General officers in the Confederate States Army Edmund Kirby Smith, who was appointed general late in the war and into the PACS. Pierre G.T. Beauregard, had also initially been appointed a PACS general but was elevated to ACSA two months later with the same date of rank. These generals outranked all other grades of generals, as well as all lesser officers in the Confederate States Army. The first group of officers appointed to general were Samuel Cooper, Albert Sidney Johnston, Robert E. Lee, Joseph E. Johnston, and Pierre G.T. Beauregard, with their seniority in that order. This ordering caused Cooper, a staff officer who would not see
Armies in the American Civil War capital, he remained in contact with Breckinridge in the Valley and Beauregard in North Carolina (and later at Bermuda Hundred and Petersburg). Federal and Confederate medical systems followed a similar pattern. Surgeons general and medical directors for both sides had served many years in the prewar Medical Department, but were hindered by an initial lack of administrative experience in handling large numbers of casualties (see table 5), as well as the state of medical science in the mid‑19th century. Administrative procedures improved with experience, but throughout the war the simple lack of knowledge about the true causes of disease and