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The civil war’s medical cadets: medical students serving the Union1 ∗
HISTORY
The Civil War’s Medical Cadets: Medical Students Serving the Union Guy R Hasegawa, PharmD ready taught him “a great deal about practical medicine” and that his station was “one of the best possible schools for a student.” Medical student Charles Rivers Ellet4 wrote in June 1861 that he routinely followed a physician during rounds in an Army hospital in Washington, DC, to see how he questioned and prescribed for patients. After rounds Ellet proceeded to the dispensary, prepared medicines, and learned from the hospital steward all he could about the character and effects of the drugs. Both Hutchinson and Ellet later enlisted as regular medical cadets. The act of August 3, 1861, authorized a corps of medical cadets, up to 50 of whom could serve at a time, to act under the direction and control of medical officers alone as dressers in general hospitals and as ambulance attendants. Applicants were to be 18- to 23-year-old men of liberal education who had studied medicine for 2 years and completed at least one course of lectures at a medical college. (In this context, “studying” meant learning under a preceptor. Medical schools typically offered one course of lectures a year, delivered over about 5 months.5 Graduation required attendance at two courses, which could be identical.) Applicants who passed examination would be enlisted for a 1-year term in the Army with a rank equivalent to that of a West Point cadet (between sergeant major and second lieutenant) and pay of $30 a month along with quarters, fuel, and transportation.6 Initially no food ration was allowed.
Among the medical personnel serving the United States during the Civil War was an obscure group of young men called medical cadets. Composed of medical students, the US Army medical cadet corps was created to dress wounds and act as ambulance attendants. As mounting war casualties overwhelmed Army surgeons, medical cadets found themselves taking on much more responsibility for patient care. Although all but ignored in histories of Civil War medicine, the story of the medical cadets provides valuable insight about medical training and military medicine during that conflict. ORIGINS Formation of the corps of medical cadets was approved by Congress on August 3, 1861.1 When and where the idea of medical cadets arose is unknown, but the necessity for surgeons’ assistants was recognized early in the war. In May 1861 a delegation representing New York civilian relief agencies recommended to the Army Medical Department that “in case of need the Medical Bureau may call to the aid of the regular medical force a set of volunteer dressers, drilled for this purpose by the hospital physicians and surgeons of New York, giving them such subsistence and such recognition as the rules of the service may allow under a generous construction.”2* Whatever the effect of that recommendation, medical students began volunteering their services even before the medical cadet corps was established. For example, Edwin Hutchinson,3 a medical student from Utica, New York, accompanied his friends in the 14th New York Infantry as an unpaid medical assistant. He wrote on August 3, 1861, from the regiment’s camp at Arlington Heights, Virginia, that his first-hand experience had al-
ENLISTMENT Applicants for a position as medical cadet provided their date and place of birth, place of residence, period of medical studies, certification of attendance at one full course in a medical college, and testimonials of character and physical fitness.7 “Of a great number of applicants” for the first 50 positions, reported Surgeon General Clement Finley8 in November 1861, 66 were found qualified and invited to appear before an examining board. Of those, 48 were approved and enlisted, 7 failed to appear for examination, 7 were rejected, and 1 de-
No competing interests declared.
Received February 21, 2001; Accepted March 2, 2001. From the Publications and Drug Information Systems Office, American Society of Health-System Pharmacists, Bethesda, MD. Correspondence address: Guy R Hasegawa, PharmD, American Society of Health-System Pharmacists, 7272 Wisconsin Ave, Bethesda, MD 20814. * Quotations are reproduced with original capitalization, punctuation, and emphasis. Only misspellings have been corrected.
© 2001 by the American College of Surgeons Published by Elsevier Science Inc.
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clined enlistment; 3 others were awaiting examination for remaining vacancies. On April 16, 1862, Congress approved 20 additional medical cadet positions.9 Reenlistment was allowed, and records of the Surgeon General’s office show that 273 men enlisted for 300 1-year terms during the corps’ 5-year existence (Table 1).10,11 Enlistment and discharge dates show that the number of medical cadets on duty at any particular time from September 1861 to April 1865 was close to the 50 or 70 allowed. Philadelphia’s medical schools proved to be a particularly rich source of medical cadets; at least 23 medical students from the University of Pennsylvania12 and 18 from Jefferson Medical College,13 for example, enlisted in the corps. Supplementing the regular (enlisted) medical cadets was a separate class of civilian medical cadets. These “acting medical cadets,” who worked under contract, are described later in this article. Surgical dressers were yet another class of medical personnel that probably had duties similar to those of medical cadets. Surgical dressers were civilians whose services were provided by contract at $50 a month.14 Those contracts were annulled in July 1863 because it was “not intended to further continue or recognize such an office.”15 DUTIES The activities of medical cadets ranged from the fantastic to the mundane. After serving for a short time at Seminary General Hospital in Alexandria, Virginia,11 medical cadet Charles Rivers Ellet found himself on the Mississippi with the Union steam ram fleet, which was under the command of his father, Colonel Charles Ellet Jr, and uncle, Lieutenant Colonel Alfred W Ellet. After the Battle of Memphis in June 1862 the medical cadet accepted the surrender of that city,16 helped carry a message past enemy pickets to Commodore David Farragut,17 and commanded a portion of the ram fleet.18 Young Ellet’s career as a medical cadet, such as it was, officially ended when he was commissioned as colonel of infantry in the US Mississippi Marine Brigade; at 19, he was one of the youngest men to hold so high a rank.19 Unlike Ellet, the vast majority of medical cadets served most of their terms in Army general hospitals.11 Of such assignments, about half were in the District of Columbia, Pennsylvania, Virginia, or Maryland, and another quarter were in New York, Tennessee, Kentucky, or Missouri. Some hospitals served by medical cadets were as far from the fighting as Connecticut, Rhode
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Island, and Wisconsin. Medical cadets were commonly paired with a medical officer in caring for specific wards of patients, and routine activities included dressing wounds, assisting in postmortem examinations, and helping with administrative duties, such as the issuing of clothing.20,21 Medical cadet Edward Mitchell,22 younger brother of neurologist Silas Weir Mitchell, reported dressing about 50 badly wounded men daily at Douglas Hospital in Washington, DC. When surgeons’ workloads became overwhelming because of staff shortages or an influx of patients, medical cadets took personal charge of wards. Edwin Hutchinson23 and a fellow medical cadet were made responsible for several buildings at US General Hospital in Annapolis until more surgeons could be assigned; Hutchinson himself saw about 170 patients daily during that period. Medical cadet Charles Leale24 was in charge of two wards, which contained patients with gangrene and chronic diarrhea, at the general hospital in Elmira, New York. A month after his term as medical cadet ended, Leale, as an Army surgeon, was the first physician to examine President Lincoln after the shooting in Ford’s Theater.25 Medical cadets assisted surgeons in operations24 and at times probably performed surgical procedures and made treatment decisions themselves. Medical cadet Elliott Coues26-29 (Fig. 1) published several accounts of medical and surgical treatment that were detailed enough to suggest that he had a major if not the primary role in caring for the patients described. Coues’s keen observational skills served him well in his later career as a naturalist. He was, in fact, considered a prodigy in ornithology when he joined the medical cadet corps at 19 years of age.30 Regardless of how often medical cadets actually wielded a saw or scalpel, many looked forward to surgical cases. Edward Mitchell31 complained to family friend William Keen that his hospital was full of patients with boring “never-to-be-got-rid-of chronic diseases” and hoped for “a good time coming.” Mitchell32 eagerly anticipated treating casualties from the cavalry battle at Brandy Station, Virginia, in June 1863. “If we get the Rebel wounded,” he wrote, “so much the better, for a great many of them were stuck by Rush’s Lancers [the Sixth Pennsylvania Cavalry] in the first charge they made, and lance wounds are rather a great luxury in military surgery.” Medical cadets also looked forward to examining an-
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Table 1. Regular (Enlisted) Medical Cadets10,11 Davies, Ira L Adams, J F A Davis, Myron J Agnew, Henry Davis, Rezin P Allen, George Otis Day, Walter D F Allen, John W Dean, Henry A Anderson, Wendell A Dearborn, Brainard Andress, Theophilus H Delafield, Rufus Andrews, William J Devendorf, Charles A Applegate, Lewis Dodge, Augustus W Atkins, Francis H Doherty, Hugh Atkinson, E L Atlee, Washington Lemuel, Jr Dougall, Charles Hammond Downes, William H Austin, William Morris Drake, James S Ayres, Lewis Carlton Draper, Edgar Le Roy Barnes, Edwin Draper, Joseph R Barney, Reuben Dudley, Dwight Bates, Edward F Dudley, Frederick A Bauer, Herman Dulin, Edgar A Beach, William F Dyer, Augustus E Beers, John E Eicherbelger, William C Beltz, Daniel E Ellet, Charles Rivers Bennett, George S Ellison, Owen Birdsall, Samuel Esselborn, Albert P Bitting, Louis C Farrelly, Ellis M Blanchard, James A Fisher, Charles H Bodman, Lewis H Fitch, Frederick J Bosley, George H Fitch, Samuel A Bowen, Charles H Folsom, Norton Bradford, F G H Forwood, John F M Bradley, William Horace Francis, Thomas Bradley, W L Franklin, Thomas H Browne, William A Frazer, Duncan R Buckly, William B Frothingham, Edward Buffington, Alexander L Fuller, William Burnham, William G Gail, William H Burrington, S O Gardner, William H Bush, Theodore Gilbert, Daniel D Campbell, Alexander W Gill, George F Campbell, Merritt B Gillespie, John E Carleton, Charles G Graham, John Casey, Francis P Gray, Harry Castle, Frederick Augustus Gray, Samuel Getz Chamberlain, Myron L Gregory, James R Chaney, Thomas M Grier, Matthew James Close, Eldridge W Griffith, Alfred Coe, William Henry Groot, Cornelius A Comings, Lewis B Grover, William B Congdon, Edgar H Gunn, George H Connell, John J Haefner, Gustavus A Coues, Elliott Hannen, Henry S Coxe, Thomas C Hardy, Robert M Crafts, John M Harris, David Crump, A W Harrison, Francis H Culbreth, George S Harrison, William David Curtis, Edward Hathaway, Robert Curtis, Romaine J
