During its brief existence, the Confederate States of America created many new institutions. This paper concerns one of these, the Medical Department of the Confederate States Army. From a very small nidus of experienced physicians, this organization expanded to supervise thousands of officers, to build many huge hospitals, and to expend millions of dollars. The Medical Department also experienced some administrative failures, the most obvious of which were the failure to vaccinate against smallpox and the inability to control the loss of manpower associated with medical furlough. Like all institutions, the Medical Department produced both successes and failures. The fact that the South lost the War Between the States tends to obscure the successes and emphasize the failures.