Editing Union army (section)

===Medical Department===
{{main|Medical Corps (United States Army)}}

The Army Medical Department (AMD) was rivaled only by the Quartermaster's Department in the scope and complexity of its responsibilities: caring for sick and wounded soldiers, operating [[field hospital|field]] and [[general hospital]]s, and acquiring and distributing medicine, medical equipment, hospital food and similar supplies.  Functions such as [[Casualty evacuation|evacuating]] soldiers off the battlefield or constructing hospitals were handled were handled by other departments, though later in the war the AMD assumed many of these roles.  In March 1864 it was placed in charge of casualty evacuation ([[U.S. Ambulance Corps]]) and the organization and operation of [[Train (military)|medical supply trains]].  In December it was given control over the construction and equipping of military hospitals, and of [[hospital train]]s and [[hospital ship]]s in February 1865.  Other responsibilities assumed during the war included care for disabled veterans and their families, prisoners of war, refugees and freed slaves; maintaining medical records of the dead and wounded; and preparing a medical and surgical history of the war. The AMD started out the war staffed by a conservative and inflexible leadership which negatively impacted its functioning, but would eventually be rectified by war's end.<ref name="Newell163">Newell & Shrader, p. 163–164</ref>

{|class="wikitable" style="float: right" 
! style="text-align:l center; background:#acc;" |Position
! style="text-align:l center; background:#acc;" |1862
! style="text-align:l center; background:#acc;" |1863
! style="text-align:l center; background:#acc;" |1864
! style="text-align:l center; background:#acc;" |1865
|-
|+Regular army medical personnel<ref>Newell & Shrader, p. 166</ref>
|-
|Surgeon General ([[Brigadier General (United States)|BG]])
|1
|1
|1
|1
|-
|Assistant Surgeon General ([[Colonel (United States)|COL]])
|1
|1
|1
|1
|-
|Medical Inspector General (COL)
|1
|1
|1
|1
|-
|Medical Inspector ([[Lieutenant Colonel (United States)|LTC]])
|8
|16
|16
|16
|-
|Surgeon ([[Major (United States)|MAJ]])
|50
|50
|50
|50
|-
|Assistant Surgeon ([[Captain (United States O-3)|CPT]])
|14
|5
|3
|
|-
|Assistant Surgeon ([[First lieutenant#United States|1LT]])
|100
|109
|111
|114
|-
|Medical Storekeeper
|6
|6
|6
|6
|-
|Medical Cadet
|70
|70
|70
|70
|-
|[[Hospital Steward]]
|201
|471
|650
|931
|-
|}

In April 1861 the AMD was the largest of the staff departments in the regular army: a [[Surgeon General of the United States Army|Surgeon General]] (with the rank of colonel), thirty surgeons, eighty-three assistant surgeons, and fifty-nine [[Hospital Steward]]s.  However this number was barely adequate to meet the needs of the army in peacetime, and in May 1861 an additional ten surgeons and twenty assistant surgeons were added to cover the new regular army regiments being raised.  Later that year in August, Congress authorized the appointment of fifty medical [[cadet]]s to be chosen from young men with a liberal education and prior medical experience.  They had the rank and pay of West Point cadets and were to act as [[ambulance attendant]]s in the field and assistants in general hospitals.<ref name="Newell166">Newell & Shrader, p. 168–177</ref>

In April 1862, Congress authorized a substantial reorganization of the AMD.  Beyond promoting the surgeon general to brigadier general and adding additional staff, one of the most controversial was the introduction of medical inspectors, as a number of these were appointed by Secretary Stanton for "political" purposes.  Charged with supervising all aspects of sanitary conditions within the army, their purview included the inspection of quarters, camps, hospitals and transports; their duties were later expanded to include issuing certificates of [[Military discharge|discharge]] for reasons of disability.  Congress also gave the surgeon general the authority to hire as many hospital stewards as necessary, and a month later they authorized the addition of six trained [[apothecaries]] and [[druggists]] as medical storekeepers.<ref name="Newell166"/>