Haynes, Charles F Hayward, Joseph W Henry, Robert J Holman, Samuel Holmes, William J R Hopkins, George N Howard, George C Hoy, Albert H Hubbard, Edward D Hunt, Charles M Hunt, Sylvester H Hutchins, Edward Ridgeway Hutchinson, Edwin Hysore, William F Jorgenson, Joseph Keith, T Scott Kerr, George Kimball, B M Kingston, Samuel T Knorr, George F Lampson, Mortimer Landers, Thomas Larrabee, John Albert Lashells, Theodore B Lautenbach, Robert Leale, Charles Augustus Le Moyne, Francis Lester, Elias Lewis, George F Light, Abiah Hutchinson Livermore, Frank Lloyd, David Corey Longshaw, William, Jr Longwill, Robert H Lovell, Charles A Lyford, Elisha H Lyman John N Macfarlan, Malcolm Magruder, John W Mansfield, R W McCollam, Samuel McElderry, Henry Menzie, George L Merrill, George V R Mershon, Stacy B Miles, William H Miller, Trueman W Miller, William Henry Milton, Charles A Minassian, Simon G Minor, John C Mitchell, Edward Donnaldson Mitchell, Ezra, Jr Montgomery, John J
atomical specimens. “Yesterday,” reported Mitchell,33 “I was engaged all the morning after I had finished my ward in operating, ligating arteries etc. on the subject left
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Moore, John Morris, Henry A Morrison, Henry C Motter, George T Moxley, M King Munger, Merritt J Neilson, John L Nelden, Charles R Newell, Arthur C Nichols, J DeForrest O’Brien, Charles E O’Reilly, Robert Maitland Orth, Henry Luther Paine, Amasa E Paine, Horatio Painter, J Ellwood Palmer, Elmore Parker, Joseph Benson Parks, Hilton F Parsons, John Pelton, Arthur M Phillips, James A Piek, Augustus Theodore Pilsbury, John Milton Pindell, Joseph T Pitcher, Steward C Pooley, Thomas R Porter, Edward E Post, J A Pratt, E B Prentiss, J L Randall, Charles Lovett Raub, Abraham A Reed, Albert S Reed, John W Rice, George L Rice, John McD Ridgeway, Thomas E Rippard, William H Ritter, Frederick William, Jr Robbins, Henry Alfred Robert, Charles S Roberts, Jacob Robinson, Joseph M Rockefeller, Irwin M Rorbach, Frederick Ruger, Henry H Russ, Eben J Ruth, Melancthon Lore Sanborn, Charles E Santee, Ephraim A Sargent, Eli D Saylor, George Wallace Schneider, Louis Searl, Oscar F
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Seguin, Edward C Semig, Bernard Senseney, B Rush Seward, John Leddell Sheppard, Henry Shields, George W Shoemaker, Edwin B S Shurtleff, Carleton A Skillman, A B Slaughter, B Frank Sommers, John Spayd, Charles William Henry Stephenson, Robert A Stevens, Lloyd Stille, Henry M Stone, Richard French Storror, Edward Sullivan, John Sweetland, John B Taylor, William O Terabery, George W Thorp, Abner Tonner, John Alexis Trimble, Ethelbert J A Tripp, John D Trueworthy, E W Turner, Obed C Vanderburgh, David Williams S Van Derveer, Albert Van Duyn, John Van Gieson, Henry C Veeder, Andrew T Voris, James Henderson Ward, Charles S Ware, Edward H Watts, Henry R Weaver, Charles H Weil, Samuel H Weisel, Edmund T Weisel, George W Weld, Francis M Welsh, Joseph Wesseler, Frederick W White, Columbus J White, John S Wiggin, Augustus W Wilder, Burt G Williams, Richard J Wilson, Charles P Winants, Josiah O Winslow, John Worcester, Samuel Worthington, George C Young, John D
by the [medical] examining board. Dr Moss is very kind, leaving the instruments and subject at my disposal. I take the advantage offered and have already learned con-
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and worked until late at night dressing wounded until all were attended to. His conduct deserves great commendation.” During a portion of that campaign, one group of Army hospitals and camps had 66 surgeons, 12 medical cadets, 12 hospital stewards, and 537 nurses on duty.36 At least 14 medical cadets served on hospital transport ships.11
Figure 1. Medical cadet Elliott Coues (1842–1899). From collection of F Terry Hambrecht, MD; used with permission.
siderable.” If a letter by a British observer is to be believed,34 some medical cadets took this interest to extremes. “The Yankees,” wrote the observer about a field hospital after the Battle of Antietam, “have creatures they call Medical Cadets and these fiends, the moment a limb was off would pounce on it from behind trees, and fight for it, and in a few minutes it would be cut into little bits for practise . . . . I saw one of these Cadets seize a leg almost before it was off and holding it by the toe run away with it, still quivering and bleeding, and dragging and bumping it along the ground, while the other devils chased him.” Some medical cadets did serve in field hospitals, and others may have been ambulance attendants. Information about medical cadets’ duties outside of general hospitals is sketchy, but the exploits of one during the Union’s Peninsular Campaign in 1862 were praised by artillery officer James Thompson.35 “Medical Cadet Frank Le Moyne,” reported Thompson, “was on the field of battle or near the battery during the entire day,
LIFE AS A MEDICAL CADET In some ways a medical cadet was something between an officer and an enlisted man, and that uncertainty was reflected in his regulation uniform. His frock coat was that of a junior officer and, as for officers, shoulder straps were specified; those of a medical cadet consisted of a rectangle of green cloth upon which was centered a halfinch-wide strip of gold lace.37 The trousers of a medical cadet bore a narrow buff welt comparable to the colored welt worn by regimental officers. The medical cadet’s belt plate and sword were those of a noncommissioned officer, and although a dress hat with trimmings was regulation for all other soldiers, the only headwear indicated for medical cadets was the plain forage cap. Regulations mentioned no sash for medical cadets but specified one for all commissioned officers and for some noncommissioned officers that medical cadets outranked. However ambiguous the uniform, medical cadets were officially noncommissioned officers. Any notions that Edwin Hutchinson38 entertained about having the perquisites of a commissioned officer were dispelled after he reported for duty in Annapolis as a new medical cadet. “We are by no means allowed [payment for] a servant,” he wrote. “[We are] not entitled to a ration. This cuts us out of $108 a year apiece. By the kindness of Dr Randall, we have most of the things which are cooked for the soldiers sent up to us [gratis], but this is not like having $9 a month cash [in commutation for food]. If we were allowed a ration, it would almost pay our living expenses.” Hutchinson39 knew of medical cadets at other hospitals who also received free meals. Their uncomfortable position prompted a group of medical cadets to petition Congress on April 16, 1862, to upgrade their rank and pay to that of a brevet second lieutenant of infantry40 ($105.50 a month total, including pay and allowances for food and a servant41). Medical cadets, said the petition, were “obliged, by every circumstance of position and character, to associate with commissioned officers [Army surgeons],” and this in-
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creased their expenses to the point that no cadet paid just $30 a month could make ends meet “without pecuniary assistance from his friends.”40 New assistant surgeons typically received $121.83 a month total (including pay and allowances for food, forage, and a servant)41 and could afford to eat relatively well. Medical cadets dining with officers were expected to pay their share of the mess bill; Mitchell22,42 paid $4.50 to $40 a month. Furthermore, continued the petition, a medical cadet was “compelled by every prestige of military discipline, from want of rank to seek his associates among noncommissioned officers, thus rendering his position a most anomalous and embarrassing one.”40 The unfairness of the lack of a food ration was recognized early, as shown by Surgeon General Finley’s recommendation in November 1861 to add a ration.8 On April 16, 1862—the same date as the medical cadets’ petition—Congress authorized one food ration daily in kind or commutation (30 cents a day) but left the medical cadets’ rank unchanged.9 At least one former medical cadet resented what he considered the exploitation of the medical cadet corps. After the war former medical cadet Frederick Castle43 (Fig. 2) envisioned preparing a history of the corps but failed repeatedly to secure a roster of medical cadets from the Surgeon General’s office. “It might be surmised,” he fumed, “that the government, after having unjustly availed itself of a grade of service at hardly a fourth of the nominal cost [of an assistant surgeon], had purposed to withhold even the credit [to the medical cadets] for [their] having done more than obligation demanded, by neither publishing a roster of the corps nor enabling others to do so.” Castle eventually got a copy of the roster but died before he could write a history. Edward Curtis, who as an Army surgeon assisted in the postmortem examination of President Lincoln,44 was a medical cadet at West Philadelphia General Hospital when he summed up the cadet experience in a parody of “Gay and Happy,” a popular song of the time:45 The Medical Cadets Hymn We’re the Med. Cads gay and happy Summoned from our homes to save By the Surgeon’s holy mission Wounded warriors from the grave. Chorus: So let the war be waged as it will We’ll be gay & happy still
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Figure 2. Medical cadet Frederick Augustus Castle (1842–1902). From FA Castle papers, National Library of Medicine.
