Southern distinctiveness, especially as manifested in its commitment to slavery, its ‘‘peculiar institution,’’ was only one of the complex causes of the conﬂicts that resulted in the Civil War, but there is little doubt that slavery was—as Lincoln said—‘‘somehow’’ at the heart of the conﬂict. Decades before the outbreak of the war, with the Confederate bombard- ment of Fort Sumter on April 12, 1861, the gap between North and South in terms of social, economic, and cultural experiences had become unbridgeable. Nevertheless, neither side was prepared for the awesome bloodbath of a war that did not end until April 9, 1865, when Robert E. Lee surrendered to Ulysses S. Grant at Appomattox Court House in Virginia. Neither the Union nor the Confederacy expected the War Between the States to last very long; thus, neither side made suitable provisions for sanitation or care of the sick and wounded. Many volunteer ﬁghting units joined the war effort without hospital tents, supplies, surgeons, or record keepers. Temporary, overcrowded, unsanitary facilities, such as old barns, tobacco warehouses, and private homes, served as makeshift hospitals. Medical staff and facilities were immediately overwhelmed by the troops suffering from fevers and ﬂuxes. In the ﬁrst six months of the war, 30 percent of the soldiers contracted malaria, typhoid fever, smallpox, and dysentery. Other debilitating conditions included asthma, tuberculosis, epilepsy, sunstroke, venereal diseases, rheumatism, dyspepsia, and boils at sites that made mounting a horse very difﬁcult. Surgical services were more primitive than necessary, considering the state of the art in the 1860s, because of the lack of supplies, equipment, and facilities, and the poor training of many surgeons.
But war wounds and diseases provided a grisly proving ground for inexperienced surgeons and physicians. Although anesthesia had been in use since the 1840s, many military surgeons thought it unnecessary in amputations and claimed that anesthetics prolonged shock and bleeding and inhibited healing. The medical situation of the South was even worse than that of the North. Because of the naval blockade of the South, medical supplies, such as chloroform, quinine, belladonna, digitalis, and opium, were almost impossible to obtain. Robert E. Lee admitted that his army did not have proper medical and sanitary support. Indeed, it had no Sanitary Commission and its Medical Department was not properly equipped. As the war dragged on, military activities consumed more and more medical resources, medical school enrollments declined, and civil- ian asylums and hospitals lost critical staff members. Even plans for urban sanitary improvements and the collection of vital statistics were suspended as resources were increasingly consumed by war-related activities. The struggles of nurses and doctors during the war and the suffer- ing of their patients make painfully evident the disproportion between advances in the techniques of healing and those of killing. Almost three million men served in the war; about six hundred thousand died. Of this total mortality, the Union loss was about 360,000; the Confederate army lost about 260,000 men.
As in all wars up to the twentieth century, more soldiers died of disease than in battle. Union medical ofﬁcers reported more than six million cases of sickness. There were more than a million cases of malaria among white Union troops, about 140,000 cases of typhoid fever, 70,000 cases of measles, 60,000 cases of pneu- monia, 70,000 cases of syphilis, and 110,000 cases of gonorrhea between May 1, 1861, and June 30, 1866. The huge assemblies of men and ani- mals that had previous lived in rural isolation and their movement through unfamiliar regions provided the perfect environment for the dissemination of previously localized diseases. Many thousands of sol- diers who had been weakened by diseases, injuries, and wounds during the war died at home; their deaths and those of others they infected were not part of the Army’s mortality ﬁgures. Many others suffered chronic illnesses and disabilities because of their injuries or loss of limbs. Scurvy, sunstroke, colic, diarrhea, dysentery, and typhoid fever were common, which was not surprising considering the lack of nutritious food and safe drinking water. Military doctors warned their ‘‘superiors’’ that scurvy undermined the ‘‘ﬁghting powers of the army’’ even if soldiers did not realize that they were sick, but it was a battle to secure well-known antiscorbutics, such as potatoes, onions, cabbage, tomatoes, squash, beets, and fresh lemons.
