# Armed Forces Institute of Pathology: Its First Century 1862-1962/Chapter II

CHAPTER II
Background and Beginnings
In May 1862, the United States had been at war with the Confederate States for a year and a month. After early defeats at Bull Run and Wilson's Creek, the course of the war had been marked by great victories and wide conquests. In the western theater, Fort Donelson had fallen to "Unconditional Surrender" Grant, Nashville had been occupied by Buell, the battle of Shiloh had resulted in victory for the Union, the great port of New Orleans had been taken by Farragut. In the East, the mountain counties of western Virginia had been detached from the Old Dominion, the defenses of the North Carolina sounds had been breached, the deep water harbor of Port Royal in South Carolina had been occupied to provide a safe base for the blockaders of the Atlantic ports, and, most conspicuous of all, General McClellan's mighty Army of the Potomac had advanced up the Virginia Peninsula, pushing the Confederate defenders back almost into the outskirts of Richmond itself.
For the Union, the war had gone well in its first year, but it had been at a cost in suffering and death from wounds and disease at which the people were appalled. The Nation had gone to war in traditional hip-hip-hurrah fashion, with little regard for the visible dangers of the battlefield and even less regard for the invisible but more deadly dangers of the diseases that lurked in the unclean camps.
Indeed, even if there had been a more realistic appreciation of these risks and dangers, there was not in the existing state of medical knowledge and military organization a great deal that could be done about them. Though anesthesia had been introduced in America some 15 years earlier, methods were still crude, and it was used with considerable misgiving. Bacteria were known to exist but had not yet been accepted as a cause of disease. Antiseptic surgery was still in the future, and asepsis was not yet even an ideal to be sought. The occurrence of pus in wounds or as a result of surgery was looked upon as part of the process of healing, a necessary suppuration. ​
Some Medical Problems of the 1860's
Medical men were still divided into dogmatic schools of thought, according to the theoretical basis on which they practiced. The dominant school, the allopaths, depended upon the administration of powerful dosages of drugs to combat the suppositious causes of sickness or to neutralize its effects; the homeopaths believed in small doses of medicine, operating on the theory that "like cures like." The nature of the curative agents largely relied upon by the medical profession led Dr. Oliver Wendell Holmes to observe, in an address before the Massachusetts Medical Society in May 1860, that "if the whole materia medica, as now used, could sink to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes."
Dr. Holmes granted that there were exceptions to his sweeping condemnation, but his opinion as to the efficacy of much of the orthodox treatment of disease was warranted by the fact that methods of treatment were derived more from speculation and theory than from directed and controlled experimentation.
Even if there had been a more general recognition of the importance of experiment and scientific observation, there was, in America in the early 1860's, little of the apparatus or equipment for observation of even simple symptoms. Even such familiar tools of the physician as the clinical thermometer and the stethoscope were all but unknown and little used, and it was not until the war was half over that the headquarters of the Medical Department of the Army enjoyed the possession of an achromatic microscope, the basic working tool of the pathologist.
Not because of these lacks—for at the time they were not recognized as such—but because of the almost total lack of organized readiness for the removal and treatment of the wounded, the Medical Department of the Army came under criticism and condemnation. To many, the suffering of the sick, and especially of the wounded, seemed unnecessarily severe because of the failure of the Department to foresee the mounting needs of war and to organize to meet them. The charge against the Department was "stiff adherence to antiquated forms and modes of action outworn even for peace conditions."
Whether the deficiencies of the Medical Department were greater than those of other staff departments of the Army may be questioned, and certainly the framework of the governing law, under which the Medical Department was compelled to rely on the quartermaster for transportation and hospital construction and upon the Commissary Department for subsistence, was faulty. ​But the fact that medical shortcomings, real or supposed, manifested themselves in the sensitive area of human suffering and death made all the more glaring every instance of ineptitude, inadequacy, inefficiency, or just plain indifference.
That there were such instances goes without saying. How could it have been otherwise, when a department set up to care for the medical needs of an army of 16,000 men, with all its methods geared to the slow tempo and small- scale demands of peacetime, suddenly found itself called upon to care for an army rapidly growing to the million mark and engaged in an active and hard- fought war?
A New Surgeon General
On 15 May 1861, the 80-year-old Thomas Lawson, Surgeon General of the Army since 1836, died. To succeed him, Clement Alexander Finley, veteran of more than 40 years' service in the Department, was named Surgeon General, to face the problems of an ever-expanding and hugely demanding war. In the opinion of the United States Sanitary Commission, an unofficial body with official recognition which was, in a sense, a forerunner of the American Red Cross, the new Surgeon General was too much devoted to routine, and lacked the flexibility of outlook, the largeness of concept, and the vigor in action which the situation required.
The Sanitary Commission pressed for passage by Congress of a bill enlarging and reorganizing the Medical Department of the Army, and likewise sought to have the 64-year-old Finley replaced as Surgeon General. In March of 1862, Finley fell afoul of the new Secretary of War, the imperious and irascible Edwin M. Stanton, and was forced to resign. In April, Congress passed, and President Abraham Lincoln signed, the bill reorganizing the Department and, on the 25th of the month, a new Surgeon General, William Alexander Hammond, was appointed (fig. 1).
The new Surgeon General, who was to become the father of the Army Medical Museum and, through it, of the Armed Forces Institute of Pathology, was less than 34 years old at the time of his appointment. His selection over officers who were his seniors in age, rank, and experience was due in large measure to the recommendation and persistent pressure of the Sanitary Com-
Figure i.—Brig. Gen. William Alexander Hammond, The Surgeon General, U.S. Army, 1862-1864.
Dr. Hammond was born in Annapolis, Md., on 28 August 1828, was reared in Pennsylvania, and studied medicine in New York, where he received his degree at the age of 20. He passed the examination for entrance into the Army Medical Service and in 1849 became an assistant surgeon. In the next 10 years, he served as medical officer at various frontier posts and also at West Point. He took advantage of a sick leave spent in Europe to study in the medical ​centers there. Returning to duty, he submitted a report on a nutritional research project of his own which won for him an American Medical Association prize in 1857. In the report on this study, in which Dr. Hammond had used himself as one of his "guinea pigs," he described himself as 6 feet 2 inches in height; from 215 to 230 pounds in weight; of a rather full habit of body; and disinclined to exercise for its own sake.