Gay & happy, gay & happy We’ll be gay & happy still. Falls a soldier in the battle Stricken by a Rebel ball We, the Med. Cads. kneel beside him Mindful then of duty’s call. Chorus Ours the art to soothe the anguish Of each ragged gaping wound Tending every stricken warrior Thickly as they strew the ground. Chorus Loud may roar the war around us Nought care we for shot or shell Pledged we stand to save the fallen Though we face the fires of hell. Chorus
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Next there comes a life of labor At the General Hospital But there’s nought of toil or terror That can Med. Cads brave, appall. Chorus Pus may pour its foetid odor, Maggots squirm in slimy bed Phagedena stalk around us Gangrene rear its ghastly head. Chorus Measly some and febrile others Others still like pallid ghosts Stagger through o’erwhelming labors Steadfast still we man our posts. Chorus Thus though life be hard and weary Philosophic Med. Cads. we: Thick may crowd the dead and dying Still we’ll gay and happy be. Chorus
Whatever the medical cadets thought of themselves, they were valued by others. In November 1861 Surgeon General Finley stated that the medical cadets were “increasing the efficiency of the medical department by an intelligent assistance” and recommended adding 50 positions to the 50 already authorized.8 Surgeon General William Hammond reported in November 1862 that the current number of medical cadets was “altogether too small for the necessities of the service” and requested authority to “appoint as many as may be required in accordance with existing law on the subject.”46 The number of authorized positions never exceeded 70. Not every member of the medical cadet corps was a perfect young man. Three were dishonorably discharged.11 One, the only man to serve more than two terms as a medical cadet, was dismissed for drunkenness,47 and another was found guilty of taking bribes from four soldiers to procure their discharge from the service.48 At least one medical cadet deserted his post.11 Duty as a medical cadet could be hazardous. At least five died during their term of service.11 Edward Hubbard, for example, succumbed to typhoid fever while on duty at Cumberland General Hospital in Tennessee.49 Although Edward Mitchell completed his 1-year term, the diphtheria he contracted on duty led to his death at 21 years of age.50 When the war ended, the few medical cadets who were not quickly discharged were retained to help care for convalescent soldiers.11 By June 1866 none were serving, and the corps was effectively abolished in July 1866
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when the elements of the Medical Department were restated without mention of medical cadets.51 FURTHER MILITARY SERVICE Although the establishment of the medical cadet corps may initially have been a stopgap measure to provide the Army hospitals with helping hands, it quickly became apparent that the corps could be a pool of future military surgeons. Surgeon General Hammond46 stated in November 1862 that “an army medical school, in which medical cadets and others seeking admission into the [medical] corps could receive such special instruction as would better fit them for commissions, and which they cannot obtain in the ordinary medical schools, is a great desideratum.” Edwin Hutchinson52 got wind of some version of Hammond’s suggestion. “I . . . heard,” he wrote, “that the Cadets were to be invited to remain in service another year. Six months . . . they are to be on furlough, so that they may attend the last course of medical lectures and graduate. The latter six months . . . they are to do service in the Hospitals, and then appear before the Regular Army Board for the post of Ass’t Surgeon. . . . Even though all do not enter the service, yet, each one will have a splendid education.” Nothing came of Hammond’s progressive vision, at least during the war. Becoming a military surgeon was undoubtedly on the mind of many medical cadets. Of the 247 men who served up to one term as medical cadet, 94 (38%) became a commissioned or contract surgeon, and of the 26 men who served more than one term, 17 (65%) made that progression (Table 2).11,53,54 (A medical cadet did not have to complete a term before starting duty as a commissioned or contract surgeon.) Medical cadet Hutchinson55 illustrated how far training as a medical cadet could take someone in the Medical Department. After completing his term as medical cadet, Hutchinson became an assistant surgeon, surgeon, surgeon-incharge of a division hospital, and surgeon-in-charge of a corps hospital, all without having received a medical diploma. Robert O’Reilly resumed medical school courses after his service as a medical cadet and returned to the Army to eventually become Surgeon General.12 ACTING MEDICAL CADETS The ranks of regular medical cadets were supplemented by medical students who remained civilians and contracted with the Medical Department for at least 3
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Table 2. Further Military Service of Regular Medical Cadets11,53,54
Disposition
No further military service Assistant surgeon or surgeon Regimental Volunteers Regular army Colored troops Navy Total Contract surgeon Army Navy Total
Cadets serving up to one term (n ⴝ 247) n %
Cadets serving more than one term (n ⴝ 26) n %
153
62
9
35
44 10 5 16 5 80
18 4 2 6 2 32
5 4 3 1 0 13
19 15 12 4
8 6 14
3 2 6
4 0 4
50 15 15
months of service.56 These students, called acting medical cadets, typically received no pay; compensation was officially limited to quarters and one food ration a day. A position as acting medical cadet was open to students who had studied medicine for 1 year rather than the 2 required of regular medical cadets.57 How many acting medical cadets there were is unknown because they were not enlisted in the Army and were often omitted from official reports;58 it is likely that their numbers were in the hundreds. Some acting medical cadets enlisted to become regular medical cadets. The prospect of gaining surgical experience no doubt enticed many medical students into working without pay as acting medical cadets. An official of the War Department’s Record and Pension Office described acting medical cadets as “students from Medical Colleges in the Cities who were permitted [emphasis added] to assist the surgeons in Genl hospitals.”58 West Philadelphia General Hospital, for one, seems to have been flooded early in the war with students from local medical schools; at one time the hospital had 41 acting medical cadets on duty.21,59 Many were probably from the University of Pennsylvania, which contributed at least 36 acting medical cadets to the Army.12 The hospitals were not always flush with acting medical cadets. During periods of high demand the Medical Department called for more medical students to volunteer,57 and medical officers offered inducements to attract and retain acting medical cadets. In August 1862 a
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circular from the Surgeon General’s office reminded medical officers that “acting medical cadets will in no instance be mustered or paid [40 cents and one ration a day41] as contract nurses.”60 This practice, said the circular, was “fraudulent in itself, and degrading to the office of the Medical Cadets.” Surgeon John Cuyler,61,62 medical director at Fort Monroe, Virginia, found it necessary to pay at least two acting medical cadets $30 a month in addition to one food ration a day. The payment was required, said Cuyler, because it was absolutely necessary to have the acting medical cadets available to help dress the wounded. Acting medical cadets, although eagerly sought at times by the Medical Department, were considered to differ from regular medical cadets in some substantive way. When Surgeon John Campbell, Medical Director of the Department of the Susquehanna, asked Surgeon II Hayes of Satterlee (formerly West Philadelphia) General Hospital if he had any regular medical cadets to spare, Hayes63 replied that he had only two on duty and could spare neither. Perhaps Campbell specified regular medical cadets because they were more used to Army ways and could be transferred whether they liked it or not; acting medical cadets were free to terminate their contracts at any time after 3 months.56 After the war, when Frederick Castle43 appealed to other former regular medical cadets to send him their address, he reported with disgust that the only person to respond “was not a medical cadet, but only an acting med. cadet.” A genuine difference between an acting and regular medical cadet was that service as the latter, but not the former, was counted in computing longevity pay and retirement benefits for men who also served as a commissioned officer.58,64 DISCUSSION AND CONCLUSION When he first considered the position of medical cadet in August 1861, Edwin Hutchinson65 concluded, “I do not think the position a desirable one . . . rations will be taken out of [cadets’ pay] . . . the actual pay . . . amounts to almost nothing. The time of enlistment is for one year only, with the certainty of being removed after that time, and while they are in the army they will actually have to act as servants to the Ass’t Surgeons. They will not be any more likely to pass the regular Army examination after having served in this capacity, than if they were fresh applicants.” After his
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service as a medical cadet, Hutchinson would have seen that his view was inaccurate in many ways. The initial lack of a food ration was corrected 8 months after formation of the corps, and some medical cadets received free rations even before the allowance became official. Toward the end of his term as medical cadet, Hutchinson found his pay sufficient to enjoy strawberries at 2 cents a quart,66 share with a fellow medical cadet the hiring of two servants,67 and send money home at least once.68 Contrary to Hutchinson’s prediction, the duties performed by medical cadets more often resembled those of an assistant surgeon than an assistant surgeon’s servant. Although Hutchinson thought that the period of intense learning would automatically stop when the 1-year term ended, he failed to realize that reenlistment was possible. Finally, although it is difficult to say whether medical cadets were more likely than other applicants to obtain a surgeon’s commission, medical cadets as a group attained that goal quite often. Medical cadets, in fact, may have been better candidates for military surgeon than civilian applicants, who usually had little relevant surgical experience. The pairing of medical cadets with surgeons in caring for wards helped prepare the cadets for being on their own, and many practiced relatively independently when the need arose. Hutchinson23 summed up what many medical cadets must have thought about the educational aspect of their service. He wrote, “I will probably see more patients and have a chance to give more medicine [in 4 months] than I could in 2 years of practice. . . . I could not possibly have a better opportunity for acquiring knowledge of medicine than that I now enjoy.” In numbers alone, medical cadets constituted a relatively small proportion of Union medical personnel. The information available about them, though, indicates that they contributed in important ways to patient care and represented a well-prepared pool of future military surgeons. Acknowledgment: I thank F Terry Hambrecht, MD, for his assistance in identifying and securing reference material and for his review of this article’s draft.
