Lincoln and Medicine

5. Lincoln and Medical Matters during the Civil War

56 c h a p t e r f i v e Lincoln and Medical Matters during the Civil War When Abraham Lincoln assumed the presidency on March 4, 1861, he had little experience with medical issues beyond family illnesses and several legal cases that involved alleged medical malpractice or questions of sanity.1 Once he became president, Lincoln, in his role as commander in chief, had overall responsibility for the military, including its medical arm. Practically, however, the secretary of war and the secretary of the navy, along with their departments, managed the details of military affairs. Yet, over the course of the war, Lincoln made certain choices that could, directly or indirectly, help or hinder the medical care of the troops. The choices, affected at times by bureaucracy or compassion, generally fit into three broad areas of interaction with medical personnel, civilian aid groups, and individual patients. In 1860, the US Army was more or less prepared to take care of whatever wounds and illnesses its 16,000 troops suffered with a department consisting of one surgeon general, thirty surgeons, and eighty-three assistant surgeons. However, a number of medical officers soon left the army and seceded with their states. Thomas Lawson had joined the military medical corps during the War of 1812 and had served as surgeon general since 1836. In no physical condition to lead the department in wartime, Lawson died of a stroke on May 15, 1861. His replacement, Clement A. Finley, was appointed on the basis of seniority, not because of any skills or desire to expand the Medical Matters during the Civil War | 57 medical service to meet the needs of the rapidly enlarging army. Lincoln would, of course, have signed the commission of Surgeon General Finley, but, overwhelmed with other things to do at the start of his term and the war, the president would probably have left Finley’s selection to the medical bureaucracy. Unfortunately, Finley neglected to order supplies, countermanded the construction of a hospital, and generally tried to save money rather than be prepared to save the sick and wounded. Army medical care was also complicated by split responsibilities. The quartermaster department was to provide construction of facilities, transportation, and equipment, while the subsistence department provided supplies.2 The army in all its departments was chaotic and undersupplied in the early months of the war, so it is hardly surprising that the medical department had many difficulties. However, civilians stepped in to try to remedy the situation. Local groups provided food and clothing for soldiers from their area. Larger organizations, such as the United States Sanitary Commission, were formed to provide centralized coordination for the efforts of the local groups, as well as medical supplies and sanitation guidelines that the army medical department was not able to provide.3 The Sanitary Commission originated in New York in April 1861 and was based on a concept developed in Great Britain during the Crimean War in the mid-1850s. Because the army and its medical department feared and resented any civilian interference or control, they generally opposed the work of the Sanitary Commission and similar groups, despite the crucial aid the commissions provided to the undersupplied soldiers. Four Sanitary Commission founders met with Lincoln as well as with Secretary of War Simon Cameron, Colonel Robert Wood of the medical department, and other Washington leaders in May 1861 to try to gain some official standing for the commission . After some discouragement, Cameron finally issued an order establishing the commission on June 9, naming certain people to inquire into inspection of new recruits, sanitary conditions of troops and camps, and anything else necessary “to the means of preserving and restoring the health, and of securing the general comfort and efficiency of troops.” Finley and Wood opposed the commission. 58 | Medical Matters during the Civil War At first, Lincoln was somewhat reluctant to support the commission as well because he thought it might be “a fifth wheel to the coach,” something unnecessary. But the president did sign the order on June 13, noting, “I approve the above.” In July 1861, when military officers and the medical department opposed the commission in a bill before Congress, Lincoln supported the commission.4 Despite his busy schedule, Lincoln made time to see sanitary commissioners, even if the appointment had to be at 9:00 p.m. On August 2, 1861, he notified General John C...