One surgeon described using water from the Chickahominy swamp, which was full of the bodies of dead horses and soldiers. Perhaps attempts to disguise the noxious qual- ity of drinking water by adding a ‘‘gill of whisky’’ per canteen helped disinfect the water. The stench of the army camp and hospital, he reported, was enough to ‘‘cause a turkey buzzard to contract typhoid fever.’’ Many soldiers were tormented by hordes of lice, which they referred to as ‘‘bodyguards.’’ Doctors also complained about soldiers who had been recruited despite constitutional defects that made them unﬁt for army life. Cursory medical exams failed to detect recruits who were too young, others who were too old, and a few who were actu- ally female. In addition to the many soldiers who survived physical wounds and surgical amputations, some returned to their homes with severe psychological trauma caused by the stress of the war.
Having analyzed pension records and case studies of Civil War veterans who were com- mitted to insane asylums, historians have suggested that their symptoms would now be diagnosed as post-traumatic stress disorder. Civil War diagnostic categories that might now come under this heading include sunstroke, homesickness, and irritable heart. The symptoms of a con- dition diagnosed as irritable heart, soldier’s heart, or neurocirculatory asthenia included chest pains, palpitations, breathlessness, fatigue, syn- cope, and exercise intolerance. Irritable heart was ﬁrst recognized as an important issue during the Civil War because it incapacitated thousands of soldiers. All areas of the country were affected, directly or indirectly, by the war. Years of turmoil left a legacy of malnutrition, hookworm infes- tation, and malarial fevers that affected the health of returning troops, their families, and communities for many years. In the South, the war caused the destruction of many libraries, medical schools, and other educational institutions. Medical societies and journals vanished and many Southern physicians emigrated to the North. Many farmers returned home to discover that their homes, barns, crops, and livestock had been destroyed. The Civil War triggered major epidemics among horses, mules, cattle, and hogs. Hog cholera, which was ﬁrst reported in Ohio in the 1830s, spread to at least twenty states by 1860. One probable mode of transmission foreshadows the Mad Cow story: meat scraps from dis- eased carcasses were fed to healthy animals, which then became infected. Bovine pleuropneumonia, or lung fever, caused by Myco- plasma mycoides and transmitted via droplet infection, was a localized problem before the Civil War.
Imported animals from Europe during the 1840s exacerbated the problem. The disease kills about half of the infected animals, but many of the survivors became carriers. After the war, cattle fever, pleuropneumonia, bovine tuberculosis, and hog chol- era remained as major problems for agriculture. Cattle and horses were attacked by brucellosis, equine inﬂuenza, vesicular stomatitis, Eastern equine encephalomyelitis, Potomac fever, and glanders. Advances in transportation and increased commerce after the war exacerbated the dissemination of the diseases of livestock. Although the development of nursing in America is a complex story, the Civil War was a transforming event for the thousands of women who participated in nursing and other philanthropic activities during the war. Memorable descriptions of military hospitals, the suffer- ing of the sick and wounded, and the tasks undertaken by male and female nurses were written by celebrated authors, like Louisa May Alcott and Walt Whitman, and little known ﬁgures, such as Jane Stuart Woolsey, who wrote Hospital Days: Reminiscence of a Civil War Nurse (1868) to describe her work as the superintendent of nursing at a Union barrack hospital near Alexandria, Virginia. Alcott worked as a nurse’s aide in a 40-bed ward in a hotel turned into a hospital after the ﬁrst battle of Bull Run. Stories of the staff’s struggles to care for wounded soldiers, as well as those stricken by diphtheria, pneumonia, typhoid, and other diseases, were published in a Boston newspaper as ‘‘Hospital Sketches.’’ Dr. Elizabeth Blackwell and other medical women founded the Women’s Central Association for Relief and organized programs in several New York City hospitals to train women to serve as nurses. Most nurses had little or no training, but the tasks assigned to them were simple: bathing patients, dressing wounds, providing clean linens, preparing and serving nourishing meals, administering medications, and writing and reading letters for their patients. Civil War nurses were expected to provide care and comfort, rather than medical support, but were burdened by the disparity between the availability of humanitarian aid and the enormity of the suffering and loss of life caused by the war.