2. 3.
4.
5. 6. 7. 8. 9. 10.
11. 12. 13. 14.
15. 16. 17. 18. 19. 20. 21. 22.
23. 24. 25.
REFERENCES 1. The War of the Rebellion: a compilation of the official records of the Union and Confederate Armies. Washington, DC: US Government Printing Office; 1870–1901. Reissued in The Civil
26.
War CD-ROM, version 1.55, Carmel, IN: Guild Press of Indiana; 1996: ser 3, vol 1:396–400 (hereafter OR). Stille´ CJ. History of the United States Sanitary Commission. Philadelphia: Lippincott; 1866:529–530. Reissue. Gansevoort, NY: Corner House Historical Publications; 1997. Edwin Hutchinson (EH) to Father, 1861 Aug 3 [letter]. Edwin Hutchinson papers, mss 751, Louisiana and Lower Mississippi Valley Collections, LSU Libraries, Baton Rouge, LA (hereafter Hutchinson papers). Charles Rivers Ellet to Uncle, 1861 Jun 30 [letter]. Family correspondence and oversized correspondence from Charles Rivers Ellet, Ellet family papers, box 4, folder 10, M698, Department of Special Collections, Stanford University Libraries, Stanford, CA. Steiner PE. Physician-generals in the Civil War. Springfield, IL: Charles C Thomas; 1966:107. Revised regulations for the Army of the United States, 1861. Philadelphia: JGL Brown; 1861:288. Reissue. Harrisburg, PA: National Historical Society; 1980 (hereafter Regulations). Wood RC. Med Surg Rep 1861;6:456. OR, ser 3, vol 1:633–636. OR, ser 3, vol 2:22–23. List of medical cadets in service during the War of the Rebellion. Entry 127 (E127; Statements of service of Civil War medical cadets, 1862–65), record group 112 (RG112; Records of the Office of the Surgeon General [Army]), National Archives, Washington, DC (NA). Summaries of service of medical cadets. E127, RG112, NA. Jordan E. University of Pennsylvania men who served in the Civil War, 1861–1865. No publisher, no date. Maxwell WJ. General alumni catalog of Jefferson Medical College. Philadelphia: Jefferson Medical College Alumni Association; 1917. Chas W Swan to Surgeon General Hammond, 1862 Sep 16 [letter]. Entry 581 (E581; Papers relating to Medical Cadets), record group 94 (RG94; Records of the Adjutant General’s Office, 1780s–1917), NA. ES Dunster to E Swift, 1863 Jul 10 [letter]. E581, RG94, NA. OR, ser 1, vol 10, pt 1:909–910. OR, ser 1, vol 15:498. OR, ser 1, vol 17, pt 1:139. Lewis GD. Charles Ellet, Jr.: the engineer as individualist. Urbana, IL: University of Illinois Press; 1968:212. William M Austin to Assistant Surgeon General, 1864 Jul 31 [letter]. E581, RG94, NA. West N. History of the Satterlee U.S.A. Gen. Hospital, at West Philadelphia, Pa., from October 8, 1862, to October 8, 1863. West Philadelphia: Hospital Press; 1863:8–9. Edward D Mitchell (EDM) to Mother, 1863 May 23 [letter]. S Weir Mitchell Papers, mss 2/0241-03, ser 3.9, folder 3. Historical Services Division, Library of the College of Physicians of Philadelphia, Philadelphia, PA (hereafter Mitchell papers). EH to Mother, 1862 May 24 [letter]. Hutchinson papers. Leale CA. Medical autobiography of Chas. A. Leale. Entry 561 (Personal papers of medical officers and physicians), RG94, NA. Mulliken JB. Charles Augustus Leale: Lincoln’s young physician. Surgery 1972;71:760–770. Coues E. Report of some cases of amputations and resections, from gunshot wounds, performed at the Mount Pleasant U.S. General Hospital, by C. A. McCall, M.D., U.S.A. Med Surg Rep 1862;9:194–196, 229–232.
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27. Coues E. Notes on the “soldiers’ chronic diarrhoea.” Med Surg Rep 1863;10:207–209. 28. Coues E. Five cases of gun shot fracture of the femur. Med Surg Rep 1863;10:3–5. 29. Coues E. A fatal case of traumatic coxalgia. Med Surg Rep 1864; 11:63–64. 30. Cutright PR, Brodhead MJ. Elliott Coues: naturalist and frontier historian. Urbana, IL: University of Illinois Press; 1981:38. 31. EDM to WW Keen, 1862 May 17 [letter]. Mitchell papers, ser 3.9, folder 6. 32. EDM to WW Keen, 1863 Jun 12 [letter]. Mitchell papers, ser 3.9, folder 6. 33. EDM to S Weir Mitchell, 1863 Jul 4 [letter]. Mitchell papers, ser 3.9, folder 4. 34. Preston RA. A letter from a British military observer of the American Civil War. Mil Aff 1952;16:49–60. 35. OR, ser 1, vol 11, pt 2:170–171. 36. OR, ser 1, vol 11, pt 1:220. 37. Regulations, pp 476–495. 38. EH to Father, 1861 Oct 24 [letter]. Hutchinson papers. 39. EH to Father, 1862 Mar 26 [letter]. Hutchinson papers. 40. Petition of the Medical Cadets of the U.S. Army. In: Miscellaneous documents of the Senate of the United States for the second session of the thirty-seventh Congress, 1861–’62. Washington, DC: Government Printing Office; 1862: miscellaneous document no 90. 41. Regulations, pp 524–526. 42. EDM to Mother, 1863 Jul 17 [letter]. Mitchell papers, ser 3.9, folder 3. 43. Undated document. Frederick Augustus Castle papers, MS C 189, History of Medicine Division, National Library of Medicine, Bethesda, MD. 44. The medical and surgical history of the War of the Rebellion, 1861–1865. Washington, DC: Government Printing Office; 1870–1888. Reissued as The medical and surgical history of the Civil War. Wilmington, NC: Broadfoot Publishing; 1991: vol 8:305 (hereafter MSH). 45. Curtis E. The Medical Cadets hymn, 1863 Feb 1. Mitchell papers, ser 3.9, folder 1. 46. OR, ser 3, vol 2:749–754. 47. Adjutant General’s Office, War Department. Special orders, no 35, 1865 Jan 23. E581, RG94, NA.
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48. Head quarters, 18th Army Corps, Department of Virginia and North Carolina. General orders, no 13, 1864 Jan 27. E581, RG94, NA. 49. Record of death and interment for Edward D Hubbard, 1864 Jul 24. E581, RG94, NA. 50. Burr AR. Weir Mitchell: his life and letters. New York: Duffield & Co; 1929:34–35. 51. Brown HE. The Medical Department of the United States Army from 1775 to 1873. Washington, DC: Surgeon General’s Office; 1873:249. 52. EH to Father, 1862 Aug 15 [letter]. Hutchinson papers. 53. List of medical cadets who obtained rank of assistant surgeon and surgeon of volunteer regiments, &c. E127, RG112, NA. 54. A roster of all the regimental surgeons and assistant surgeons in the late war and hospital service. Washington, DC: GM Van Buren; 1883. Reissue. San Francisco: Norman Publishing; 1990. 55. Hutchinson papers. 56. Contract with undergraduate to perform the duties of a medical cadet, 1864 Oct 18. E581, RG94, NA. 57. Medical cadets for the Army. Am Drug Circ Chem Gaz 1863; 7(Jan):10. 58. JF Gibson, Record and Pension Office, to Mr Slater, 1898 May 13 [memorandum]. E581, RG94, NA. 59. MSH, vol 6:926. 60. Grace W. The Army surgeon’s manual, for the use of medical officers, cadets, chaplains, and hospital stewards. New York: Bailliere Brothers; 1864:107–108. Reissue. San Francisco: Norman Publishing; 1992. 61. Certification letter from John M Cuyler for John G Perry, 1862 May 18. E581, RG94, NA. 62. Certification letter from John M Cuyler for Yarabed Vartanyan, 1862 May 21. E581, RG94, NA. 63. II Hayes to John Campbell, 1864 Sep 15 [letter]. E581, RG94, NA. 64. Secretary of War JM Dickinson to S Weir Mitchell, 1910 Mar 22 [letter]. Mitchell papers, ser 1.3, folder 4. 65. EH to Father, 1861 Aug 14 [letter]. Hutchinson papers. 66. EH to Fred, 1862 Jun 13 [letter]. Hutchinson papers. 67. EH to Father, 1862 Jun 3 [letter]. Hutchinson papers. 68. EH to Mother, 1862 Jul 18 [letter]. Hutchinson papers.