In the autumn of 1860, the future Surgeon General resigned from the Army to take the chair of anatomy and physiology at the medical school of the University of Maryland in Baltimore, but upon the outbreak of hostilities he had resigned his professorship and re-entered the Army, coming in as a lieutenant at the bottom of the promotion list, without credit for his 10 years of previous service.
The Scientific Approach
The new Surgeon General faced a mountain of problems of medical supply and administration, but he saw beyond these to the basic questions of the practice of military medicine and surgery. Within less than a month after taking office, therefore, the new Surgeon General, seeking more complete and accurate knowledge of actual conditions, issued his Circular No. 2 on 21 May 1862 (fig. 2).
This circular prescribed in detail the requirements of the "remarks" which were to accompany the monthly Reports of Sick and Wounded. Full information was called for as to fractures, gunshot wounds, amputations, and exsections by the surgeons. On the medical side, information was sought not only as to symptoms and treatment of fevers, diarrhea and dysentery, scorbutic diseases, and respiratory diseases, but also as to shelter and sanitary conditions, and as to the character and cooking of the ration, rightly regarded as factors in the causation and severity of sickness.
Almost as an afterthought, the circular announced in its closing paragraph the intention to create a medical museum. "As it is proposed to establish in
Figure 2.—Surgeon General Hammond announces his intention to establish the Army Medical Museum, 21 May 1862.
officer by whom it was prepared."
Three weeks earlier, on 1 May, General Hammond had procured, from the Adjutant General of the Army, orders for Assistant Surgeon Joseph Janvier Woodward, on duty with the Army of the Potomac, and Brigade Surgeon John Hill Brinton of the Volunteers, on duty with the Army of the Mississippi, to report to the Office of the Surgeon General for special duty. The nature of this duty was disclosed in part, on 9 June 1862, in Circular No. 5 (fig. 3). "It is intended," the circular read, "to prepare for publication the Medical and Surgical History of the Rebellion," with responsibility for the medical portion of the work assigned to Dr. Woodward and for the surgical part to Dr. Brinton, and with all medical officers called upon for cooperation (fig. 4).
The First Curator
Meanwhile, The Surgeon General was maturing his plans for a medical museum, and on 1 August 1862, he gave to Surgeon Brinton the go-ahead sign, directing him "to collect and properly arrange in the 'Military Medical Museum' all specimens of morbid anatomy, both medical and surgical, which may have accumulated since the commencement of the Rebellion in the various U.S. hospitals, or which may have been retained by any of the Medical officers of the Army." Dr. Brinton was also directed to "take efficient steps for the procuring hereafter of all specimens of surgical and medical interest that shall be afforded in the practice of the different hospitals" and to report the name of any officer who might decline or neglect to furnish such materials.
The 30-year-old Brinton had been a demonstrator of anatomy at the Jefferson Medical College in Philadelphia and had served with General Grant in the West. At Fort Donelson, under the direction of Surgeon H. S. Hewitt, he had put together the first combination of regimental hospitals and ambulances into brigade organizations, foreshadowing the broader and more comprehensive groupings for evacuation and treatment of the wounded to be worked out
Figure 3.—Circular No. 5, Surgeon General's Office, 9 June 1862.
Figure 4.—This group of U.S. Army medical officers includes several who were to be prominent in the history of the Army Medical Museum and the Library of The Surgeon General. Standing (left to right): Lt. Col. William G. Spencer, Assistant Surgeon Alfred A. Woodhull, Surgeon General Joseph K. Barnes, Assistant Surgeon Edward Curtis. Seated (left to right): Assistant Surgeons George A. Otis, Charles H. Crane, John S. Billings, and Joseph J. Woodward. (From an original glass negative dated 1864 in the AFIP files.)
hospitals at Alexandria, Falls Church, and Culpeper Court House, Va., and at Memphis, Tenn.
"My whole heart was in the Museum," he wrote afterward, "and I felt that if the medical officers in the field, and those in charge of hospitals, could only be fairly interested, its growth would be rapid and the future good of such a grand national cabinet would be immense. By it the results of the surgery of this war would be preserved for all time, and the education of future generations of military surgeons would be greatly assisted."
Figure 5.—Maj. John Hill Brinton, U.S. Volunteers, first Curator of the Army Medical Museum, 1862-1864.
Chancellorsville, Gettysburg—seeking to enlist the interest of the surgeons with the armies, to develop a "true professional interest" in the Museum as an opportunity to contribute to the "common stock of surgical knowledge" and ​to convince the skeptical that the formation of a "great National Surgical and Medical Museum was not for the collection of curiosities, but for the accumulation of objects and data of lasting scientific interest, which might in the future serve to instruct generations of students, and thus in time be productive of real use."
Dr. Brinton could hardly have foreseen that future generations of students would come to look upon many of the medical and surgical practices of the Civil War as curiosities carried over from the Middle Ages of medicine, but in his prediction that the institution which he was launching would "in time be productive of real use" he was abundantly correct—for the Medical Museum has broadened into the Institute of Pathology, serving not only the Armed Forces but, through its unique relation with the civilian specialist, serving the needs and pacing the progress of all pathology.
Collecting Specimens
Many of the Army surgeons of 1862 "entered into the scheme of the Museum with great zeal and earnestness," Dr. Brinton wrote afterward, "but some few there were, and these mostly the least educated, who failed to see its importance." In time, however, the project received "active and faithful co-operation" from the medical staff generally.
The chief difficulty encountered at first was in the field hospitals where, after battles, the medical forces were overwhelmed with the bloody work of operating under conditions and pressures which did not permit the preparation of specimens with their accompanying case histories.
"It really seemed unjust," Dr. Brinton noted, "to expect [under such circumstances even] the rough preparation necessary to preserve for the Museum the mutilated limbs." Consequently, the Curator adopted the practice of visiting the battlefields (fig. 6) where he had dug out of the trenches in which they had been buried "many and many a putrid heap" of legs and arms on which he went to work "amid surrounding gatherings of wondering surgeons and scarcely less wondering doctors." All saw, he said, that he was in earnest and as his infectious example spread from corps hospital to corps hospital, "active co-operation was eventually established."
