From: history.amedd.army.mil
Outside the Union's Ambulance Corps, other specialists appeared during the Civil War. A remarkable example of hospital administration could be found on the Confederate side of the line. In Richmond, Sally Louisa Tompkins headed Robertson Hospital, which, staffed with Confederate Army physicians, had a mortality rate lower than any other in the city. Abuses by some private hospitals caused the Confederacy to pass a law restricting the treatment of Confederate soldiers to hospitals commanded by commissioned officers. Jefferson Davis desired to retain Tompkins' hospital, and thus Captain Tompkins became the only woman commissioned in the Confederate Army.
Such specialists were needed. Administrative requirements bedeviled medical officers of both sides, a situation aggravated by the rapid expansion from a small regular army to a very large, mostly volunteer, military. "Army doctors in administrative positions apparently were quite at a loss in performing the duties incident to them." They were assisted by enlisted hospital stewards, who were responsible for general administration and were superior to all other hospital noncommissioned officers, enlisted soldiers, and nurses. But seldom was there the guiding hand of an officer who understood administration and was devoted to that function alone.
Pharmacy was emerging as the accepted specialty for the compounding and dispensing of drugs. Schools of pharmacy had been established in the 1820s and the American Pharmaceutical Association formed in 1852. Civilian pharmacists were employed in the larger Army hospitals in the Civil War because, unlike the French, the Americans provided no commissions for pharmacists. The American Journal of Pharmacy criticized the lack, but there was no movement in that direction, and the argument over commissioning pharmacists would continue well into the next century.
Chiropody, performed by civilians under contract to the Army, would be incorporated into the Medical Service Corps in the next century. Isachar Zacharie, a skilled chiropodist and political opportunist, received publicity as the favored bunion cutter for Lincoln, Secretary of War Stanton, and General McClellan. Lincoln credited Zacharie as the specialist who "put me on my feet," and his fame led to calls for the creation of a chiropody corps.
The need for a medical supply system operated by members of the Medical Department was a lesson learned over and over again. Supply problems generated frequent complaints, but line officers continued to relegate medical logistics to the status of "least important in the Army." Letterman, as he had done with the ambulances, worked out an arrangement with the Army of the Potomac's quartermaster that gave him exclusive control of medical wagons. He said that it was very important to place this capability within the medical organization so as to make the medical system self-sustaining and largely independent.
Congress improved the situation on 20 May 1862, when it authorized the Medical Department to commission U.S. Army Medical Storekeepers (USAMS), a precursor of Medical Service Corps medical logistics officers. General Hammond, while pleased with the congressional action, said the number allotted was too small. The War Department appointed a selection board, limited appointments to apothecaries or druggists, and required applicants to post a $40,000 bond before entering active duty-an extraordinary sum for the day.
Hammond called the medical storekeepers "a most useful class of officers," and he expanded their duties to include medical purveying, thereby releasing physicians in those assignments to medical duties. Four of the six successful candidates were later given additional appointments as acting medical purveyors. Medical storekeepers were paid $1,750 a year, including the quarters and allowances of a first lieutenant, but no rank was assigned and by custom they were addressed variously as "captain" or "mister." Their abridged military status meant that neither they nor their families were eligible for pensions or death benefits. Congress rectified the oversight in 1867 by giving them the rank and pay of cavalry captains.
Henry N. Rittenhouse, USAMS, described his position as "one of considerable magnitude." Hennell Stevens, USAMS, said accountability was "right and thorough." George Taylor Beall, USAMS, was commissioned as a medical storekeeper in 1866 and assigned to the medical purveyor's office in Santa Fe, New Mexico. In 1875 he transferred to the St. Louis Medical Depot where he was responsible for purchasing over $1 million in medical supplies and equipment before his retirement in 1894.93 The duties of Rittenhouse, Stevens, and Beall required a knowledge of pharmaceuticals, but Rittenhouse insisted that the major prerequisite was general management skills. "Scientific knowledge is not much called into play; what is required is a thorough business knowledge, a familiarity with the various customs of ordinary business transactions, sound judgment, and intimate acquaintance with the regulations, laws, orders, and circulars of the Medical Department."
Overall, Civil War advances in the care of the sick and wounded had resulted less from improvements in medical science than from improved organization for medical support and the addition of new specialists to the Medical Department, such as the officers of the Ambulance Corps and the U.S. Army Medical Storekeepers. The war had seen the emergence of a genuine chain of evacuation, the appearance of large numbers of female nurses in the military hospitals, and the creation of the largest, most complex, best integrated military medical system the United States was to know until the twentieth century.
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