The Civil War’s Medical Cadets: Medical Students Serving the Union Guy R Hasegawa, PharmD ready taught him “a great deal about practical medicine” and that his station was “one of the best possible schools for a student.” Medical student Charles Rivers Ellet4 wrote in June 1861 that he routinely followed a physician during rounds in an Army hospital in Washington, DC, to see how he questioned and prescribed for patients. After rounds Ellet proceeded to the dispensary, prepared medicines, and learned from the hospital steward all he could about the character and effects of the drugs. Both Hutchinson and Ellet later enlisted as regular medical cadets. The act of August 3, 1861, authorized a corps of medical cadets, up to 50 of whom could serve at a time, to act under the direction and control of medical officers alone as dressers in general hospitals and as ambulance attendants. Applicants were to be 18- to 23-year-old men of liberal education who had studied medicine for 2 years and completed at least one course of lectures at a medical college. (In this context, “studying” meant learning under a preceptor. Medical schools typically offered one course of lectures a year, delivered over about 5 months.5 Graduation required attendance at two courses, which could be identical.) Applicants who passed examination would be enlisted for a 1-year term in the Army with a rank equivalent to that of a West Point cadet (between sergeant major and second lieutenant) and pay of $30 a month along with quarters, fuel, and transportation.6 Initially no food ration was allowed.
Among the medical personnel serving the United States during the Civil War was an obscure group of young men called medical cadets. Composed of medical students, the US Army medical cadet corps was created to dress wounds and act as ambulance attendants. As mounting war casualties overwhelmed Army surgeons, medical cadets found themselves taking on much more responsibility for patient care. Although all but ignored in histories of Civil War medicine, the story of the medical cadets provides valuable insight about medical training and military medicine during that conflict. ORIGINS Formation of the corps of medical cadets was approved by Congress on August 3, 1861.1 When and where the idea of medical cadets arose is unknown, but the necessity for surgeons’ assistants was recognized early in the war. In May 1861 a delegation representing New York civilian relief agencies recommended to the Army Medical Department that “in case of need the Medical Bureau may call to the aid of the regular medical force a set of volunteer dressers, drilled for this purpose by the hospital physicians and surgeons of New York, giving them such subsistence and such recognition as the rules of the service may allow under a generous construction.”2* Whatever the effect of that recommendation, medical students began volunteering their services even before the medical cadet corps was established. For example, Edwin Hutchinson,3 a medical student from Utica, New York, accompanied his friends in the 14th New York Infantry as an unpaid medical assistant. He wrote on August 3, 1861, from the regiment’s camp at Arlington Heights, Virginia, that his first-hand experience had al-
ENLISTMENT Applicants for a position as medical cadet provided their date and place of birth, place of residence, period of medical studies, certification of attendance at one full course in a medical college, and testimonials of character and physical fitness.7 “Of a great number of applicants” for the first 50 positions, reported Surgeon General Clement Finley8 in November 1861, 66 were found qualified and invited to appear before an examining board. Of those, 48 were approved and enlisted, 7 failed to appear for examination, 7 were rejected, and 1 de-
No competing interests declared.
Received February 21, 2001; Accepted March 2, 2001. From the Publications and Drug Information Systems Office, American Society of Health-System Pharmacists, Bethesda, MD. Correspondence address: Guy R Hasegawa, PharmD, American Society of Health-System Pharmacists, 7272 Wisconsin Ave, Bethesda, MD 20814. * Quotations are reproduced with original capitalization, punctuation, and emphasis. Only misspellings have been corrected.
© 2001 by the American College of Surgeons Published by Elsevier Science Inc.
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clined enlistment; 3 others were awaiting examination for remaining vacancies. On April 16, 1862, Congress approved 20 additional medical cadet positions.9 Reenlistment was allowed, and records of the Surgeon General’s office show that 273 men enlisted for 300 1-year terms during the corps’ 5-year existence (Table 1).10,11 Enlistment and discharge dates show that the number of medical cadets on duty at any particular time from September 1861 to April 1865 was close to the 50 or 70 allowed. Philadelphia’s medical schools proved to be a particularly rich source of medical cadets; at least 23 medical students from the University of Pennsylvania12 and 18 from Jefferson Medical College,13 for example, enlisted in the corps. Supplementing the regular (enlisted) medical cadets was a separate class of civilian medical cadets. These “acting medical cadets,” who worked under contract, are described later in this article. Surgical dressers were yet another class of medical personnel that probably had duties similar to those of medical cadets. Surgical dressers were civilians whose services were provided by contract at $50 a month.14 Those contracts were annulled in July 1863 because it was “not intended to further continue or recognize such an office.”15 DUTIES The activities of medical cadets ranged from the fantastic to the mundane. After serving for a short time at Seminary General Hospital in Alexandria, Virginia,11 medical cadet Charles Rivers Ellet found himself on the Mississippi with the Union steam ram fleet, which was under the command of his father, Colonel Charles Ellet Jr, and uncle, Lieutenant Colonel Alfred W Ellet. After the Battle of Memphis in June 1862 the medical cadet accepted the surrender of that city,16 helped carry a message past enemy pickets to Commodore David Farragut,17 and commanded a portion of the ram fleet.18 Young Ellet’s career as a medical cadet, such as it was, officially ended when he was commissioned as colonel of infantry in the US Mississippi Marine Brigade; at 19, he was one of the youngest men to hold so high a rank.19 Unlike Ellet, the vast majority of medical cadets served most of their terms in Army general hospitals.11 Of such assignments, about half were in the District of Columbia, Pennsylvania, Virginia, or Maryland, and another quarter were in New York, Tennessee, Kentucky, or Missouri. Some hospitals served by medical cadets were as far from the fighting as Connecticut, Rhode
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Island, and Wisconsin. Medical cadets were commonly paired with a medical officer in caring for specific wards of patients, and routine activities included dressing wounds, assisting in postmortem examinations, and helping with administrative duties, such as the issuing of clothing.20,21 Medical cadet Edward Mitchell,22 younger brother of neurologist Silas Weir Mitchell, reported dressing about 50 badly wounded men daily at Douglas Hospital in Washington, DC. When surgeons’ workloads became overwhelming because of staff shortages or an influx of patients, medical cadets took personal charge of wards. Edwin Hutchinson23 and a fellow medical cadet were made responsible for several buildings at US General Hospital in Annapolis until more surgeons could be assigned; Hutchinson himself saw about 170 patients daily during that period. Medical cadet Charles Leale24 was in charge of two wards, which contained patients with gangrene and chronic diarrhea, at the general hospital in Elmira, New York. A month after his term as medical cadet ended, Leale, as an Army surgeon, was the first physician to examine President Lincoln after the shooting in Ford’s Theater.25 Medical cadets assisted surgeons in operations24 and at times probably performed surgical procedures and made treatment decisions themselves. Medical cadet Elliott Coues26-29 (Fig. 1) published several accounts of medical and surgical treatment that were detailed enough to suggest that he had a major if not the primary role in caring for the patients described. Coues’s keen observational skills served him well in his later career as a naturalist. He was, in fact, considered a prodigy in ornithology when he joined the medical cadet corps at 19 years of age.30 Regardless of how often medical cadets actually wielded a saw or scalpel, many looked forward to surgical cases. Edward Mitchell31 complained to family friend William Keen that his hospital was full of patients with boring “never-to-be-got-rid-of chronic diseases” and hoped for “a good time coming.” Mitchell32 eagerly anticipated treating casualties from the cavalry battle at Brandy Station, Virginia, in June 1863. “If we get the Rebel wounded,” he wrote, “so much the better, for a great many of them were stuck by Rush’s Lancers [the Sixth Pennsylvania Cavalry] in the first charge they made, and lance wounds are rather a great luxury in military surgery.” Medical cadets also looked forward to examining an-
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Table 1. Regular (Enlisted) Medical Cadets10,11 Davies, Ira L Adams, J F A Davis, Myron J Agnew, Henry Davis, Rezin P Allen, George Otis Day, Walter D F Allen, John W Dean, Henry A Anderson, Wendell A Dearborn, Brainard Andress, Theophilus H Delafield, Rufus Andrews, William J Devendorf, Charles A Applegate, Lewis Dodge, Augustus W Atkins, Francis H Doherty, Hugh Atkinson, E L Atlee, Washington Lemuel, Jr Dougall, Charles Hammond Downes, William H Austin, William Morris Drake, James S Ayres, Lewis Carlton Draper, Edgar Le Roy Barnes, Edwin Draper, Joseph R Barney, Reuben Dudley, Dwight Bates, Edward F Dudley, Frederick A Bauer, Herman Dulin, Edgar A Beach, William F Dyer, Augustus E Beers, John E Eicherbelger, William C Beltz, Daniel E Ellet, Charles Rivers Bennett, George S Ellison, Owen Birdsall, Samuel Esselborn, Albert P Bitting, Louis C Farrelly, Ellis M Blanchard, James A Fisher, Charles H Bodman, Lewis H Fitch, Frederick J Bosley, George H Fitch, Samuel A Bowen, Charles H Folsom, Norton Bradford, F G H Forwood, John F M Bradley, William Horace Francis, Thomas Bradley, W L Franklin, Thomas H Browne, William A Frazer, Duncan R Buckly, William B Frothingham, Edward Buffington, Alexander L Fuller, William Burnham, William G Gail, William H Burrington, S O Gardner, William H Bush, Theodore Gilbert, Daniel D Campbell, Alexander W Gill, George F Campbell, Merritt B Gillespie, John E Carleton, Charles G Graham, John Casey, Francis P Gray, Harry Castle, Frederick Augustus Gray, Samuel Getz Chamberlain, Myron L Gregory, James R Chaney, Thomas M Grier, Matthew James Close, Eldridge W Griffith, Alfred Coe, William Henry Groot, Cornelius A Comings, Lewis B Grover, William B Congdon, Edgar H Gunn, George H Connell, John J Haefner, Gustavus A Coues, Elliott Hannen, Henry S Coxe, Thomas C Hardy, Robert M Crafts, John M Harris, David Crump, A W Harrison, Francis H Culbreth, George S Harrison, William David Curtis, Edward Hathaway, Robert Curtis, Romaine J
