Standardizing the Charts: Exploring the Civil War Legacy of William Hammond on Medical Recordkeeping

- Yousuf Latif

Today’s world of modern American medicine is heavily data based – from even before a patient enters the site of care to after they leave, patient data is being collected and categorized in the electronic medical record (EMR). Age, address, vitals, medications, pre-existing conditions, family history, procedure records, progress notes, and more can be added to the chart with every visit. While EMR interfaces may differ, much of the information collected today is standardized across practices throughout the country. This was not always the case, however, and one of the crucial pivot points towards the standardization and collection of patient data can be attributed to the American Civil War, and the efforts that took place under the tenure of Surgeon General William A. Hammond. Dr. Hammond took office in 1862, and at this time, the union army was struggling with disease and disorganization both in its hospitals as well as in its recordkeeping. Hammond and his subordinates’ reforms during the war standardized, medical records, and transformed medical notes from ad hoc physician notes into a more formal and structured system that influenced both military and civilian health records thereafter.

Prior to the Civil War, there were some efforts to compile records on sickness and mortality, however, there was little standardization and these statistics were not collected at regular intervals, or at a scale comparable with the Civil War. One such example from 1856 was The Statistical Report on the Sickness and Mortality in the Army of the United States, published by the office of the Surgeon General of the US Army. Although it was one of the earlier large reports, it was actually fairly involved, and included data on mortality as well as sickness by specific illness down to the regimen level (1). However, this was not a routine report – instead it covered a somewhat arbitrary sixteen year period – and the report acknowledges that its input data was at times lacking. Types of records varied by physician, there were no standard forms used, diagnoses were often vague or non-exhaustive, and often times data was either discarded or not collected. Civilian hospitals before the war also had little to no central reporting, as there was not national framework to guide them.

As Surgeon General, Hammond began to lay the foundations to correct some of these issues in data collection. In his role he directed for departmental surgeons to consolidate and send monthly reports of the sick, wounded, and killed in action to the Surgeon General’s office. His push for the collection of these reports, as well as bed cards and case histories allowed for the creation of the Medical and Surgical History of the War of the Rebellion report – an impressively detailed medical record of the war (2). Hammond also issued Circular No. 2, which in addition to establishing the Army Medical Museum also directed medical offers to “diligently collect and forward to the office of the Surgeon General all specimens of morbid anatomy, surgical or medical, which may be regarded as valuable; together with projectiles and foreign bodies removed; and such other matter as may prove of interest in the study of military medicine and surgery”(3). Hammond also required that physicians sent case histories with the samples they sent, in order for these records to better advance science and be able to be instructive to future army medical practitioners. (4). Other key reformers in the Civil War also helped to standardize the information that the healthcare system collected. Jonathan Letterman, the medical director of the Army of the Potomac, required that assistant-surgeons submitted reports of each case seen in the hospital, including the patient name, rank, company, hospital site, detail of the injury, the treatment given, and the eventual outcome. This data would be used to make tables detailing by unit the location of wounds, type of weapon that caused the injury, and treatment operation performed. Letterman also began to require that army medical directors made monthly reports to be delivered to the Office of the Surgeon General that noted issues faced and deficiencies that needed correcting, as well as to compile reports on hospital supply levels (4).

While the reforms and pushes for standardization in record keeping during this time were not always perfectly followed, they were a seminal moment towards the standardization of forms and the more regular recording of medical information. In the years that followed, army reporting became embedded in Army medical practice, and reporting of sickness and mortality became more standardized and regular through the eventual adoption of annual reports and standardized disease categories (5). While the story of Civil War medicine often focuses on battlefield amputations and early medical practices, an unsung part of its legacy is in the paperwork. Hammond and his department took the disorganized practice of notekeeping and set forth an expectation of uniform and detailed medical records. These were a turning point in American medical record keeping – this expectation never disappeared, and eventually made its way from military medicine to the civilian world. Hammond’s reforms ushered the way to our modern reporting standards that expect health data to be uniform, centralized, and used to guide policy.


References

1. Coolidge, R. H. (n.d.). Statistical Report on the Sickness and Mortality in the Army of the United States, Compiled from the Records of the Surgeon General’s Office; A Period of Sixteen Years, from January, 1839, to January, 1855.AMEDD Center of History & Heritage. https://achh.army.mil/history/book-mexicanwar-casualtystats-mexwarstats 

2. Love, A. G., Hamilton, E. L., & Hellman, I. L. (n.d.). Tabulating Equipment and Army Medical Statistics. AMEDD Center of History & Heritage. https://achh.army.mil/history/book-misc-tabulatingequipandarmymedstats-chapter2 

3. Price, D. (2021, April 24). The Civil War and the Army Medical Museum. National Museum of Civil War Medicine. https://www.civilwarmed.org/army-medical-museum/ 

4. Barr, G. (n.d.). Writing a Better System into Place: How Record-keeping During the Civil War Transformed Military Medicine in the United States. Galter Health Sciences Library & Learning Center. https://galter.northwestern.edu/news/writing-a-better-system-into-place-how-record-keeping-during-the-civil-war-transformed-military-medicine-in-the-united-states?category=75 

5. Marble, S. (2025a, April 20). U.S. military medical surveillance: Two centuries of progress. MSMR. https://pmc.ncbi.nlm.nih.gov/articles/PMC12091953/