Dorothea Lynde Dix (1802–1887), who had devoted her life to improving the treatment of the insane, was appointed Superintendent of Female Nurses in 1861. The responsibilities assigned to Dix by the Secretary of War included recruitment of female army nurses, hospital visitation, distribution of supplies, management of ambulances, and so forth. Despite her ofﬁcial position, Dix had no real authority or means of enforcing her rules and directives. Famous for her demand that war nurses should be middle-aged women, plain in appearance, Dix was not popular with Army doctors, hospital surgeons, volunteer nurses, and the leaders of the U.S. Sanitary Commission. Because of disputes between Dix and the Sanitary Commission about their overlapping areas of authority, leaders of the Commission portrayed her as a ‘‘phil- anthropic lunatic’’ and an obstacle to the war effort. Louisa May Alcott said that, although Dix was regarded as a ‘‘kind old soul,’’ nurses considered her ‘‘very queer, fussy, and arbitrary.’’ Displaced from her old position as noble role model for American girls, Dix has been analyzed by modern historians and pronounced a ‘‘disastrous failure’’ and a rival, rather than a supporter, of Clara Barton, another former female icon. Clara Barton (1821–1912), founder of the American branch of the Red Cross, was also involved in nursing during the war, but she was primarily associated with the monumental task of obtaining supplies, including medicines, and identifying the dead and wounded. When the war ended, Barton helped organize the exchange of prisoners of war and a bureau of records to search for missing men. She went to Andersonville, the notorious Confederate prison camp in Georgia, to lead the effort to identify and mark the graves of Union soldiers.
During the war about 13,000 of some 32,000 prisoners died at the camp, from scurvy, dysentery, typhoid, gangrene, and other conditions caused by malnutrition, ﬁlth, and neglect. As President of the American Red Cross, Barton attempted to expand the role of the organization beyond war relief to the provision of aid for other forms of disaster. In support of the Union Army, representatives of the Women’s Central Association of Relief and other religious, medical, and reform organizations, including the Lint and Bandage Association, and the Physicians and Surgeons of the Hospitals of New York, went to Washington to formally request the establishment of a sanitary com- mission. Despite some resistance from military leaders, the Secretary of War authorized the U.S. Sanitary Commission in June 1861. Operat- ing as a voluntary organization, the Sanitary Commission attempted to provide food, medical supplies, and other forms of humanitarian assis- tance to soldiers, investigate and improve sanitary conditions at military camps and hospitals, and implement a comprehensive system of record keeping. The Sanitary Commission actively solicited donations in order to purchase and distribute supplies, organize transportation to hospi- tals, and provide support for soldiers’ aid societies. Under the auspices of the Commission, volunteers provided humanitarian services for sick and wounded soldiers, distributed soap and other toiletries, and established kitchens for the preparation of spe- cial diets for invalids, hospital libraries, and rest facilities for soldiers. Historians suggest that participation in the work of the Sanitary Com- mission prepared many women for the roles they created in post-war reform movements at the local and national level.
Many Sanitary Com- mission branches refused to allow blacks to participate in volunteer work, forcing many African-American men and women to participate in other war relief societies. In order to reach a general audience, especially the families of Union soldiers, the Commission published a newspaper called the Sanitary Reporter and created a hospital directory to help relatives locate wounded and missing soldiers. The lists compiled by 1864 contained the names of close to six hundred thousand sick, wounded, and dead soldiers. Publication of statistical data about the Army’s incompetence in the distribution of food, clothing, bedding, and medical supplies, camp sanitary conditions, and hospital management was an obvious source of embarrassment to military bureaucrats. Memoirs and letters of Civil War surgeons provide intimate portraits of camp life, army politics, and their often frustrating attempts to care for sick and wounded soldiers. Doctors complained that it was almost impossible to get medical supplies from ‘‘drunken and incom- petent quartermasters.’’ Supplies of food were often inadequate, but whisky was freely available—perhaps as ‘‘medicinal whiskey.’’ Doctors suspected that whisky was always transported even if medical supplies were left behind. Daniel M. Holt, for example, assistant surgeon in the 121st New York Volunteers, quickly discovered that the demands on a military doctor were quite different from those of a country doctor.