Haynes, Charles F Hayward, Joseph W Henry, Robert J Holman, Samuel Holmes, William J R Hopkins, George N Howard, George C Hoy, Albert H Hubbard, Edward D Hunt, Charles M Hunt, Sylvester H Hutchins, Edward Ridgeway Hutchinson, Edwin Hysore, William F Jorgenson, Joseph Keith, T Scott Kerr, George Kimball, B M Kingston, Samuel T Knorr, George F Lampson, Mortimer Landers, Thomas Larrabee, John Albert Lashells, Theodore B Lautenbach, Robert Leale, Charles Augustus Le Moyne, Francis Lester, Elias Lewis, George F Light, Abiah Hutchinson Livermore, Frank Lloyd, David Corey Longshaw, William, Jr Longwill, Robert H Lovell, Charles A Lyford, Elisha H Lyman John N Macfarlan, Malcolm Magruder, John W Mansfield, R W McCollam, Samuel McElderry, Henry Menzie, George L Merrill, George V R Mershon, Stacy B Miles, William H Miller, Trueman W Miller, William Henry Milton, Charles A Minassian, Simon G Minor, John C Mitchell, Edward Donnaldson Mitchell, Ezra, Jr Montgomery, John J
atomical specimens. “Yesterday,” reported Mitchell,33 “I was engaged all the morning after I had finished my ward in operating, ligating arteries etc. on the subject left
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Moore, John Morris, Henry A Morrison, Henry C Motter, George T Moxley, M King Munger, Merritt J Neilson, John L Nelden, Charles R Newell, Arthur C Nichols, J DeForrest O’Brien, Charles E O’Reilly, Robert Maitland Orth, Henry Luther Paine, Amasa E Paine, Horatio Painter, J Ellwood Palmer, Elmore Parker, Joseph Benson Parks, Hilton F Parsons, John Pelton, Arthur M Phillips, James A Piek, Augustus Theodore Pilsbury, John Milton Pindell, Joseph T Pitcher, Steward C Pooley, Thomas R Porter, Edward E Post, J A Pratt, E B Prentiss, J L Randall, Charles Lovett Raub, Abraham A Reed, Albert S Reed, John W Rice, George L Rice, John McD Ridgeway, Thomas E Rippard, William H Ritter, Frederick William, Jr Robbins, Henry Alfred Robert, Charles S Roberts, Jacob Robinson, Joseph M Rockefeller, Irwin M Rorbach, Frederick Ruger, Henry H Russ, Eben J Ruth, Melancthon Lore Sanborn, Charles E Santee, Ephraim A Sargent, Eli D Saylor, George Wallace Schneider, Louis Searl, Oscar F
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Seguin, Edward C Semig, Bernard Senseney, B Rush Seward, John Leddell Sheppard, Henry Shields, George W Shoemaker, Edwin B S Shurtleff, Carleton A Skillman, A B Slaughter, B Frank Sommers, John Spayd, Charles William Henry Stephenson, Robert A Stevens, Lloyd Stille, Henry M Stone, Richard French Storror, Edward Sullivan, John Sweetland, John B Taylor, William O Terabery, George W Thorp, Abner Tonner, John Alexis Trimble, Ethelbert J A Tripp, John D Trueworthy, E W Turner, Obed C Vanderburgh, David Williams S Van Derveer, Albert Van Duyn, John Van Gieson, Henry C Veeder, Andrew T Voris, James Henderson Ward, Charles S Ware, Edward H Watts, Henry R Weaver, Charles H Weil, Samuel H Weisel, Edmund T Weisel, George W Weld, Francis M Welsh, Joseph Wesseler, Frederick W White, Columbus J White, John S Wiggin, Augustus W Wilder, Burt G Williams, Richard J Wilson, Charles P Winants, Josiah O Winslow, John Worcester, Samuel Worthington, George C Young, John D
by the [medical] examining board. Dr Moss is very kind, leaving the instruments and subject at my disposal. I take the advantage offered and have already learned con-
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and worked until late at night dressing wounded until all were attended to. His conduct deserves great commendation.” During a portion of that campaign, one group of Army hospitals and camps had 66 surgeons, 12 medical cadets, 12 hospital stewards, and 537 nurses on duty.36 At least 14 medical cadets served on hospital transport ships.11
Figure 1. Medical cadet Elliott Coues (1842–1899). From collection of F Terry Hambrecht, MD; used with permission.
siderable.” If a letter by a British observer is to be believed,34 some medical cadets took this interest to extremes. “The Yankees,” wrote the observer about a field hospital after the Battle of Antietam, “have creatures they call Medical Cadets and these fiends, the moment a limb was off would pounce on it from behind trees, and fight for it, and in a few minutes it would be cut into little bits for practise . . . . I saw one of these Cadets seize a leg almost before it was off and holding it by the toe run away with it, still quivering and bleeding, and dragging and bumping it along the ground, while the other devils chased him.” Some medical cadets did serve in field hospitals, and others may have been ambulance attendants. Information about medical cadets’ duties outside of general hospitals is sketchy, but the exploits of one during the Union’s Peninsular Campaign in 1862 were praised by artillery officer James Thompson.35 “Medical Cadet Frank Le Moyne,” reported Thompson, “was on the field of battle or near the battery during the entire day,
LIFE AS A MEDICAL CADET In some ways a medical cadet was something between an officer and an enlisted man, and that uncertainty was reflected in his regulation uniform. His frock coat was that of a junior officer and, as for officers, shoulder straps were specified; those of a medical cadet consisted of a rectangle of green cloth upon which was centered a halfinch-wide strip of gold lace.37 The trousers of a medical cadet bore a narrow buff welt comparable to the colored welt worn by regimental officers. The medical cadet’s belt plate and sword were those of a noncommissioned officer, and although a dress hat with trimmings was regulation for all other soldiers, the only headwear indicated for medical cadets was the plain forage cap. Regulations mentioned no sash for medical cadets but specified one for all commissioned officers and for some noncommissioned officers that medical cadets outranked. However ambiguous the uniform, medical cadets were officially noncommissioned officers. Any notions that Edwin Hutchinson38 entertained about having the perquisites of a commissioned officer were dispelled after he reported for duty in Annapolis as a new medical cadet. “We are by no means allowed [payment for] a servant,” he wrote. “[We are] not entitled to a ration. This cuts us out of $108 a year apiece. By the kindness of Dr Randall, we have most of the things which are cooked for the soldiers sent up to us [gratis], but this is not like having $9 a month cash [in commutation for food]. If we were allowed a ration, it would almost pay our living expenses.” Hutchinson39 knew of medical cadets at other hospitals who also received free meals. Their uncomfortable position prompted a group of medical cadets to petition Congress on April 16, 1862, to upgrade their rank and pay to that of a brevet second lieutenant of infantry40 ($105.50 a month total, including pay and allowances for food and a servant41). Medical cadets, said the petition, were “obliged, by every circumstance of position and character, to associate with commissioned officers [Army surgeons],” and this in-
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creased their expenses to the point that no cadet paid just $30 a month could make ends meet “without pecuniary assistance from his friends.”40 New assistant surgeons typically received $121.83 a month total (including pay and allowances for food, forage, and a servant)41 and could afford to eat relatively well. Medical cadets dining with officers were expected to pay their share of the mess bill; Mitchell22,42 paid $4.50 to $40 a month. Furthermore, continued the petition, a medical cadet was “compelled by every prestige of military discipline, from want of rank to seek his associates among noncommissioned officers, thus rendering his position a most anomalous and embarrassing one.”40 The unfairness of the lack of a food ration was recognized early, as shown by Surgeon General Finley’s recommendation in November 1861 to add a ration.8 On April 16, 1862—the same date as the medical cadets’ petition—Congress authorized one food ration daily in kind or commutation (30 cents a day) but left the medical cadets’ rank unchanged.9 At least one former medical cadet resented what he considered the exploitation of the medical cadet corps. After the war former medical cadet Frederick Castle43 (Fig. 2) envisioned preparing a history of the corps but failed repeatedly to secure a roster of medical cadets from the Surgeon General’s office. “It might be surmised,” he fumed, “that the government, after having unjustly availed itself of a grade of service at hardly a fourth of the nominal cost [of an assistant surgeon], had purposed to withhold even the credit [to the medical cadets] for [their] having done more than obligation demanded, by neither publishing a roster of the corps nor enabling others to do so.” Castle eventually got a copy of the roster but died before he could write a history. Edward Curtis, who as an Army surgeon assisted in the postmortem examination of President Lincoln,44 was a medical cadet at West Philadelphia General Hospital when he summed up the cadet experience in a parody of “Gay and Happy,” a popular song of the time:45 The Medical Cadets Hymn We’re the Med. Cads gay and happy Summoned from our homes to save By the Surgeon’s holy mission Wounded warriors from the grave. Chorus: So let the war be waged as it will We’ll be gay & happy still
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Figure 2. Medical cadet Frederick Augustus Castle (1842–1902). From FA Castle papers, National Library of Medicine.
