Monday, October 11, 2010

Medical Department #36 - Medical Cadets

Readers of this blog or my "Medical Department" column in The Civil War News should be no stranger to Guy R. Hasegawa, Pharm.D., as his work has been the subject of several columns and posts over the years, including Civil War pharmacy and quinine substitutes in the Confederacy , his contributions as co-editor and author of Years of Change and Suffering, or his presentations at history conferences.

This is all with good reason: first - he is a dear friend; second - his scholarship is always marked by an interesting subject, impeccable primary research, and an engaging writing style.

Below, find a (really) old "Medical Department" column (October 2001) based on Guy's research and start to look forward to the November 2010 column which is also an interview with Guy about the medical implications of chemical weapons in the Civil War. I"ll post that one on the blog in late October after it appears in print.


“Medical Cadets”
"Medical Department" - October 2001 - The Civil War News
by James M. Schmidt

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.
So went a song describing the mission of the Civil War’s “medical cadets,” as penned by one (Edward Curtis) in 1863. Their story, generally ignored in histories of Civil War medicine, is the subject of an excellent article, “The Civil War’s Medical Cadets: Medical Students Serving the Union,” in a recent issue of the Journal of the American College of Surgeons (Vol. 193, No. 1, July 2001, pp. 81-89). The article was written by Guy R. Hasegawa, Pharm.D., whose first-rate research on pharmacy in the Civil War was the subject of my December 2000 column.

Indeed, it was while doing his Civil War pharmacy research that Dr. Hasegawa learned about the contributions of this dedicated cadre of men. “When I was working on the pharmacy project, I decided to see what the National Library of Medicine had in its manuscript collection that related to the Civil War,” he told me. “The listing for the F. A. Castle papers mentioned something about the cadets, and so I requested them.” It was there that he discovered a treasure of information, including documents, rosters, and photographs.

The U.S. Army medical cadet corps was composed of medical students, with the aim of providing a cadre of ambulance attendants and wound dressers. However, as surgeons became overwhelmed with increasing casualties, the cadets soon found themselves taking on increased responsibility and independence.

Congress approved creation of a corps of fifty cadets in August 1861, to act under the control of medical officers. Applicants were to be 18- to 23-year-old men of liberal education who had studied medicine for two years and completed at least one course of lectures at a medical college. Applicants who passed the initial examination were enlisted for a one-year term in the Army, with a rank equivalent to that of a West Point cadet (between a sergeant major and a second lieutenant). They were initially given pay of $30 a month, along with quarters, fuel, and transportation, as well as the opportunity to reenlist.

Given the fact that by August 1861, a handful of major battles had already been fought, a corps of only fifty cadets seemed rather small to me. Dr. Hasegawa told me that he suspects that penny-pinching was not the reason why: “I think the number was kept small as the concept was new and untried. Also, the scope of the human and material cost of the war may not have been fully appreciated,” he said.

Of a great number of applicants for the initial positions, 66 were found qualified and invited to appear before the examining board. Of those, 48 were approved and enlisted; others either failed to appear for the examination, or were rejected. In April 1862, Congress approved twenty additional positions. Dr. Hasegawa discovered that by the end of the war, 273 men had enlisted for 300 1-year terms. The article also discusses civilian personnel who performed similar duties, including “acting medical cadets” and contract surgical dressers.

Most of the cadets served the majority of their time in Army general hospitals. They were generally paired with a medical officer caring for a specific ward. And their activities included dressing wounds, assisting in postmortem examinations, and helping with administrative duties. When workloads overwhelmed the surgeons, cadets took charge of the wards themselves. They also assisted surgeons in operations and may have eventually performed some procedures themselves.

Though it may seem somewhat morbid, the medical cadets relished the opportunities to learn from anatomical specimens, either amputated limbs or cadavers. In the article, Dr. Hasegawa quotes from a letter by a British observer disgusted at the “enthusiasm” with which the cadets sought such opportunities: “I saw one of these Cadets seize a leg almost before it was off and holding it by the toe run away with it…”

While most of the cadets remain little known, a handful truly distinguished themselves. Medical cadet Charles Rivers Ellet was assigned to the Union steam ram fleet on the Mississippi, commanded by his father, Col. Charles Ellet, Jr., and his uncle, Lt. Col. Alfred Ellet. After the Battle of Memphis in June 1862, cadet Ellet accepted the surrender of the city, carried messages, and even commanded a portion of the fleet!

Medical cadet Charles Leale was trusted with responsibility of taking charge of two wards at the general hospital in Elmira, New York. Only a month after his term as a cadet ended, Leale, as an army surgeon, was the first physician to examine President Lincoln after the shooting at Ford’s Theater.

Despite their valuable service, the cadets did have to fight for what they thought was due them. Though by rank they were in the “no man’s land” between being officers and enlisted men, much of their professional and social interaction was with the officer corps. Yet, until they pressed the authorities on their own behalf, they were not given some of the perks the officer had, most notably a food allowance.

Surgeon General Hammond was pleased with the demonstrated success of the cops, and pressed Congress to approve more positions. He also recommended the founding of an “army medical school” to give medical cadets and other applicants instruction which could not be obtained at civilian schools. One rumored plan had the cadets (who had already completed at least one term of lectures) completing their training with another 6 months of lectures, followed by service in the army’s hospitals. Unfortunately, nothing ever came of the suggestion. Indeed, it was 1976 before the Uniformed Services University was established to specifically educate and train military physicians.

As with his Civil War pharmacy research, the medical cadet article is meticulously documented. The paper includes photographs of two notable cadets, a roster listing the nearly 300 enlisted cadets, and nearly seventy footnotes drawing on mostly primary and archival sources.

Indeed, Dr. Hasegawa, senior editor with the American Journal of Health-System Pharmacy (based in Maryland), made extensive use of the National Archives (NA) and other collections. Though he considers himself a novice user, he does have some good advice for other potential users of the NA. “First, do your homework, and be as specific as possible in stating your research interest,” he told me. He suggests consulting the NA website and reading useful books, like Munden and Beers’ The Union: A Guide to Federal Archives Relating to the Civil War and Beer’s companion book on Confederate archives.

His second suggestion is to allow plenty of time: “It takes time to locate microfilm or have paper records retrieved,” he said. He also noted that Civil War documents are generally handwritten and are difficult to read quickly. In short, he concludes: “Don’t fool yourself into thinking that any sizable project can be done in one day.” He is also quite certain that there are “undiscovered gems” of Civil War medical information in the archives for the researcher who is diligent and patient enough to find them.

In conclusion, Dr. Hasegawa feels there were at least two major benefits from the medical cadet “experiment.” First, the cadets provided competent medical care at a low cost to the government. Indeed, their training surpassed that of most nurses or hospital stewards. Second the cadets represented a convenient and experienced pool of candidates for positions as commissioned or contract Army and Navy surgeons. In turn, the cadets appreciated the opportunity to learn more medicine in one year than they might otherwise learn in five.

Despite the hardships of dangerous work and a lack of pay equal to his contributions, cadet Edward Curtis was able to finish his song on a stoic, if not upbeat, note:

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

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