During his two years of army life, Holt lost 21 pounds, suffered from gastrointestinal problems, and contracted tuberculosis. Sick, discour- aged, and worried about re-establishing his practice, Holt left the army in 1864. He died in 1868, only 47 years of age. John Vance Lauderdale, another doctor from New York, served as a contract surgeon on a hospital ship that brought the sick and wounded from southern battleﬁelds to northern hospitals. His brother told him that all doctors agreed that he would ‘‘learn more of surgery in one year in the Army than in a life time of private practice or in the hospitals of New York.’’ But Lauderdale felt he learned little at all except about his own therapeutic inefﬁcacy. Patients died from dysentery, malaria, hospital gangrene, and typhoid fever, but he had nothing better to dose them with than whisky. After surgical operations, soldiers might die of shock, bleeding, or infection, or they might suc- cumb to the diarrheas, dysenteries, and fevers so common at camps and hospitals. Many doctors confessed that they had learned a great deal about the horrors of war, the futility of contemporary medicine, and their own deﬁciencies. Perhaps surgeons also returned home with folklore about wounds and healing. Maggot therapy, for example, was based on the obser- vation that certain ‘‘worms’’ seemed to cleanse a wound of pus, while ignoring healthy ﬂesh. This technique had already been described by military surgeons during the Napoleonic wars. Bacteria that can make insects sick may have been responsible for the exceptional healing of Civil War soldiers’ wounds that glowed in the dark. According to Civil War folklore, soldiers with wounds that glowed in the dark had better survival rates than soldiers with nonglowing wounds. Microbiologists think this might have some basis in fact. The luminescent bacterium Photorhabdus luminescens, an insect pathogen, has been investigated as a potential biocontrol agent. Some Photorhabdus strains produce antibiotics that inhibit the growth of bacteria that could cause infections in open wounds. Nevertheless, military medicine gave many doctors an unprec- edented opportunity to gain surgical experience, if not competence, and some appreciation for the importance of sanitation and hygiene. Doctors also learned about pathology and neurology by carrying out autopsies and by attempting to rehabilitate soldiers who had survived amputations.
Civil War surgeons became notorious for amputating legs and arms that might have been saved under different circumstances. On the other hand, soldiers with fractures and wounds that might have been treated conservatively in private practice were probably saved by the amputation of limbs that were already hopelessly mangled and infected by the time they received medical care. When civilian surgeons blamed army doctors for being too eager to cut off limbs, Jonathan Letterman (1824–1872), Medical Director of the Army of the Potomac, argued that amputations done as soon as possible after injury were essential to sav- ing lives. ‘‘If any objection could be urged against the surgery of those ﬁelds,’’ Letterman wrote, ‘‘it would be the efforts .. . of surgeons to practice ‘conservative surgery’ to too great an extent.’’ Caricatures showed the beleaguered ﬁeld surgeon holding a knife between his teeth between amputations, throwing amputated limbs onto an ever-growing pile. Even during the war, reporters and commentators were especially harsh in their judgments of military surgeons, despite the fact that the mistakes of commanders and generals were the true causes of so much suffering and death. In response to critics, Letterman did not claim that there were no incompetent surgeons in the army, but he urged them to remember the medical ofﬁcers who ‘‘lost their lives in their devotion to duty .. . and others sickened from excessive labor which they conscientiously and skillfully performed.’’ Of course military doctors lost many patients to disease and wounds, but even the best doctors, under optimum conditions in the 1860s could do little to cure or prevent most diseases; nor could they cure post-surgical infections. The work of the ﬁeld surgeon was brutal, rushed, and stressful, but Civil War sur- geons were not necessarily careless, heartless, and incompetent.