In his visit to the Army of the Potomac, after the battle of Fredericksburg, Dr. Brinton was accompanied by Dr. William Moss, the Assistant Curator, the
Figure 6.—Surgeon John H. Brinton (front row, center), with a group of Union Army officers in the field.
after the interests of the Museum." On the afternoon of 15 December, Dr. Brinton "encountered Dr. Moss, my assistant, bringing with him an immense number of surgical specimens for the Museum, some of these in boxes, which we sneaked over in the wagons; the remainder were carried in great bags on the backs of one or two very black negroes." Upon his return from the field, the Curator sent his assistant back "down to the army for more" specimens. "By this time," he said, "the surgeons generally were becoming interested in the Museum project, and were taking pains to get and preserve what they could for the collection."
To spare the field surgeons as much as possible in the preparatory work, the Museum issued "Suggestions to the Medical Officers of the Army as to the Preparation and Forwarding of Specimens to the Army Medical Museum, Surgeon General's Office, Washington, D.C." After a listing of the types of "specimens illustrative of surgical injuries and affections" and the "specimens of diseases" which were desired, the Suggestions continued: "It is not intended to impose on medical officers the labor of dissecting and preparing the specimens ​they may contribute to the Museum. This will be done under the superintendence of the Curator."
Instructions for forwarding "such pathological objects as compound fractures, bony specimens, and wet preparations generally, obtained after amputation, operation or cadaveric examination" included rough removal of all unnecessary soft parts, wrapping in cloth so as to preserve all spicula and fragments, attaching a tag of wood or sheet lead bearing the number of the specimen and the name of the officer sending it, and immersing the object in a keg or small cask of diluted alcohol or whisky. When filled, the cask was to be forwarded to the Office of the Surgeon General by express, collect. At the same time, a corresponding list or history of the cases was to be mailed to The Surgeon General.
To facilitate the collection of specimens, the following medical officers at major hospital centers were designated to receive and forward them:
    Surgeon Lavington Quick, U.S. Volunteers, Baltimore
    Acting Assistant Surgeon Edward Hartshorne, U.S. Army, Philadelphia
    Acting Assistant Surgeon George Shrady, U.S. Army, New York
    Surgeon M. Goldsmith, U.S. Army, Louisville
    Assistant Surgeon F. L. Town, U.S. Army, Nashville
    Surgeon John S. Hodgen, U.S. Army, St. Louis
    Surgeon H. S. Hewitt, U.S. Volunteers, Army of the Mississippi
In acknowledging receipt of specimens submitted in response to circular letters and individual communications, Dr. Brinton, upon occasion, inquired as to particular cases of which he had knowledge. For example, in a letter of 17 December 1862, thanking Surgeon John S. Hodgen at St. Louis, Mo., for his contributions, Brinton mentioned that he had not seen among them "one of a gunshot wound of the ear which occurred at Fort Donelson and was treated in the Hospital under your charge last winter," and asked for the specimen and also for "the round ball which inflicted the injury should it be in your possession." Not every wounded man was willing to give up the severed portion of his anatomy or the projectile by which he was struck. As an instance of this occasional unwillingness, there is the case of Pvt. W. H. Knaup of the 2d New Jersey, who was struck by a shell fragment in the left cheek and lost the angle of his jaw. Brinton wrote the surgeon in charge of the hospital at Chester, Pa., to which Knaup had been removed, to "make him ​give up the shell by which he was struck and the loose angle of jaw for the Army Museum," adding, "Keep every specimen you can."
Some of the operating surgeons, through ignorance or misunderstanding of orders, believed that the specimens resulting from their operations were their own to dispose of as they saw fit. One such instance was that of Surgeon R. B. Bontecou, of the hospital at Beaufort, S.C., who, while on duty in the Peninsula, collected between 70 and 80 preparations which he gave to Dr. Thomas M. Markoe of New York. Brinton wrote to the recipient of the gift, explaining that "all the specimens collected by medical officers belong to the national museum" and calling for the return of those which had been transferred to him by Surgeon Bontecou "under the mistaken impression that he possessed the right to part with them." There is no record of the receipt of anything from Dr. Markoe, but eventually Dr. Bontecou contributed 101 specimens. And then there was at least one case of outright theft of specimens by "the men who had charge of the dead house" at a general hospital, and the sale of the specimens to a New York physician.
In spite of early indifference and the very real difficulties of collection, the specimens came in, even though the case histories which were to have accompanied them were frequently lacking. Enough material had been received by the end of 1862 to warrant the issuance of a small catalog in January 1863 (fig. 7). In a covering letter to Surgeon General Hammond, the Curator noted that "all the contained specimens," numbering 1,349 objects, had been collected since the Museum's establishment in August and the number was "being daily augmented." Of the objects cataloged, 985 were surgical specimens, 106 were medical, and 103 were missiles, "for the most part extracted from the body." Through the cooperation of the Ordnance Department of the Army, the Museum was enabled to display also a series of projectiles for small arms, field and heavy guns, and a set of the bayonets in use in the United States and foreign countries.
This first catalog of the Museum was "offered simply as a numerical list of the objects" in the collection with no attempt to classify the various injuries or to describe in detail the preparations included.
Figure 7.—A page from the first Catalogue of the Army Medical Museum. The specimen shown is the one listed as No. 76 in the catalogue.
conoidal bullets devised by Capt. C. E. Minié of the French Army and widely adopted by both sides in the Civil War. Comparatively few American surgeons had had experience with gunshot wounds, and fewer still had so much as ​seen wounds made by Minie balls—hence the emphasis upon such specimens in what soon came to be the largest collection of such specimens in the world.
Some 30 of the specimens other than gunshot wounds were from reamputations or other secondary operations. Two were from victims of railroad accidents; one was the result of a kick by a horse. Only two were saber wounds, and there were no instances of wounds by the bayonet. One specimen was from a case of gangrene of the face attributed to salivation—a condition resulting from excessive dosage of calomel or other mercurial drugs. The most numerous single disease listed as the cause of the lesions shown in the specimens was typhoid fever, designated in 17 cases. The most frequently mentioned disease was "Chickahominy diarrhoea," 10 cases. The Museum's specimens, as they may be observed in its original catalog, were illustrative of the effects of military action and camp conditions upon the life and health of the soldier.