Most regular army medical officers served in staff positions, whether at the office in Washington or out in the field as regimental surgeons, [[attending physician]]s in general hospitals, medical purveyors who ran medical supply depots and laboratories, or as the medical director of a division, corps, field army or military department.  Medical directors oversaw the operation of field hospitals and the associate medical personnel, field sanitation and medical supply within their command.  However, there was no statutory basis for their assignment, and it wasn't until February 1865 when Congress bowed to pressure and provided for officers serving in these capacities to receive rank, pay and emoluments appropriate to their responsibilities.<ref name="Newell166"/>

Added to the relatively small number of regular army medical personnel were a further 546 surgeons and assistant surgeons volunteers, appointed by the president to supplement regular army personnel in staff positions; another 5,532 civilian doctors employed under contract (mainly in general hospitals) as acting assistant surgeons; a small number of medical officers of the [[Veteran Reserve Corps]]; and the thousands of regimental surgeons and assistant surgeons appointed to the volunteer regiments by their respective state governors.  Thousands more civilians were employed by the AMD as nurses, clerks, hospital attendants, laborers, etc.  The AMD was further augmented by a number of private and semi-official philanthropic organizations, foremost among which was the [[United States Sanitary Commission]] (USCC).<ref name="Newell166"/>

The chaotic aftermath of the first Battle of Bull Run – no coordination between field hospitals and casualty evacuation, regimental surgeons refusing to treat soldiers from other units, and the few ambulance drivers robbing their charges or fleeing – exemplified the inadequacies of pre-war planning and preparations.  Burdened with an aged and conservative leadership, it took the injection of more enlightened leaders to make the necessary reforms for the AMD to meet these new challenges.  By the war's end, the AMD had implemented a better method of evacuating battlefield casualties to field hospitals and general hospitals, established laboratories to test and certify drugs and other medicines, identified reliable sources of supply and implemented effective contracting procedures, and increased the number of medical personnel to see to the needs of over a million men under arms.<ref name="Newell192">Newell & Shrader, p. 188–192</ref>

Some challenges remained however, against which only small progress was made.  Although improved [[field sanitation]] reduced disease rates and some advances like the use of [[chloroform]] proved helpful, a lack of [[aseptic surgery]] or general understanding of the [[germ theory]] led to many deaths from disease, [[Shock (circulatory)|shock]] or [[secondary infection]].  [[Psychological trauma]] was not well understood and the average soldier made due with an inadequate diet for maintaining their health.  The AMD's reliance on the Quartermaster and Subsistence departments for transportation and rations respectively left these subject to interdepartmental rivalry until late in the war, and personal conflict between military commanders and their supporting medical personnel could lead to problematic health outcomes.  Despite these faults, AMD personnel did their best to alleviate the suffering of their fellow soldiers and laid the groundwork for future improvement.<ref name="Newell192"/>

;Leadership
The Surgeon General at the start of the war was Colonel [[Thomas Lawson (military physician)|Thomas Lawson]], who at 97 years was on his deathbed and his duties were being carried out Major Robert C. Wood, one of his assistants.  When he passed in May 1861 Lawson was succeeded by [[Clement Finley]], another old soldier who was characterized by contemporaries as "utterly ossified and useless".  Finley was slow to act, failed to reform the AMD to address the needs of the war, and particularly opposed to the use of female nurses.  He was forced to retire by Secretary Stanton in April 1862 and replaced with [[William A. Hammond]], who immediately went about reorganizing the AMD, eliminating [[red tape]] and promoting competent young men to positions of authority.  His strong independent streak also earned the enmity of Secretary Stanton, who in September 1863 sent him on an extended tour of the western theater and made Colonel [[Joseph Barnes (American physician)|Joseph Barnes]] the acting Surgeon General.  When Hammond was arrested, court-martialed and dismissed in August 1864, Barnes was promoted to fill his position.  Barnes remained the Surgeon General until after the war's end and succeeded in continuing Hammond's reforms by maintaining an excellent relationship with Secretary Stanton.<ref>Newell & Shrader, p. 164–166</ref>