Gay & happy, gay & happy We’ll be gay & happy still. Falls a soldier in the battle Stricken by a Rebel ball We, the Med. Cads. kneel beside him Mindful then of duty’s call. Chorus Ours the art to soothe the anguish Of each ragged gaping wound Tending every stricken warrior Thickly as they strew the ground. Chorus Loud may roar the war around us Nought care we for shot or shell Pledged we stand to save the fallen Though we face the fires of hell. Chorus
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Next there comes a life of labor At the General Hospital But there’s nought of toil or terror That can Med. Cads brave, appall. Chorus Pus may pour its foetid odor, Maggots squirm in slimy bed Phagedena stalk around us Gangrene rear its ghastly head. Chorus Measly some and febrile others Others still like pallid ghosts Stagger through o’erwhelming labors Steadfast still we man our posts. Chorus Thus though life be hard and weary Philosophic Med. Cads. we: Thick may crowd the dead and dying Still we’ll gay and happy be. Chorus
Whatever the medical cadets thought of themselves, they were valued by others. In November 1861 Surgeon General Finley stated that the medical cadets were “increasing the efficiency of the medical department by an intelligent assistance” and recommended adding 50 positions to the 50 already authorized.8 Surgeon General William Hammond reported in November 1862 that the current number of medical cadets was “altogether too small for the necessities of the service” and requested authority to “appoint as many as may be required in accordance with existing law on the subject.”46 The number of authorized positions never exceeded 70. Not every member of the medical cadet corps was a perfect young man. Three were dishonorably discharged.11 One, the only man to serve more than two terms as a medical cadet, was dismissed for drunkenness,47 and another was found guilty of taking bribes from four soldiers to procure their discharge from the service.48 At least one medical cadet deserted his post.11 Duty as a medical cadet could be hazardous. At least five died during their term of service.11 Edward Hubbard, for example, succumbed to typhoid fever while on duty at Cumberland General Hospital in Tennessee.49 Although Edward Mitchell completed his 1-year term, the diphtheria he contracted on duty led to his death at 21 years of age.50 When the war ended, the few medical cadets who were not quickly discharged were retained to help care for convalescent soldiers.11 By June 1866 none were serving, and the corps was effectively abolished in July 1866
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when the elements of the Medical Department were restated without mention of medical cadets.51 FURTHER MILITARY SERVICE Although the establishment of the medical cadet corps may initially have been a stopgap measure to provide the Army hospitals with helping hands, it quickly became apparent that the corps could be a pool of future military surgeons. Surgeon General Hammond46 stated in November 1862 that “an army medical school, in which medical cadets and others seeking admission into the [medical] corps could receive such special instruction as would better fit them for commissions, and which they cannot obtain in the ordinary medical schools, is a great desideratum.” Edwin Hutchinson52 got wind of some version of Hammond’s suggestion. “I . . . heard,” he wrote, “that the Cadets were to be invited to remain in service another year. Six months . . . they are to be on furlough, so that they may attend the last course of medical lectures and graduate. The latter six months . . . they are to do service in the Hospitals, and then appear before the Regular Army Board for the post of Ass’t Surgeon. . . . Even though all do not enter the service, yet, each one will have a splendid education.” Nothing came of Hammond’s progressive vision, at least during the war. Becoming a military surgeon was undoubtedly on the mind of many medical cadets. Of the 247 men who served up to one term as medical cadet, 94 (38%) became a commissioned or contract surgeon, and of the 26 men who served more than one term, 17 (65%) made that progression (Table 2).11,53,54 (A medical cadet did not have to complete a term before starting duty as a commissioned or contract surgeon.) Medical cadet Hutchinson55 illustrated how far training as a medical cadet could take someone in the Medical Department. After completing his term as medical cadet, Hutchinson became an assistant surgeon, surgeon, surgeon-incharge of a division hospital, and surgeon-in-charge of a corps hospital, all without having received a medical diploma. Robert O’Reilly resumed medical school courses after his service as a medical cadet and returned to the Army to eventually become Surgeon General.12 ACTING MEDICAL CADETS The ranks of regular medical cadets were supplemented by medical students who remained civilians and contracted with the Medical Department for at least 3
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Table 2. Further Military Service of Regular Medical Cadets11,53,54
Disposition
No further military service Assistant surgeon or surgeon Regimental Volunteers Regular army Colored troops Navy Total Contract surgeon Army Navy Total
Cadets serving up to one term (n ⴝ 247) n %
Cadets serving more than one term (n ⴝ 26) n %
153
62
9
35
44 10 5 16 5 80
18 4 2 6 2 32
5 4 3 1 0 13
19 15 12 4
8 6 14
3 2 6
4 0 4
50 15 15
months of service.56 These students, called acting medical cadets, typically received no pay; compensation was officially limited to quarters and one food ration a day. A position as acting medical cadet was open to students who had studied medicine for 1 year rather than the 2 required of regular medical cadets.57 How many acting medical cadets there were is unknown because they were not enlisted in the Army and were often omitted from official reports;58 it is likely that their numbers were in the hundreds. Some acting medical cadets enlisted to become regular medical cadets. The prospect of gaining surgical experience no doubt enticed many medical students into working without pay as acting medical cadets. An official of the War Department’s Record and Pension Office described acting medical cadets as “students from Medical Colleges in the Cities who were permitted [emphasis added] to assist the surgeons in Genl hospitals.”58 West Philadelphia General Hospital, for one, seems to have been flooded early in the war with students from local medical schools; at one time the hospital had 41 acting medical cadets on duty.21,59 Many were probably from the University of Pennsylvania, which contributed at least 36 acting medical cadets to the Army.12 The hospitals were not always flush with acting medical cadets. During periods of high demand the Medical Department called for more medical students to volunteer,57 and medical officers offered inducements to attract and retain acting medical cadets. In August 1862 a
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circular from the Surgeon General’s office reminded medical officers that “acting medical cadets will in no instance be mustered or paid [40 cents and one ration a day41] as contract nurses.”60 This practice, said the circular, was “fraudulent in itself, and degrading to the office of the Medical Cadets.” Surgeon John Cuyler,61,62 medical director at Fort Monroe, Virginia, found it necessary to pay at least two acting medical cadets $30 a month in addition to one food ration a day. The payment was required, said Cuyler, because it was absolutely necessary to have the acting medical cadets available to help dress the wounded. Acting medical cadets, although eagerly sought at times by the Medical Department, were considered to differ from regular medical cadets in some substantive way. When Surgeon John Campbell, Medical Director of the Department of the Susquehanna, asked Surgeon II Hayes of Satterlee (formerly West Philadelphia) General Hospital if he had any regular medical cadets to spare, Hayes63 replied that he had only two on duty and could spare neither. Perhaps Campbell specified regular medical cadets because they were more used to Army ways and could be transferred whether they liked it or not; acting medical cadets were free to terminate their contracts at any time after 3 months.56 After the war, when Frederick Castle43 appealed to other former regular medical cadets to send him their address, he reported with disgust that the only person to respond “was not a medical cadet, but only an acting med. cadet.” A genuine difference between an acting and regular medical cadet was that service as the latter, but not the former, was counted in computing longevity pay and retirement benefits for men who also served as a commissioned officer.58,64 DISCUSSION AND CONCLUSION When he first considered the position of medical cadet in August 1861, Edwin Hutchinson65 concluded, “I do not think the position a desirable one . . . rations will be taken out of [cadets’ pay] . . . the actual pay . . . amounts to almost nothing. The time of enlistment is for one year only, with the certainty of being removed after that time, and while they are in the army they will actually have to act as servants to the Ass’t Surgeons. They will not be any more likely to pass the regular Army examination after having served in this capacity, than if they were fresh applicants.” After his
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service as a medical cadet, Hutchinson would have seen that his view was inaccurate in many ways. The initial lack of a food ration was corrected 8 months after formation of the corps, and some medical cadets received free rations even before the allowance became official. Toward the end of his term as medical cadet, Hutchinson found his pay sufficient to enjoy strawberries at 2 cents a quart,66 share with a fellow medical cadet the hiring of two servants,67 and send money home at least once.68 Contrary to Hutchinson’s prediction, the duties performed by medical cadets more often resembled those of an assistant surgeon than an assistant surgeon’s servant. Although Hutchinson thought that the period of intense learning would automatically stop when the 1-year term ended, he failed to realize that reenlistment was possible. Finally, although it is difficult to say whether medical cadets were more likely than other applicants to obtain a surgeon’s commission, medical cadets as a group attained that goal quite often. Medical cadets, in fact, may have been better candidates for military surgeon than civilian applicants, who usually had little relevant surgical experience. The pairing of medical cadets with surgeons in caring for wards helped prepare the cadets for being on their own, and many practiced relatively independently when the need arose. Hutchinson23 summed up what many medical cadets must have thought about the educational aspect of their service. He wrote, “I will probably see more patients and have a chance to give more medicine [in 4 months] than I could in 2 years of practice. . . . I could not possibly have a better opportunity for acquiring knowledge of medicine than that I now enjoy.” In numbers alone, medical cadets constituted a relatively small proportion of Union medical personnel. The information available about them, though, indicates that they contributed in important ways to patient care and represented a well-prepared pool of future military surgeons. Acknowledgment: I thank F Terry Hambrecht, MD, for his assistance in identifying and securing reference material and for his review of this article’s draft.