The work of preserving the specimens and preparing them for museum purposes was done at the Museum by a professional anatomical "preparator," Frederic Schafhirt, assisted by his son, Adolph, and later, also by his son, Ernst. The senior Schafhirt, who bore the courtesy title of "Doctor," was born and trained in Germany and had been an assistant in anatomical work for Dr. Joseph Leidy of the University of Pennsylvania.
The preservative commonly used was alcohol diluted in strength to 70 percent. This alcohol was secured by re-distilling the illicit liquors seized and confiscated by the provost marshal of Washington, a source of supply which was found adequate for Museum purposes for some years. Dr. Brinton recalled afterward that the side lot of the Museum was "piled with kegs, bottles, demijohns and cases, to say nothing of an infinite variety of tins, made so as to fit unperceived on the body, and thus permit the wearer to smuggle liquor into camp."
New Quarters for the Museum
During these early months of the Museum's life, its quarters were moved twice. The first move was from the "top of my desk," as Brinton wrote, to some "shelves put up for the purpose in my rooms in the Surgeon-General's office," then located in the old Riggs Bank Building (fig. 8) at the corner of President Place (now Pennsylvania Avenue) and 15th Street, NW., Washington, D.C. From these shelves, on the second floor rear of the bank building, the growing collection was soon removed to rooms in a building at 180 Pennsylvania
Figure 8.—The first home of the Museum.
Avenue, NW., which stood on lots since numbered as 1719-1721 (fig. 9) . While in this building, the first catalog was issued, but as increasing numbers of specimens came in from the hospitals and the field, new and larger quarters were imperatively demanded.
Figure 9.—The second home of the Museum.
contemporary documents as a "mechanics' library," the "Library Building occupied by Miss Middleton's School," and "the Art Gallery Building." It might have been intended for use by the subsequently famous Corcoran Gallery of Art, but ​it was in use as a school and was known as "Mr. Corcoran's School House" when it was taken over by the Government. Mr. Corcoran agreed to put the building in repair and rent it for $1,000 a year. The proposition was accepted by the Curator, and on 16 May The Surgeon General asked permission of Secretary Stanton to rent the building on these terms, the rent to be paid out of an appropriation of $5,000 for the Museum which had been made at the closing session of the Congress.
On 21 May, the Secretary of War directed that the Military Governor of Washington, Maj. Gen. Ethan Allen Hitchcock, take possession of the building and turn it over to the Medical Department of the Army for the use of the Medical Museum, which was done in Special Orders No. 116, Headquarters, Military District of Washington, on 22 May 1863.
Dr. Brinton stated in a letter of 24 August to Col. Joseph K. Barnes, Medical Inspector and Acting Surgeon General, that Secretary Stanton had ordered that "no rent will be paid for the building" owned by Mr. Corcoran, but regardless of rent or no rent, the Medical Department took possession of "the building known as Corcoran's School House near Dr. Gurley's Church, together with its outbuildings thereto, having been turned over to this department by order of Secretary of War" and on 1 June assigned the quarters to the Museum, directing Surgeon Brinton to "take charge thereof, and make such alterations and repairs as may be necessary to fit it for the purpose of the army Medical Museum." Brinton was cautioned, however, to "avoid all useless alterations or expense."
Figure 10.—The third home of the Museum. Picture is from an engraving by H. H. Nichols of the Museum staff.
Grounds for Anxiety
Apparently, judging from the anxious tone of Brinton's letter of 24 August 1863 to Col. Joseph K. Barnes, the Acting Surgeon General, there was some apprehension that the Museum project might be caught in the backwash of the increasingly bitter differences between Surgeon General Hammond and the Secretary of War. These differences between two men of powerful personality and clashing temperament had progressed to the point, by 2 July 1863, that a special commission of three civilians was appointed to scrutinize The Surgeon General's papers, seeking cause for his removal. The Surgeon General had added to the ranks of his opponents by the issuance, on 4 May 1863, of his Circular No. 6 striking calomel and tartar emetic from the list of Army medical supplies—an action which outraged many physicians who were accustomed to use calomel as a standard medication, if not as a sovereign remedy. Before the month of August was out, Hammond was ordered out of Washington on a vague and ill-defined mission of inspection in the South with headquarters at New ​Orleans, whence he was to report to the Secretary every 10 days, while Colonel Barnes acted as Surgeon General. 17
It was obvious that the Secretary of War was determined to be rid of the innovating and independent Hammond, and it might well have been apprehended that this determination extended beyond the person of the unwanted Surgeon General to all his works, as well. At any rate, Curator Brinton, while disclaiming any need for such representations, urged upon Acting Surgeon General Barnes that the plan for the Museum be carried out. "It is unnecessary for me, Colonel," he wrote, "to urge upon you the value of our National Medical Museum. Its claims to usefulness are recognized by the civil profession throughout the country and it is by them weekly and almost daily considered. The cabinet as it stands is not a mere Museum of curiosities. It is a collection which teaches."
"It is practical," he continued, "and has already powerfully influenced for the better the treatment of the wounded soldier." In confirmation, he called to mind the lessons to be deduced, from the study of the specimens of the Museum, as to injuries of the joints from conoidal balls, "a class of injuries previously almost unknown and the treatment of which, at the commencement of the war, was unsettled."
The proposed arrangement of the Museum in its new quarters, he added, would open the collection to the study of every surgeon, civil as well as military. Only in this way, he said, could a true knowledge of the treatment of wounds caused by modern projectiles be diffused. Concluding, he referred to the loss which would occur if the plans for the Museum should be changed. "I know of no other suitable building for the purposes of the Museum," he wrote, "and even should one be found, the fund at command would be utterly insufficient to make a second time the alterations and repairs which would be absolutely necessary."
Dr. Brinton's argument against scuttling the plan for removal of the Museum to its new and larger quarters was successful, for on 1 September Colonel Barnes was notified that the Secretary of War had "authorized the transfer of the specimens from the room in the Surgeon General's office to the Museum newly selected." 18 ​
Plans for an Army Medical School
Dr. Brinton was less successful in the attempt to establish a school of military medicine and surgery in the Museum. On 24 September 1863, four young Army medical officers then on duty in Washington, some of them being connected with the Museum and "wishing to make that institution at once practically useful," asked Acting Surgeon General Barnes for "permission to deliver a course of lectures on military medicine and surgery in the hall of the Museum." Such a course would be particularly advantageous, they suggested, because of the large number of medical cadets and junior medical officers on duty in the hospitals in the Washington area. It was proposed to deliver the lectures in the evening so that they "would in no way interfere with the official duties of anyone concerned." The proponents of the course had all had experience in lecturing on medical subjects. "These lectures of course will be delivered free," the letter read, "and with the facilities afforded by the Museum would not be a source of any expense whatever to the Government."
