one set of regulations. This starkly contrasts with the existing status quo, where Navy personnel were cared for by a hodgepodge of Army physicians on land, Navy physicians under the command of the Army, and Navy physicians under the command of the Navy, which all operated with different rules and commands.³³

With this reorganization in place, the Red Rover became an integral part of the fleet. Although its primary role was to provide medical services and accommodations, the Red Rover was still regularly used in military operations. For example, one order of Acting Rear Admiral Porter, Commander of the Mississippi River Squadron in 1863, ordered the Red Rover to “…remain at the mouth of White River and guard it and the coal barges, notifying any light draft gunboats and all coal or shore boats to stop at the mouth of White River until further orders.”³⁴ While the Red Rover’s armament was limited to one 32-pounder cannon and assorted small arms, it appears that this was more than sufficient to keep the ship safe while relaying messages on friendly waters.³⁵

Around this time, Rear Admiral Porter broke with protocol and decided to place his fleet surgeon aboard the Red Rover. In a letter to the Secretary of the Navy, Porter argues that this change was “absolutely necessary” and that the surgeon’s skills could be put to better use aboard the hospital ship than aboard the flagship.³⁶ This change seems to indicate that the Red Rover became a centralized hub of medicine within the Mississippi River Squadron. Presumably, the large stores of medical supplies aboard the ship, and its unique layout, made it far easier and more efficient for the supervision of all major medical care to occur on its decks.³⁷

Despite the successes of the Red Rover, the innovations it represented did not seem to immediately proliferate. In May of 1863, regular supply ships were still being used to transport the sick and wounded on the waters of the east coast.³⁸ This situation largely persisted until the end of the war; however, one other hospital ship, the USS Home, was put into service in July of 1864. While the Red Rover operated in the west, the Home was stationed with the Charleston blockading fleet until it was decommissioned in August of 1865.³⁹

While the use of hospitals ships may have taken some time to spread, scientific and medical knowledge was rapidly expanding and proliferating during the Civil War and the preceding decades. The Medical and Surgical History of the War of the Rebellion is filled with examples of the medical apparatus coming to a more comprehensive understanding of disease as it studied the data collected before and during the war. For example, the literature points out that malarial diseases seem to occur more frequently in the south, and especially near bodies of water.⁴⁰ It is now known that this hypothesis is correct, due to the increased prevalence of mosquitoes in these areas. Similarly, this text catalogs the development of the treatment of scurvy over the last several decades, noting the role of scientific experimentation in the discovery that vegetables and fruit are essential to preventing the development of scorbutic symptoms.⁴¹

This knowledge alone was exceptionally useful to physicians in the field, but practical realities often limited their ability to implement health intervention strategies that would take advantage of new knowledge. In many ways, the hospital ship was a kind of force multiplier that allowed physicians to more effectively utilize knowledge. For example, the icebox of the Red Rover allowed the storage of more vegetables and fruits, thus making it easier for soldiers to gain adequate nutrition and stave off scurvy. While the hospital ships made many of the health promotion measures physicians sought to implement possible, naval doctors still required authority and influence to create change.

Physician Status

Further evidence of the professionalization and advancement of Navy medicine over the course of the nineteenth century can be seen in the push towards naval medical staff receiving formal military ranks. In 1854, Congress passed legislation which mandated the assimilation of medical personnel into the military command structure. Despite the directive from Congress, this process was left unfinished until the Secretary of the Navy ordered its completion during the Civil War. ⁴²

In addition to formal ranks, physicians broadly gained more power and influence over the course of the war. By 1864 physicians had the power to appoint and dismiss all other medical and hospital staff, such as nurses, cooks, and other assistants.⁴³ This power was essential in allowing physicians to have complete control over medical operations and ensure a certain standard of quality and competence among all medical staff. As early as 1862, the advice and recommendations of the medical apparatus were being enforced through the orders of local commanders. For example, Rear-Admiral David Porter, commander of the Mississippi River Squadron, issued a list of new sanitary measures to his subordinates while stationed in Cairo, Illinois. He concludes the order by stating that, “…the comfort and health of the men must be the first thing to be looked after.”⁴⁴ The issuance of this command was provoked by the “unusual number of sick in this squadron,” which indicates that this new-found support for the recommendations of fleet physicians was a direct response to the prevalence of disease.