Most began military service with about the same training as any of their typi- cal contemporaries, but they were often worn down by the stresses and deﬁciencies of military medicine. Civil War doctors were expected to function as public health ofﬁcer, dietician, dentist, nurse, and psychol- ogist, with only minimal resources or help. Many doctors contracted camp illnesses or became disabled by accidents or enemy ﬁre, and many died. Turning the tables on civilian doctors, Letterman said that in his experience it was impossible to rely on civilian surgeons ‘‘during or after a battle. They cannot or will not submit to the privations and discom- forts which are necessary, and the great majority think more of their own personal comfort than they do of the wounded.’’ Civil War surgeons established some improvements in the manage- ment of external wounds, but mortality rates for chest, head, and abdominal wounds were very high. Amputations, which constituted about 75 percent of all Civil War operations, saved many lives, despite the crudity of surgical procedures and facilities. Many amputees recov- ered and returned to active duty, sometimes with a prosthetic limb. Anecdotes about amputees who continued to ﬁght led to the saying that if all the soldiers and ofﬁcers who had lost limbs in battle were brought together they could form their own brigade. In a grim version of recy- cling, new amputees sometimes appropriated the prosthetic limbs of sol- diers who had died in battle. In Jules Verne’s 1864 novel From the Earth to the Moon, the members of the Baltimore Gun Club, veterans of the Civil War, were notable for their ‘‘crutches, wooden legs, artiﬁcial arms with iron hooks at the wrist, rubber jaws, silver skulls, platinum noses.’’ Mutilated in the war, these men were the ingenious inventors who designed a gigantic cannon for their voyage to the moon. Thus, although accounts of Civil War amputations focus on the brutality of the procedure, the thousands of veterans who returned home with miss- ing limbs could be regarded as success stories. Prior to the war, when faced with the prospect of performing surgery, most doctors subscribed to the principle of ‘‘conservative thera- peutics,’’ that is, doctors tried to avoid surgical interventions and sur- gical mutilations. Civil War surgeons, however, had to make decisions about treatment under very different conditions.
Unless surgeons acted quickly and without pity, many of the wounded would probably have died of their injuries. When treating men whose arms and legs had already been fractured and torn open by bullets, amputation was the course of action most likely to save the patient from gangrene, tetanus, pyemia, and other deadly infections almost invariably acquired on the battleﬁeld or in the hospital. Army surgeons believed that: ‘‘Life is bet- ter than a limb; and too often mutilation is the only alternative to a rapid and painful death.’’ The U.S. Sanitary Commission recommended amputation for patients whose limbs had been badly lacerated and for those with compound fractures. The Manual of Military Surgery used by Confederate surgeons also suggested amputation when the limb had been badly injured. An estimated 60,000 amputations were performed during the war; about 35,000 men survived such operations, but mortality statistics were imprecise and unreliable. Anesthesia made it possible to perform ampu- tations that would have been impossible or invariably fatal previously.
The outcome of surgery depended on many variables: the time since injury, part of the body, and type of surgical procedure. Ofﬁcial Union records suggest that amputation at the hip performed more than 24 hours after the wound was incurred were almost invariable fatal, but the mortality rate for amputation at the ankle was about 25 percent. Physicians discovered also that artiﬁcial limbs might make mobility pos- sible again, but prosthetic devices did not trick the body into forgetting its lost parts. Silas Weir Mitchell (1829–1914), one of the founders of American neurology, carried out studies of causalgia and a problem he labeled ‘‘phantom limb pain’’ at the hospital for ‘‘stumps and ner- vous diseases’’ established by Surgeon General John Hammond to care for amputees suffering from chronic pain and disability. Mitchell’s research provided fundamental insights into the workings of mind and body. Previously, the phantom limb phenomenon had been dis- missed as a hallucination or neurosis. But, based on his observations and his knowledge of the physiology of the nervous system, Mitchell attributed the phenomenon to an ascending neuritis associated with some change in the central nervous system.