The officers who thus proposed what would nave been the first school of the sort were: Doctors Brinton and Woodward, Dr. Roberts Bartholow, and Dr. D. W. Bliss. Others who were to have lectured included Surgeons John A. Lidell and A. C. Hamlin, Assistant Surgeon William Thomson, of the Volunteers, and Surgeon Richard H. Coolidge of the Regular Army, who was to have taught the customs of the service and military medical ethics.
The Acting Surgeon General submitted the proposition to the Secretary of War, who said he would decide the matter the next day. Surgeon Brinton tells the story :
On the morrow, about nine o'clock, on his drive from his home to the war office, he [the Secretary] stopped at the Museum Building, descended from his carriage, ran hastily through the Museum rooms, looked angrily at the dear little lecture room, stamped his foot, growled, "Ugh," drove to his office, sent for Acting Surgeon General Barnes and said sharply to him, "Are these lectures to be given in the evenings?" To an affirmative reply, he growled, "They will go to the theatre and neglect their duties. It shan't be," and thus was the end of a favorite plan for doing some good for the Medical Corps of the Army, and for disseminating a more correct and general knowledge of military medicine and surgery. 19
And, it might be added, it was to be another 30 years before the idea of an Army Medical School was to come to fruition. ​
The Museum's Collections Grow
However disappointed Brinton and Woodward may have been at Secretary Stanton's brusque dismissal of their promising plan, they still enjoyed the support of Acting Surgeon General Barnes both in their work on the "History" and on the Museum project. On 25 November 1863, and again on 24 June 1864, Dr. Barnes issued circular letters to all medical officers in aid of the Museum. In the first letter, he invited attention to the possibilities of illustrations and representations of the results of surgical operations by means of plaster casts which, it was said, could "in many instances be conveniently obtained — without subjecting the patient to the slightest inconvenience." It was suggested that cases in which the results of the operation had been unfavorable would be as "instructive and valuable for future reference and study" as those which had resulted favorably.
The 1864 circular of Acting Surgeon General Barnes directed medical officers in charge of hospitals "to diligently collect and preserve for the Army Medical Museum all pathological specimens which may occur in the hospitals under their charge." Listing the types of objects desired, the circular contained directions for forwarding them to the Surgeon General's Office, substantially repeating and reinforcing the "Suggestions" printed in the 1863 Catalogue of the Museum. 20
Under the stimulus of these orders, and as a result of the missionary efforts of the Museum staff, specimens continued to come in, particularly after the great battles. Two barrels, filled with the gruesome materials resulting from the work of the surgeons, were sent in by a member of the Museum staff after Gettysburg.
One specimen from that battle which came in, without need of orders from The Surgeon General or solicitation by Museum staff members, was an amputated leg, received in a small coffin-like box, bearing the visiting card of the donor with the message, "With the compliments of Major General D. E. S." Gen. Daniel E. Sickles, whose leg it was or had been, combined a keen sense of self-advertisement with a high estimation of the importance and interest attached to the severed anatomy of the commanding general of the III Corps. That he was correct in his estimate is evidenced by the fact that even today ​ the fractured bones of the Sickles' leg attract the interest of visitors to the public exhibits of the Museum (fig.II)." 21
Hammond In Exile
Throughout the last half of 1863, the Medical Department of the Army was in the anomalous state of having two heads— the titular Surgeon General Hammond, who was in official exile away from the seat of government, and Acting Surgeon General Barnes, in charge of affairs at the Capital. Determined to put an end to this situation, Hammond demanded reinstatement in his office or trial by court-martial. Permitted to return to Washington, he arrived on 15 January 1864, to be placed in arrest on the 17th, and ordered to trial, beginning the 19th, on charges of irregularities in the procurement of supplies and falsehood. Hammond sought a postponement to allow preparation of his defense, but it was denied him, and he was forced to proceed to trial in 48 hours on charges and specifications which had required 6 months to prepare. The ensuing trial ran for nearly 4 months, accumulated a record of 2,500 pages, and resulted in a verdict of guilty and a sentence of dismissal from the Service, approved by the implacable Secretary of War and promulgated on 18 August.
Dr. Hammond, far from being crushed by the sentence, retained the respect of the medical profession, and went on to win new honors as one of the founders of the developing specialty of neurology, with a large and lucrative practice in New York City. Fifteen years after his dismissal, on 27 August 1879, by Act of Congress and action of the President, he was restored to the retired list of the Army with his rank of brigadier general, though, at his own request, without pay for the past, present, or future. In its report recommending such action, the Senate Committee summed up the evidence as follows:
A careful, unbiased and searching scrutiny of the evidence * * * forces irresistibly the conclusion that the gravamen of all the charges save one (that of falsehood) was either disproved by the defense, abandoned by the prosecution, or eliminated by the findings of the court.
The single charge of which the gravamen was not found wanting by the Court, was in itself trifling, if not frivolous, and certainly insufficient in character and importance to arraign, try, convict, and pronounce sentence thereon, in the manner and form set forth.
Referring to Hammond's request that he not be awarded pay but only vindication, the Committee wrote:
Figure 11.—The "Incredible" General Sickles and his leg bones.
be again inscribed upon the roll of honor in companionship with those brave men who had fought the good fight and rested on their unstained laurels. 22
The verdict of the Senate Committee, concurred in by the Senate, the House of Representatives, and the President, that William Alexander Hammond deserved well of his country, has been accepted by all who are acquainted with the achievements of his 15 months in actual charge of the affairs of the Medical Department and with the circumstances surrounding his dismissal. In the face of indifference, and even obstinate opposition, he had initiated reforms and launched institutions which were to be of lasting benefit, and even his unfulfilled recommendations were to come to fruition in later years.