In addition to gaining recognition, influence and formal rank, the validity and importance of the surgeon’s role was enshrined in law. In Section 16 of An Act for the Better Government of the Navy of the United States, which was enacted on 17 July 1862, Congress states:

He [the commanding officer] shall cause a convenient place to be set apart for sick or disabled men, to which he shall have them removed, with their hammocks and bedding, when the surgeons shall so advise, and shall direct that some of the crew attend them and keep the place clean. He shall frequently consult with the surgeon in regard to the sanitary condition of his crew, and shall use all proper means to preserve their health…. Any commanding officer offending herein shall be punished at the discretion of a court-martial.⁴⁵

Despite the steps taken towards gaining more respect, recognition, and influence for the U.S. Navy physician corps during the Civil War, the role of many physicians was still quite different from that of a twenty-first century Navy medical officer. In Diseases and Injuries of Seamen, U.S. Navy surgeon G.R.B. Horner states the following:

…the [Navy] medical man is constantly liable to commit blunders in etiquette, and violate rules made to enforce discipline and excite respect to superior rank, as well as to insure prompt attention to orders and their proper execution. The novice, then, of the medical corps has two distinct sets of duties to perform — naval and professional — and a third set forming a combination of the two… The last named duties are frequently the hardest to perform, from the difficulty in defining them, and hence the collisions and misunderstandings which so often occur between medical men and others of the navy. ⁴⁶

In other words, Navy physicians were not simply tasked with caring for the sick and injured. Instead, they were fully expected to participate in all aspects of Navy life and military operations. They were required to fit themselves into the navy command structure in a way that did not entirely fit with the role they needed to serve. While the above passage was written in 1854, the evidence shows that this state of affairs persisted during the Civil War. For example, although Johnathan Foltz was a Fleet Surgeon, a senior medical officer, his journals note that he traveled ashore with simple foraging parties.⁴⁷

While the precise reasoning for this seemingly unnecessary risk to highly specialized and hard to replace personnel is hard to determine, these practices show that navy physicians could not simply stay below decks and practice medicine. This dual duty problem likely placed an unnecessary mental and physical burden on physicians. This time could have been spent attending to the injured, preparing for the next battle, or filling out the paperwork that Foltz claimed he had no time for. Fortunately, this “dual duty” problem was somewhat ameliorated when the process of giving Navy physicians formal rank was completed.

Conclusions

Many consider the contributions of the Federal Navy, especially the blockading actions, to be an integral component of the Union’s ultimate triumph during the Civil War.⁴⁸ Therefore, the work of Navy physicians, who preserved the health and vitality of Union seamen, should be considered an integral component of the Union war effort. It is well established that disease can utterly ruin armed forces and render them incapable of fulfilling their duties. The threat of diseases was perceived to be so serious that entire ports were quarantined to contain disease outbreaks.⁴⁹ A ship which carried the risk of being a disease vector was treated no differently. When the captain of the USS Colorado reported the presence of a disease ”resembling in some respects yellow fever” aboard his vessel, he was ordered to simply cruise offshore until the disease died down.⁵⁰ In an effort to reduce the waste of life, manpower, resources, and time caused by the prevalence of disease, the medical apparatus of the U.S. Navy sought to innovate, evolve, and change.

Of these innovations, the move towards standardization and the use of hospital ships seem to have had the greatest long-term impact. Any student in fields related to pharmacy, physiology, anatomy, or medicine will know the importance of nomenclature in medical research and practice. Similarly, any individual who handles record keeping or accounting can attest to the importance of standardization in the documentation of events, expenses, and incidents. These practices are essential to the functioning of modern medical systems and are the core of what allows them to provide efficient, high-quality care.

Hospital ships would develop into a significant feature of the American Navy after their appearance in the Civil War. Despite being at peace, the Navy used the USS Pawnee as a hospital ship from 1869 to 1882.⁵¹ With the start of the Spanish American War, the USS Solace and USS Relief/Repose were brought into service.⁵² These vessels were joined by the USS Comfort and a different USS Relief in 1918 and 1930, respectively.⁵³ Since then, several hospital ships have been used by the U.S. Navy throughout war and peacetime.

Clearly, the BUMED and Navy medical apparatus’ advances during the Civil War had a major impact on the development of the Navy, the progress of medical knowledge, and the outcome of the war. Further study of these issues is therefore required. In addition to improving the understanding of the development of the American Navy and military medicine, further study in this area can easily be juxtaposed with existing literature on the practices of the Royal Navy in the mid-nineteenth century. The contrast could provide interesting insight into the development of medical and sanitation theory before the inception of germ theory. This could also open avenues into new research discussing the relative competencies of the U.S. and U.K. naval medical apparatuses.

The mid-nineteenth century was a time of significant scientific and technological advancement in many fields of study, such as medicine and public health. In particular, the military medical apparatus of the United States underwent a process of innovation, professionalization, and modernization. The U.S. Navy was as much a part of this trend as the U.S. Army, even though the study of the Navy has been neglected. Many of the innovations pursued by the Navy during this era continue to have an impact on naval medicine to this day.

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Primary

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Footnotes