Civil War 'contract' Surgeons: their role and surgery sets during the War

By Dr. Michael Echols, American Civil War Surgical Antiques

(The following are the personal edited research notes of Michael Echols, the source of which may or may not be completely documented)

Part I of II.  For Part II, see: Form 18 and contract surgeons

One of the biggest problems I confront on a regular basis in collecting Civil War surgical antiques, is dealers or individuals saying they own a surgical set of someone who served as a surgeon during the Civil War.  Okay, but there were basically two kinds of  'surgeons' during the War: Army surgeons and Civilian 'contract' surgeons on both sides. We need to define who and what these two groups did during the War.  To be fair, there were medical school teaching surgeons and private surgeons who volunteered during the War who were among the most competent surgeons on record.  Many of those surgeons also served on both sides during the War as army officers.  There were also surgeons in the various state volunteer armies, who were mustered into regular regiments of the Union Army.

There is an excellent reference (quoted or paraphrased below) by Dr. Jay Bollet, Civil War Medicine: Challenges and Triumphs, which is a well documented book where he makes the point that contract surgeons were relegated to working in the rear area hospitals changing dressings and attending to the general health of patients, not doing complicated, amputations, or field surgery.  The qualified surgeons were admitted to the Union and Confederate Armies and reviewed for their competence or lack there of, and eliminated from doing surgery if they did not pass muster.  The point here is contract surgeons were not in the field or rear hospitals using their surgery kits to amputate limbs or resect fragments from bullet fractured bones.  It just didn't happen often if at all.  The real surgeons were in the regular Army on both sides, were supplied by the Army with Army owned and purchased surgical sets, not the sets found in some closet one hundred plus years after the fact, no matter how much some collectors or families would like to romance that idea.

Contract surgeons are a major source of provenance problems in relating any existing or pre-existing surgical set to the Civil War.  Everyone wants to think their surgery set was a part of the Civil War.  But the 'surgery' performed during the Civil War is greatly misunderstood or exaggerated.  A part of those misconceptions is the misunderstood role of the 'contract' surgeons.

During the early days of the War, there were only 200 medical officers in the Union Army and some of those left to join the Confederate Army and form the medical service for the Confederacy.  Of those remaining only a very few had any experience doing actual major surgery necessary for treating battle wounds.  Until the Union could recruit and verify the abilities of new surgeons, they used 'contract' surgeons who may never have actually done any surgery other than minor procedures. These 'contract' surgeons were paid by the day, they came and went as needed in areas where battles took place.  They would have been the local doctors who came to help.  (Yes, they would have brought and used their own surgery sets)  During this time (pre-1861) it was rare for any kind of major surgery to be performed unless it was thought to be the absolutely last resort.
 
There were a few teaching centers at medical hospitals where major surgery was done, but it was not even part of the teaching experience for most medical students.  (That said, there are many medical textbooks which show and teach extensive invasive surgery as practiced in teaching hospitals in both America and Europe in 1850 and earlier.)  Most American medical  students only went to medical school for two years and then generally worked as an apprentice afterwards.  Physician/surgeons in major cities like New York, Boston, or Philadelphia, would have had extensive surgical experience,  but not by the type of doctor found across much of rural America at the time of the Civil War.  If you wish to read more on this area of medical surgical history, there is a fine book about medical schools prior to the Civil War:  "Medical Education Before the Civil War", by Wm. F. Norwood.

Below: Taken from 'A History of the Army Medical Department: Civil War Medicine 1861-1865' by Mary C. Gilletty

"The quality of the Army's contract physicians was important, since during the course of the war more than 5,500 civilian doctors assisted the Medical Department. Many routinely staffed general hospitals while others provided help only in emergencies when it was necessary to locate more physicians quickly. In the last group were some of the nation's most prominent doctors. When a battle resulted in overwhelming numbers of casualties, those who flocked to the scene might include quacks, cultists, and practitioners of questionable ethics, men who were not under military discipline and who could, therefore, come and go as they liked, taking assignments that pleased them and rejecting all others. They often performed unnecessary operations or wrought havoc as they dug about for bullets.
 
As a result of the problems experienced with doctors so casually assembled, the Union Army Medical Department decided to call only upon members of a reserve surgeons corps formed by the governors of various states. These gentlemen were paid the salary of contract surgeons and came in if called. They served under Medical Department orders and were required to remain at their assigned posts at least fifteen days, unless officially released sooner." 

Civil War Surgery: The truth about what surgeons did and did not do during the War
(Source of the following:  "The Medical and Surgical History of the War of the Rebellion. (1861-65.)  Part III, Volume II, Chapter XIV.--The Medical Staff and Materia Chirugica")

"Beside the medical officers of the regular and volunteer staff, and the medical officers of regiments, there was a class designated as Acting Assistant Surgeons, who were private physicians, uncommissioned, serving under contract to do duty with the forces in the field or in general hospitals. This class was very large and embraced in its number some of the most eminent surgeons and physicians of the country. The Medical Cadets were generally young men, students of medicine, who were assigned to duty in general hospitals as dressers and assistants. The Medical Department was still further increased by a number of Hospital Stewards, who were enlisted as needed, and who performed the duties of druggists, clerks, and storekeepers."