The Second Curator
The change in surgeons general was followed, a month later, by the relief of Major Brinton from his duties in the Surgeon General's Office and also as Curator of the Medical Museum, and by orders for him to report to Assistant Surgeon General Robert C. Wood at Louisville, Ky., for assignment in the West. On 3 October, Dr. George Alexander Otis (fig. 12), who had been Brinton's assistant since July, was named as his successor and was to serve as Curator longer than any other individual. 23
The new Curator, 34 years old, was from Massachusetts but had received his M.D. degree from the University of Pennsylvania, had studied in Paris, and had practiced for 2 years in Richmond, where he had founded and edited the Virginia Medical and Surgical Journal. From 1854 to trie outbreak of the war, he had practiced in Springfield, where he had joined a Massachusetts regiment as surgeon. After 3 years' service, in which he had attracted the favorable attention of Charles Henry Crane, Assistant Surgeon General, he was assigned to the Museum." 24
Reorganization of the Museum
Figure 12.—Lt. Col. George A. Otis, the second Curator of the Army Medical Museum, 1864-1881.
Sections were continued under the exclusive control of Dr. Woodward, an arrangement which, according to Otis's report of i July 1865, was to work with "entire harmony and concert of action" between the respective departments. This division of labor was not new, since during Brinton's curatorship, pathological work, as distinguished from the collection and preparation of specimens, had been largely assigned to Woodward. Like his associate, Brinton, Woodward was a Philadelphian, born in 1833, and a graduate in medicine at the University of Pennsylvania in 1853. He was a founding member of the Pathological Society of Philadelphia, organized in 1857, and had published several papers dealing with microscopic studies before entering the Army at the outbreak of war. In connection with his duties at the Museum, he had written "The Hospital Steward's Manual," published in 1862, a valuable guide for the work of the forerunners of today's medical corpsmen, and "Outlines of the Chief Camp Diseases of the United States as Observed During the Present War," published in 1863. 25
Pioneering in Microscopy
It was in the study of "camp fevers and diarrheas" that Dr. Woodward (fig. 13) made the pioneer use in America of the newly discovered aniline dyes in staining tissue, so that certain parts become more visible under the microscope. The idea of staining specimens so as to cause particular features to stand out more clearly was as old as Van Leeuwenhock himself, but the unstable nature and the limited range of colors of most of the vegetable and animal dyes available had limited the use of the idea until the discovery, by the English youth, William Henry Perkin, of aniline dyes made from coal tar. The new dye industry flourished famously in Germany and it was there, in 1862 and 1863, that the new colors were used to stain specimens for microscopic examination.
Figure 13.—Lt. Col. Joseph J. Woodward, MC, who pioneered in America in the use of aniline dyes for staining microscope slides and in photomicrography "using the highest powers."
of Investigating the Histology of the Human Intestine and Remarks on Some of the Points To Be Observed in the Study of the Diseased Intestine in Camp Fevers and Diarrheas."
From the title of Dr. Woodward's paper and its opening statement that "the use of these colors for the purpose of staining certain parts of tissues and thus rendering them more visible appears to be unknown in this country and, so far as I can learn from the journals accessible to me, is imperfectly understood abroad," it appears that, working independently in the Army Medical Museum, ​young Dr. Woodward had hit upon and developed one of the great basic techniques of the pathologist. 26
Woodward, Curtis, and the Camera
Another of the indispensable tools of present-day pathology in which Woodward did pioneer work was the photographing of objects visible only under the microscope. In this work, he was assisted by Dr. Edward Curtis (fig. 14), whom Woodward described in his letter to Virchow as a patient and dexterous young man (Woodward himself was 31; Curtis was 5 years younger) with preliminary training as a microscopist, who was capable of independent investigation in pathology.
The work in photomicrography, first undertaken late in 1864 (fig. 15), was described in a report to The Surgeon General, published on 1 November 1865 as Circular No. 6, and again in the second part of the Catalogue of the Microscopical Section of the Museum, published in 1867. 27 In these early experiments with microscopic photography, the source of illumination was the sun itself, ingeniously harnessed "to insure a perfectly steady and at the same time an intense light," according to the account of the process as given in the catalogue.
The room in which the photograph was to be taken, darkened so as to dispense with a light-tight bellows, became the "camera" with a window facing south as the "shutter," through which the direct rays of the sun, caught
Figure 14.—Maj. Edward Curtis, U.S. Volunteers, who collaborated with Dr. J. J. Woodward in photomicrography.
Figure 15.—Photomicrography spreads. A. The idea of photomicrography had spread from the Medical Museum to the general hospitals, as shown by this memorandum of its use in the Douglas Hospital in Washington.
Figure 15.—Continued. B. The miscroscope shown is one of those issued by the Surgeon General's Office.
rays of the solar beam. Pictures were "snapped" by opening an aperture in the light-tight shield with which the window was fitted.
The apparatus with which Surgeon Woodward and Assistant Surgeon Curtis worked was, to a large extent, of their own devising. At that time, all plates used in photography had to be sensitized, exposed, and developed while wet with chemicals mixed and applied at the time and place where the picture was to be taken. Projection printing had not been perfected, so that it was still necessary to expose the bulky wet plates in the size desired for the final print. With all these complications in photography, experience showed that better pictures were obtained by the employment of a "practical photographer * * * to manage the dark room" while the microscopist focused his "whole attention to the optical arrangements." Despite difficulties and complications, the pioneer photomicrographers made pictures which suffer not at all in comparison with those made today.
Figure 16.—Pioneer photomicrography. A. By sunlight. B. The microscope is wedded to the camera.
Despite the frustrating delays of overcast weather and the vagaries of passing clouds even on sunny days and determined to make the "process wholly independent of the weather," experiments were undertaken in 1869, using electric lights and magnesium lamps (fig. 17), such as were used for "magic lantern" lectures. Both proved successful, but the electric light was superior. In fact, Woodward reported to The Surgeon General on 5 January 1870, that an electric lamp, powered by a 50-unit battery, gave better results with less trouble than sunlight, and claimed for the Museum and for himself the credit of having demonstrated the serviceability of artificial lighting as a source of illumination for making negatives of high powers. The use of artificial lighting made it possible, as Dr. Woodward reported in 1870, "to sit down quietly of an evening, and during 4 hours of work to produce from 12 to 30 negatives, or more" — a casual reference to the working habits which, along with his zeal and enthusiasm, accounted for his prodigious output. But even before his successful demonstration of the use of artificial light, Dr. Woodward, assisted by Dr. Curtis, made negatives which were clear and well defined at the magnification of 2,344 diameters, and which retained their clarity and definition even when enlarged photographically to 19,050 diameters (fig. 18). 28
Making photomicrographs, however, was but one facet of the work carried on by Lieutenant Colonel Woodward and Major Curtis. There was always the work on the massive medical volumes of the Medical and Surgical History and on the voluminous and growing materials of the Record and Pension Division, which had been committed to Woodward's care.