2. 3.
4.
5. 6. 7. 8. 9. 10.
11. 12. 13. 14.
15. 16. 17. 18. 19. 20. 21. 22.
23. 24. 25.
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War CD-ROM, version 1.55, Carmel, IN: Guild Press of Indiana; 1996: ser 3, vol 1:396–400 (hereafter OR). Stille´ CJ. History of the United States Sanitary Commission. Philadelphia: Lippincott; 1866:529–530. Reissue. Gansevoort, NY: Corner House Historical Publications; 1997. Edwin Hutchinson (EH) to Father, 1861 Aug 3 [letter]. Edwin Hutchinson papers, mss 751, Louisiana and Lower Mississippi Valley Collections, LSU Libraries, Baton Rouge, LA (hereafter Hutchinson papers). Charles Rivers Ellet to Uncle, 1861 Jun 30 [letter]. Family correspondence and oversized correspondence from Charles Rivers Ellet, Ellet family papers, box 4, folder 10, M698, Department of Special Collections, Stanford University Libraries, Stanford, CA. Steiner PE. Physician-generals in the Civil War. Springfield, IL: Charles C Thomas; 1966:107. Revised regulations for the Army of the United States, 1861. Philadelphia: JGL Brown; 1861:288. Reissue. Harrisburg, PA: National Historical Society; 1980 (hereafter Regulations). Wood RC. Med Surg Rep 1861;6:456. OR, ser 3, vol 1:633–636. OR, ser 3, vol 2:22–23. List of medical cadets in service during the War of the Rebellion. Entry 127 (E127; Statements of service of Civil War medical cadets, 1862–65), record group 112 (RG112; Records of the Office of the Surgeon General [Army]), National Archives, Washington, DC (NA). Summaries of service of medical cadets. E127, RG112, NA. Jordan E. University of Pennsylvania men who served in the Civil War, 1861–1865. No publisher, no date. Maxwell WJ. General alumni catalog of Jefferson Medical College. Philadelphia: Jefferson Medical College Alumni Association; 1917. Chas W Swan to Surgeon General Hammond, 1862 Sep 16 [letter]. Entry 581 (E581; Papers relating to Medical Cadets), record group 94 (RG94; Records of the Adjutant General’s Office, 1780s–1917), NA. ES Dunster to E Swift, 1863 Jul 10 [letter]. E581, RG94, NA. OR, ser 1, vol 10, pt 1:909–910. OR, ser 1, vol 15:498. OR, ser 1, vol 17, pt 1:139. Lewis GD. Charles Ellet, Jr.: the engineer as individualist. Urbana, IL: University of Illinois Press; 1968:212. William M Austin to Assistant Surgeon General, 1864 Jul 31 [letter]. E581, RG94, NA. West N. History of the Satterlee U.S.A. Gen. Hospital, at West Philadelphia, Pa., from October 8, 1862, to October 8, 1863. West Philadelphia: Hospital Press; 1863:8–9. Edward D Mitchell (EDM) to Mother, 1863 May 23 [letter]. S Weir Mitchell Papers, mss 2/0241-03, ser 3.9, folder 3. Historical Services Division, Library of the College of Physicians of Philadelphia, Philadelphia, PA (hereafter Mitchell papers). EH to Mother, 1862 May 24 [letter]. Hutchinson papers. Leale CA. Medical autobiography of Chas. A. Leale. Entry 561 (Personal papers of medical officers and physicians), RG94, NA. Mulliken JB. Charles Augustus Leale: Lincoln’s young physician. Surgery 1972;71:760–770. Coues E. Report of some cases of amputations and resections, from gunshot wounds, performed at the Mount Pleasant U.S. General Hospital, by C. A. McCall, M.D., U.S.A. Med Surg Rep 1862;9:194–196, 229–232.
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27. Coues E. Notes on the “soldiers’ chronic diarrhoea.” Med Surg Rep 1863;10:207–209. 28. Coues E. Five cases of gun shot fracture of the femur. Med Surg Rep 1863;10:3–5. 29. Coues E. A fatal case of traumatic coxalgia. Med Surg Rep 1864; 11:63–64. 30. Cutright PR, Brodhead MJ. Elliott Coues: naturalist and frontier historian. Urbana, IL: University of Illinois Press; 1981:38. 31. EDM to WW Keen, 1862 May 17 [letter]. Mitchell papers, ser 3.9, folder 6. 32. EDM to WW Keen, 1863 Jun 12 [letter]. Mitchell papers, ser 3.9, folder 6. 33. EDM to S Weir Mitchell, 1863 Jul 4 [letter]. Mitchell papers, ser 3.9, folder 4. 34. Preston RA. A letter from a British military observer of the American Civil War. Mil Aff 1952;16:49–60. 35. OR, ser 1, vol 11, pt 2:170–171. 36. OR, ser 1, vol 11, pt 1:220. 37. Regulations, pp 476–495. 38. EH to Father, 1861 Oct 24 [letter]. Hutchinson papers. 39. EH to Father, 1862 Mar 26 [letter]. Hutchinson papers. 40. Petition of the Medical Cadets of the U.S. Army. In: Miscellaneous documents of the Senate of the United States for the second session of the thirty-seventh Congress, 1861–’62. Washington, DC: Government Printing Office; 1862: miscellaneous document no 90. 41. Regulations, pp 524–526. 42. EDM to Mother, 1863 Jul 17 [letter]. Mitchell papers, ser 3.9, folder 3. 43. Undated document. Frederick Augustus Castle papers, MS C 189, History of Medicine Division, National Library of Medicine, Bethesda, MD. 44. The medical and surgical history of the War of the Rebellion, 1861–1865. Washington, DC: Government Printing Office; 1870–1888. Reissued as The medical and surgical history of the Civil War. Wilmington, NC: Broadfoot Publishing; 1991: vol 8:305 (hereafter MSH). 45. Curtis E. The Medical Cadets hymn, 1863 Feb 1. Mitchell papers, ser 3.9, folder 1. 46. OR, ser 3, vol 2:749–754. 47. Adjutant General’s Office, War Department. Special orders, no 35, 1865 Jan 23. E581, RG94, NA.
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48. Head quarters, 18th Army Corps, Department of Virginia and North Carolina. General orders, no 13, 1864 Jan 27. E581, RG94, NA. 49. Record of death and interment for Edward D Hubbard, 1864 Jul 24. E581, RG94, NA. 50. Burr AR. Weir Mitchell: his life and letters. New York: Duffield & Co; 1929:34–35. 51. Brown HE. The Medical Department of the United States Army from 1775 to 1873. Washington, DC: Surgeon General’s Office; 1873:249. 52. EH to Father, 1862 Aug 15 [letter]. Hutchinson papers. 53. List of medical cadets who obtained rank of assistant surgeon and surgeon of volunteer regiments, &c. E127, RG112, NA. 54. A roster of all the regimental surgeons and assistant surgeons in the late war and hospital service. Washington, DC: GM Van Buren; 1883. Reissue. San Francisco: Norman Publishing; 1990. 55. Hutchinson papers. 56. Contract with undergraduate to perform the duties of a medical cadet, 1864 Oct 18. E581, RG94, NA. 57. Medical cadets for the Army. Am Drug Circ Chem Gaz 1863; 7(Jan):10. 58. JF Gibson, Record and Pension Office, to Mr Slater, 1898 May 13 [memorandum]. E581, RG94, NA. 59. MSH, vol 6:926. 60. Grace W. The Army surgeon’s manual, for the use of medical officers, cadets, chaplains, and hospital stewards. New York: Bailliere Brothers; 1864:107–108. Reissue. San Francisco: Norman Publishing; 1992. 61. Certification letter from John M Cuyler for John G Perry, 1862 May 18. E581, RG94, NA. 62. Certification letter from John M Cuyler for Yarabed Vartanyan, 1862 May 21. E581, RG94, NA. 63. II Hayes to John Campbell, 1864 Sep 15 [letter]. E581, RG94, NA. 64. Secretary of War JM Dickinson to S Weir Mitchell, 1910 Mar 22 [letter]. Mitchell papers, ser 1.3, folder 4. 65. EH to Father, 1861 Aug 14 [letter]. Hutchinson papers. 66. EH to Fred, 1862 Jun 13 [letter]. Hutchinson papers. 67. EH to Father, 1862 Jun 3 [letter]. Hutchinson papers. 68. EH to Mother, 1862 Jul 18 [letter]. Hutchinson papers.