Oliver Wendell Holmes noted the relationship between the war and the American prosthetics industry. ‘‘War unmakes legs,’’ Holmes wrote, and ‘‘human skill must supply their places.’’ Those who lost a limb pro- vided an unprecedented market for prosthetic devices; tens of thousands of men returned from the war without arms and legs. The war stimu- lated the pharmaceutical industry, along with the business of supplying prosthetic devices. Civil War pensions involved compensation related to the loss of body parts and funding for the purchase of artiﬁcial limbs. Between 1861 and 1873, the United States Patent Ofﬁce granted 150 patents for artiﬁcial limbs and related devices. After the war the ﬂourishing prosthetic device industry remained proﬁtable by providing artiﬁcial limbs for those wounded while working in factories and mines and the accidents associated with the railroads and other forms of mass transportation. In many ways, the role of the Federal government in policies and practices related to agriculture, education, medicine, and science was transformed by the Civil War. During the long and bloody war, both the Union and the Confederate governments had to create and expand military medical establishments to supervise camp sanitation and cope with the management of the sick and wounded.
Medical ofﬁcers had to carry out medical inspections of recruits, establish ambulance corps, obtain and distribute medical supplies, and oversee hospital trains and hospitals. When the war began, the number of regularly appointed army surgeons and assistant surgeons in the Union Medical Department was totally inadequate to the unprecedented medical demands. Contract sur- geons were hired for three to six months with the nominal rank of acting assistant surgeon. Medical duties for surgeons and assistant surgeons were essentially the same, but the surgeon did more administrative work and was better paid. Other personnel in the Medical Department were brigade surgeons, regimental and assistant surgeons, contract surgeons, nurses, and hospital stewards who worked as apothecaries and wound dressers. William A. Hammond (1828–1900), who served as Surgeon General from 1862 to 1864, improved the efﬁciency of the Army’s Medical Department, built large general hospitals, instituted an ambu- lance service, and won the admiration of the Sanitary Commission. In modern bureaucratic organizational charts, the U.S. Army Surgeon General and the Public Health Service Surgeon General are quite sepa- rate and distinct ofﬁcials. Before the Civil War, the term ‘‘Surgeon Gen- eral’’ was the title of the senior ofﬁcer in the United State Army Medical Department. After the war, the Navy adopted the title for the Chief of its Bureau of Medicine and Surgery. When the Marine Hospital system evolved into the Marine Hospital Service, the title Supervising Surgeon was given to the newly created senior government doctor directing the MHS. Further reforms transformed the Marine Hospital Service into the United States Public Health Service.
The director of the United States Public Health Service was called the Surgeon General, or more speciﬁcally the Surgeon General of the United States, or the Surgeon General of the United States Public Health Service. Today the Surgeon General is a political appointee, with direct command of a rather small staff, but the title traditionally confers a great deal of moral authority and the individual holding the ofﬁce often acts as the chief spokesperson for the government on health issues. The Army, Navy, and Air Force still award the title of Surgeon General to their chief medical advisors. These ofﬁcials are also involved in providing advise to the Defense Department on medical policy and health issues. Surgeon General Hammond, an energetic and imposing ﬁgure at 6 feet 2 inches, and 250 pounds, was quite a change from his dogma- tic 64-year-old predecessor, C. A. Finley, who had become Surgeon General in 1861. Hammond graduated from New York University’s Medical College in 1848 and entered the U.S. Army as an assistant surgeon. In 1860, Hammond resigned from the army and accepted a position as Professor of Anatomy and Physiology at the University of Maryland Medical School. He re-enlisted at the start of the Civil War and served as inspector of hospitals and army camps. Members of the U.S. Sanitary Commission were impressed by his work and exerted considerable pressure to have him appointed Surgeon General of the Medical Department with the rank of brigadier general. Hammond created the general hospital service, oversaw the estab- lishment of an efﬁcient ambulance corps, and created two large govern- ment operated drug laboratories to produce high-quality medicines for the army. He also alienated many conservative regular and volunteer medical ofﬁcers when he removed popular drugs like calomel and tartar emetic from the Army’s ofﬁcial list of medical supplies.
The American Medical Association passed a resolution condemning Hammond’s deci- sion. Inevitably Hammond’s rapid promotion and obvious contempt for incompetents created powerful enemies, including Secretary of War Edwin M. Stanton, who charged him with graft, fraud, and exceed- ing his authority. After a trial that lasted from January to August 1864, Hammond was court-martialed and dismissed from the Army. George Strong, head of the Sanitary Commission, said that Hammond, who tended to avoid bureaucratic rules in pursuit of efﬁciency, had been guilty of ‘‘little more than the technical sin of purchasing supplies too freely.’’ Returning to New York, Hammond became Professor of the Diseases of the Mind and Nervous System at Bellevue Hospital Medical College. Widely recognized for his work in neurology, Hammond was a leader in the establishment of the American Neurological Association.