The Museum and the Lincoln Tragedy
Figure 17.—Photomicrography by artificial light. A. Using the electric light. B. Using the magnesium light.
Figure 18.—A diatom, a form of unicellular life of microscopic size, is magnified by 2,540 diameters.
and lodged in the white matter of the cerebrum just above the anterior portion of the left corpus striatum where it was found. The ventricles of the brain were full of clotted blood. A thick clot beneath the dura mater coated the right cerebral lobe. There was a smaller clot under the dura mater of the left side. ​But little blood was found at the base of the brain. Both orbital plates of the frontal bone were fractured, and the fragments pushed up toward the brain. The dura mater over these fractures was uninjured. The orbits were gorged with blood. 29
A more colorful and emotion-packed account has been left by Dr. Curtis, who wrote:
Eleven o'clock comes; the two designated pathologists are ushered into what was the bedchamber of the deceased, a room furnished in simplest style. There sit in solemn silence some officers in uniform and some civilians, while the Surgeon General paces nervously to and fro beside another silent occupant of the chamber, a shrouded figure, cold and motionless, lying outstretched upon two boards laid across trestles * * *.
The shroud is laid back, and see! A smooth clear skin fitting cleanly over well-rounded muscles, sinewy and strong * * *. Next see at the back of the head, low down and a little to the left, a small round blackened wound, such as is made by a pistol-shot at close range. There is no counter-opening, so the missile has lodged and must now be found * * *. The part is lifted from its seat, when suddenly, from out a cruel vent that traverses it from end to end, through these very fingers there slips a something hard — slips and falls with a metal's mocking clatter into a basin set beneath. The search is satisfied; a little pellet of lead.
So impressed was Dr. Curtis with the historical interest attached to the autopsy on the martyred President, that when he found some drops of the blood of the President upon his cuffs, Mrs. Curtis cut them off and saved them. Ultimately, they were presented to the Medical Museum where they may be seen today, along with a tiny sliver of bone which evidently had been driven into Mr. Lincoln's brain by the bullet and had adhered to the surgical instrument used by Dr. Curtis (fig. 19) . 30
Figure 19.—The bullet that ended President Lincoln's life, the instrument used to locate it, and bone fragments which adhered to it.
Figure 20.—Hermann Faber, whose sketch of the Lincoln deathbed scene gives some idea of the throng in attendance.
Figure 21.—This sketch, made by Hermann Faber immediately after the removal of President Lincoln's body from the Petersen house in which he died, was approved for accuracy by Surgeon General Barnes.
poster is illustrated with a familiar pose of Booth, but the picture of David E. Herold is that of a schoolboy, while the one supposed to represent John H. Surratt is of some other individual entirely. Later, after the conspirators had been captured, tried, and executed, the War Department revised the photographic part of the poster, changing the Booth picture to another pose, the picture of Herold to one made after his capture, and the Surratt picture to one of Surratt made after his capture and return to the United States. The poster exhibited at the Medical Museum is one of the revised edition (fig. 22).
Figure 22.—Reward poster, revised.
and fifth cervical vertebrae and the perforated spinal cord, all of which are now on exhibition in the Museum. 34
With the surrender at Appomattox and the collapse of the Confederacy, the war which had been responsible for the birth and growth of the Museum was approaching an end. Soon the grand armies of the Union would march in review up Pennsylvania Avenue and would disband to their homes. Many of the war-born institutions would come to a close — but not the Army Medical Museum. It would continue its mission of showing, by specimens, preparations, and illustrations, the nature and form of disease and injury, and teaching ways and procedures to alleviate suffering and lessen mortality according to the medical lights of the time.
* ↑ Duncan, Louis C: Evolution of the Ambulance Corps and Field Hospital, p. 4. In The Medical Department of the United States Army in the Civil War. Washington, 1911.
* ↑ Adams, George Washington: Doctors in Blue: The Medical History of the Union Army in the Civil War. New York: Henry Schuman. Inc.. 1052, pp. 28-31.
* ↑ Drayton, Evelyn S.: William Alexander Hammond, 1828-1900; Founder of Army Medical Museum. The Military Surgeon 109: 559-565, October 1951.
* ↑ Circular No. 2, Surgeon General's Office, Washington City, May 21, 1862. On file, National Archives, Accession No. 421, Circulars/SGO/1862-1865.
* ↑ (I) Special Orders Number 98, War Department, Adjutant General's Office, 1862. (2) Circular No. 5, Surgeon General's Office, Washington, D.C., June 9, 1862. On file, National Archives, Accession No. 421, Letter Book No. 30. March 7 to May 30, 1862/SGO, p. 319.
* ↑ Brinton, John Hill: Personal Memoirs. New York: The Neale Publishing Co., 1914, pp. 180-181.
* ↑ (I) Duncan, op. cit., The Battle of Bull Run, p. 21. (2) Duncan, op. at., Evolution of the Ambulance Corps and Field Hospital, pp. 2-4.
* ↑ Record of John Hill Brinton's Action in the Matter of the Military Medical Museum. On file in historical records of AFIP; letters of 28 July, 7, 9, 12, 18, and 19 August 1862.
* ↑ Brinton, op. at., pp. 181, 186.
* ↑ Ibid., pp. 186, 187-188, 214 220, 222.
* ↑ Catalogue of the Army Medical Museum, Surgeon General's Office, Washington, January 1. 1963, pp. 5, 6.
* ↑ (1) Record of John Hill Brinton's Action in the Matter of the Military Medical Museum, pp. 11, 22, 52, 59. On file in historical records of AF1P; letters of 28 July, and 7, 9, 12, 18, and 19 August 1862. (2) Lamb, Dr. D. S.: A History of the Army Medical Museum, 1862-1917, compiled from the Official Records. Mimeographed copy in historical records of AFIP, pp. 8, 9.
