- Frances Bengtson
During the American Civil War, the United States faced a scale of casualties and disease that challenged medical infrastructure in a way previously unimaginable in U.S. history. Beyond the hundreds of thousands of soldiers who lost their lives during the conflict, it is estimated that over 280,000 military personnel were non-mortally wounded, in the Union Forces alone. In the face of such unprecedented suffering, the nation’s medical system was forced to adapt rapidly. While surgeons and field hospitals are often the public face of Civil War medicine, much of the essential record keeping that sustained medical care fell to hospital stewards. These noncommissioned officers quietly documented the war’s medical toll, maintained hospital registers, tracked supplies, and created the administrative backbone of the wartime medical system.
Hospital stewards were enlisted men chosen for their literacy, reliability, and ability to manage detailed tasks. The position had existed prior to the war, but the massive scale of the conflict expanded both its scope and importance. The position was not easy to acquire. According to Joseph Janvier Woodward’s Hospital Stewards's Manual (1862), stewards “must have…sufficient knowledge of…pharmacy to take charge of the dispensary, acquainted with minor surgery, …application of bandages and dressings, extraction of teeth, application of cups and leeches, …knowledge of cooking” and must be “industrious, patient, and good tempered”; qualities vital for men responsible for managing sensitive medical records and inventories. Charles F. Beal, the acting assistant surgeon at Dunbarton Street Hospital in Georgetown and a hospital steward hopeful, even noted that he had gathered recommendations from three surgeons during the preparation of his application. There was even a competitive exam to qualify for the position after which the appointment had to be confirmed by the Secretary of War. Unlike many soldiers, who may have been illiterate or unskilled in clerical work, stewards were often extremely educated with ample prior experience.
Thus, the duties of hospital stewards went far beyond dispensing medicine. Stewards kept admission and discharge registers, updated daily reports, and compiled statistics on disease prevalence, mortality rates, and surgical outcomes. Stewards also tracked inventories of medical supplies, linens, bedding, and food. By maintaining accurate records, they ensured that hospitals could requisition supplies before shortages became critical. This was especially important during this era because infection and disease killed more soldiers than died on the battlefield. Maintaining proper supplies was quite literally lifesaving. In addition, stewards were responsible for documenting medical experiments, treatments, and even autopsies. Surgeons often dictated notes, but stewards copied them into official hospital records and these case notes became valuable data for military medicine.
The importance of hospital stewards did not end with the conclusion of the war. Their record keeping provided the foundation for postwar medical analysis, including the Medical and Surgical History of the War of the Rebellion, one of the most comprehensive medical reports ever produced in the nineteenth century which remains a critical source for historians and medical researchers alike. Beyond preserving data for posterity, these records also influenced veterans’ care, helping to document injuries and illnesses for pension claims and ongoing treatment. By translating individual patient experiences into organized, systematic documentation, hospital stewards ensured that the knowledge gained during the war could inform both medical practice and public health for years to come.
Today, the work of Civil War hospital stewards can be recognized as an early step toward the standardization of medical record keeping. In modern day, medical records are the foundation of modern healthcare: they track patient histories, coordinate treatment among providers, and supply data for research. The Civil War demonstrated for the first time on a national scale that organized, centralized medical records were essential for both immediate care and long-term study. White the position of hospital stewards does not exist in modern day as a single individual, in many ways, hospital stewards were predecessors to modern medical records technicians, health information managers, clinical administrators, and more. Their patient registers foreshadowed today’s electronic health records, while their statistical reports anticipated epidemiology and outcomes research. By demonstrating the value of systematic record keeping, they helped shift medicine from an individual practice toward a data-driven science.
The Civil War forced the United States to confront medical challenges on an unprecedented scale. Hospital stewards, though often overshadowed by surgeons and nurses, were the unsung workhorses of the wartime medical system. Their record keeping made possible not only the daily functioning of Civil War hospitals but also the long-term advancement of American medicine.
References
AMEDD/NCO Enlisted Soldier History. (n.d.). Retrieved September 19, 2025, from Army.mil website: https://achh.army.mil/regiment/nco-historynco
Campbell, W. T. (2014a, October 24). Meet the Hospital Steward. Retrieved September 19, 2025, from Civilwarmed.org website: https://www.civilwarmed.org/surgeons-call/steward1/
Campbell, W. T. (2014b, December 24). Seven Hospital Stewards. Retrieved September 19, 2025, from Civilwarmed.org website: https://www.civilwarmed.org/surgeons-call/steward2/
Campbell, W. T. (2018). Overworked, Undermanned and Indispensable: HOSPITAL STEWARDS IN THE CIVIL WAR. Retrieved September 19, 2025, from Jstor.org website: https://www.jstor.org/stable/26483969?casa_token=UXGgtjx5AWcAAAAA%3AelF8zvUlDExlQW66JZ6kIx1W_9UpUaZnImNrz7tXI48KNILFP_I0upTXxemaI7adNWs02eftDbcr9M8UFwy7nQSDAF2ngh0bV7br0BYMJus0BAvNtpE&seq=2
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The hospital steward’s manual: for the instruction of hospital stewards, wardmasters, and attendants, in their several duties : prepared in strict accordance with existing regulations, and the customs of service in the armies of the United States of America, and rendered authoritative by order of the Surgeon-General - Digital Collections - National Library of Medicine. (n.d.). Retrieved September 19, 2025, from Nih.gov website: https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101526781-bk
Union Medical Civil War Facts. (n.d.). Retrieved September 19, 2025, from Mycivilwar.com website: https://www.mycivilwar.com/facts/usa/usa-medical.html
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