"During the years of the war the organization of the Regular Staff had been increased so as to number one Surgeon General, one Assistant Surgeon General, one Medical Inspector General, sixteen Medical Inspectors, and one hundred and seventy Surgeons and Assistant Surgeons; there had been appointed five hundred and forty-seven (547) Surgeons and Assistant Surgeons of Volunteers; there were mustered into service between April, 1861, and the close of the war, two thousand one hundred and nine (2,109) regimental Surgeons, three thousand eight hundred and eighty-two (3,882) regimental Assistant Surgeons. During the same period there were employed eighty-five (85) Acting Staff Surgeons and five thousand five hundred and thirty-two Acting Assistant Surgeons."

As the War progressed, it quickly became apparent many of the doctors were not competent to do any kind of surgery, so the Surgeon General's Office developed testing procedures and 'boards'  for admitting surgeons to the Army Medical Department and further qualified those who had varying degrees of skill to actually do the day to day surgery on the troops.  As the more qualified doctors were recruited and processed the less qualified doctors and especially the 'contract' doctors were relegated to the rear areas to tend to the troops in ways that we would expect skilled nurses to do today.

It is essential for you to understand how little major surgical experience existed prior to the War pre-1860.   Surgery we take for granted today just did not exist other than in major teaching hospitals if at all.  Medicine was primitive at best by today's standards in most areas of the country.  For all the amputation sets made, it was a rare surgery and often done by inexperienced doctors who had never done one before.  Not all doctors were trained the same as there were no national standards.

As the War progressed, the more skilled surgeons and assistant surgeons were moved forward into the field.  Assistant surgeons may have triaged in the forward areas and the full surgeons operated behind the lines on the more seriously wounded.  As soon as possible the post surgical and seriously wounded would be transported to field hospitals  for continued care and this would  have been where 'contract' doctors would have been employed.  It would not have been in the field with a saw or knife in hand as some would like to believe.  Only the most experienced surgeons were doing amputations or complicated surgery.
 
So,the odds of a given surgery set belonging to a 'contract' surgeon being used during the War is pretty slim.  Contract surgeons were not in the Army, they were hired hands to help in the rear areas and they were not hired to do major surgery.  And anything where cutting was involved was 'major'.  Most likely a pocket roll-up surgical kit was the most any doctor ever needed given the minor nature of the 'surgery' they did.  Certainly only the most experienced doctors/surgeons drew an amputation knife or bone saw.

See more on Civil War Form 18 and Contract Surgeons .

All this said, there is a directive in the 1863 SGO Army Surgeon's Manual which specifically states that 'contract' surgeons who are issued instruments shall have their pay debited for the cost of the instruments, which would lead one to assume the contract surgeon's would then own the instruments they drew from medical stores, but that does not mean they were issued full capital operating sets or even full amputation sets.  Those sets are government issue and so marked with "U.S.Army Hosp. or Medical Dept."

The surgery sets used by the regular uniformed Union surgeons were bought and paid for by the Union Army.  They were not the personal property of the surgeon (thus no name on the brass plate) and were maintained by assistants, not the surgeons.  Surgeon's didn't walk around with large and heavy sets.  These were transported by wagon and set up by assistants in field or rear area hospitals, which were merely tents in more protected areas behind the lines.  Some well meaning local doctor may have given a hand or observed at times, but more than likely the uniformed Army surgeons ruled the scene and kept total control of the situation.  Being a military surgeon was serious business and not to be taken lightly by allowing some unknown visiting doctor to take over or do a major operation with a limited use surgery set he brought along for the day.

There may have been European and English sets used by northern doctors who served in the early days of the War as 'contract' surgeons after local battles.  The Union and certainly the Confederate contract surgeon's may have (and the emphasis is on 'May have") brought their existing sets or pocket kits with them.  The source of these sets would have been both European, English, and American in origin.  The trick is proving they were actually owned by the doctor and the set existed before or during the War.  This is extremely difficult,  but not impossible.
 
A few more thoughts about 'provenance' supported sets.  Just because someone shows up with a lot of written information about a great set, you have to prove the set belonged to the owner/surgeon.  The set has to be from the right time frame, and to be something the owner 'could' have owned.  This boils down to documenting the dates of manufacture, the source of the set, then connecting the set to the owner during the Civil War.
  
One of the big problems with European sets is dating the set to a specific time frame because there is almost no information available about specific European or English sets, with which you can date the sets to five or ten year time frames.  There are a couple of books on European and English topics (Bennion, Kickup), but nothing to match Edmonson's work on American sets.

There is extensive information on the website, American Civil War Surgical Antiques, and you can access that information by searching for:

Dr. Michael Echols, American Civil War Surgical Antiques

Dr. Echols is strictly a collector/researcher and is not a dealer.