Hammond’s court-martial was overturned in 1879, and he was restored to the rank of brigadier general. Many of the improvements in Civil War medical services were the work of Jonathan Letterman (1824–1872), Medical Director of the Army of the Potomac. Often called the father of modern battleﬁeld medicine, Letterman acknowledged his debt to the work of the French military surgeon Dominique-Jean Larrey (1766–1842). During the Napoleonic wars, Larrey introduced ambulances volantes to expedite the removal of injured soldiers from the battleﬁeld. Working closely with Hammond, Letterman established an ambulance corps, raised standards for army surgeons and medical inspections, standardized tri- age and treatment, improved hospital and camp sanitation, simpliﬁed the collection and processing of medical data, and created a system of mobile ﬁeld hospitals using large tents. The ‘‘Letterman system’’ remains the basis of the modern organization and operation of military medical systems in all armies. The importance of the ambulance corps is apparent in a compari- son of the time taken to remove the injured after the battle of Manassas and the battle of Antietam, the bloodiest one-day battle of the war.
It took one week to remove the wounded at Manassas, but with Letterman’s transportation system in operation at the battle of Antietam, the ambulance corps was able to remove all the wounded from the battleﬁeld within 24 hours. Letterman also developed the three-tiered evacuation system that is still used today. Medical ofﬁcers at Field Dressing (Aid) Stations located next to the battleﬁeld applied dressings and tourniquets. The wounded were then brought to the Field Hospital (now MASH units) closest to the battleﬁeld for emergency sur- gery and treatment. Large hospitals at some distance from the battle- ﬁeld provided long-term care. Although much of the medical organization of the war was soon dismantled, the Surgeon General’s ofﬁce did retain signiﬁcant responsi- bilities and created institutions that provided materials for research and teaching. In 1862, Hammond established the Army Medical Museum in Washington to collect and study unusual anatomical and pathological specimens, projectiles, and other foreign objects found during surgical operations in military hospitals. The museum eventually became the Armed Forces Institute of Pathology. Hammond also was responsible for initiating the compilation of a comprehensive medical and surgical history of the war. Using the pathological specimens collected during the war and mountains of wartime records, Joseph J. Woodward, George Alexander Otis, and others organized the six thousand page, six volume Medical and Surgical History of the War of the Rebellion (1861–1865). Woodward and Otis, medical ofﬁcers in the Surgeon Gen- eral’s Ofﬁce, were the major editors of the History. Otis was curator of the Army Medical Museum from 1864 to 1881.
The Civil War also left a unique, unprecedented legacy in photographs, especially photographic studies of medical and surgical cases related to injuries sustained during the war. Another distinguished member of the Surgeon General’s Ofﬁce, John Shaw Billings (1838–1913), established the Army Medical Library, which became the National Library of Medicine. In addition to creating the Index Catalogue for the collection in the Library of the Surgeon General, Billings also established the Index Medicus, so that infor- mation in the rapidly growing medical and scientiﬁc literature would be accessible to researchers. In 1883, Billings became director of the newly combined Library of the Surgeon General’s Ofﬁce and the Army Medical Museum, which became the Army Medical Library and Museum. Through a law passed in 1976, the Armed Forces Institute of Pathology became the nation’s ofﬁcial medical repository. Specimens submitted to the Armed Forces Institute of Pathology for diagnosis, either by military or civilian doctors, are kept as part of the repository. Specimens in the repository have been invaluable for research on the history of disease. For example, lung tissue preserved in parafﬁn wax from the World War I period was used to identify the virus that caused the 1918–1919 inﬂuenza pandemic. The National Museum of Health and Medicine, which is now a division of the Army Medical Museum, has pathological specimens on display in exhibits on the Civil War, the Korean Conﬂict, and the human body.
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