* ↑ Catalogue of the Army Medical Museum, Surgeon General's Office, Washington, January i, 1863, passim.
* ↑ (1) Lamb, op. cit., pp. 4, 5, 25. (2) Krinton, op. cit., pp. 181-182, 191.
* ↑ (1) National Archives, War Department Records, Adjutant General's Office, Miscellaneous 204, Accession Number 421, SG Letter Book Number 4, Surgeon General's Office, p. 108. (2) Brinton. op. at., pp. 182-184. (3) Lamb, op. at., pp. 16, 17, 19-21. (4) Lamb, D. S.: Army Medical Museum. Washington, D.C. The Military Surgeon 53: 99, 101, August 1923. (5) W. W. Corcoran Papers. On file in Manuscript Division, Library of Congress, Letter Press Copy Book, volume 22, pp. 269, 410.
* ↑ (1) Original letter, John Hill Brinton to Joseph K. Barnes, 24 August 1863. On file in historical records of AFIP. (2) Lamb, op. at., pp. 19, 20. (3) Lamb, The Military Surgeon. 53 (1923). pp. 101, 102. (4) Brinton, op. at., pp. 183, 184.
* ↑ 17 (1) Duncan, Louis C: The Strange Case of Surgeon General Hammond. The Military Surgeon 64: 107-108, January 1929. (2) Ashburn, Percy M.: Gleanings from Medical Department History. Military Surgeon 64: 449, March 1929. (3) Drayton, Evelyn S.: William Alexander Hammond, 1828-1900; Founder of Army Medical Museum. The Military Surgeon 109: 563, October 1951.
* ↑ 18 (1) Original letter, John Hill Brinton to Joseph K. Barnes, 24 August 1863. On file in historical records of AFIP. (2) Lamb, op. cit., pp. 19-21. (3) Lamb, The Military Surgeon, 53 (1923), pp. 101-102.
* ↑ 19 (1) Original letter, John Hill Brinton to Joseph K. Barnes, 24 September 1863. On file in historical records of AFIP. (2) Lamb, op. cit., pp. 23-25. (3) Lamb, The Military Surgeon, 53 (1923), pp. 103, 104. (4) Brinton, op. cit. pp. 258—259.
* ↑ 20 (1) Circular Letter, Surgeon General's Office, June 24, 1864. On file in National Archives, War Department Records. (2) Lamb, op. cit., pp. 25A, 25B, 28, 29. (3) Lamb, The Military Surgeon, 53 (1923), pp. 105-109.
* ↑ 21 (1) Brinton, John Hill: Address to the Graduates of the Army Medical School, March 13, 1896. Journal of the American Medical Association 26: 602, March 28, 1896. (2) Lamb, op. cit., p. 18. (3) Lamb, The Military Surgeon, 53 (1923), p. 100.
* ↑ 22 (1) Duncan, Louis C: The Strange Case of Surgeon General Hammond. The Military Surgeon 64: 98-110, January 1929, and 64: 252-262, February 1929. (2) Phalen, James M.: William Alexander Hammond. Army Medical Bulletin, Number 52, pp. 42-46, April 1940.
* ↑ 23 (1) Special Orders Number 245, Adjutant General's Office. On file, National Archives, Accession Number 421. Letter Book Number 9, Military, Surgeon General's Office. (2) Brinton, op. cit., pp. 307,312, 313.
* ↑ 24 Hume, Edgar Erskine: Victories of Army Medicine: Scientific Accomplishments of the Medical Department of the United States Army. Philadelphia: J. B. Lippincott Co., 1943, p. 81.
* ↑ 25 (1) Hume, op. cit., pp. 141, 142. (2) Edmonds, Henry W.: Woodward and the Changing Concept of Cancer, 1858-1873. The Military Surgeon 109: 314, 315, October 1951.
* ↑ 26 (1) Copy of letter, Joseph J. Woodward to Rudolf Virchow, 14 May 1864. On file in historical records of AFIP. (2) Leikind. Morris C: Aniline Dyes — Their Impact on Biology and Medicine. From the Report of the Smithsonian Institution for 1957, Publication Number 4330, p. 437. (3) Lamb, op. cit., p. 38. (4) American Journal of the Medical Sciences 49: 106-113, New Series, 1865.
* ↑ 27 (1) Circular No. 6, Surgeon General's Office, War Department, November 1, 1865, p. 148. (2) American Journal of Science and Arts, Second Series, Volume LXII, Whole Number XCII, New Haven, September 1866, pp. 189-195. (3) Catalogue of the Microscopical Section of the United States Army Medical Museum, Washington, 1867.
* ↑ 28 (1) Woodward, J. J.: Report to the Surgeon General .... on the Magnesium and Electric Lights as applied to Photo-Micrography, Washington, January 5, 1870. (2) Lamb, op. cit., p. 27.
* ↑ 29 (1) This account is taken from a true copy of the original, certified by Maj. George A. Otis, in the collection of the Medical Museum. In Gilmore, Col. Hugh R., Jr.: Medical Aspects of the Assassination of Abraham Lincoln. Proceedings of the Royal Society of Medicine, London, 47: 103—108, February 1954. It is Dr. Gilmore's opinion that "it is doubtful if modern medical practice could have saved Lincoln's life." (2) In a lecture at Walter Reed Army Medical Center on 25 May i960 (reported in the Washington Post of 25 May), Lt. Col. George J. Hayes, M.C., Chief of Neurological Service, said that even with the best of modern medical service, the President would have had no more than a 50-50 chance of survival, and even if he had survived, he would probably have been completely paralyzed on the right side and possibly unable to talk.
* ↑ 30 (1) Personal Recollections of the War of the Rebellion: addresses delivered before the Commandery of the State of New York Military Order of the Loyal Legion of the United States, Fourth Series, A. Noel Blakeman (editor), New York, 1912, includes "Last Professional Service of the War," pp. 54-65, read on 7 October 1908 by Companion Edward Curtis, Brevet Major, Late U.S.A. (2) From the bloodstains on the cuffs preserved by Mrs. Curtis, Col. Joseph H. Akeroyd, MSC, U.S. Army (now stationed at Brooke General Hospital) was able to type President Lincoln's blood as Type A.
* ↑ (1) Purtle, Helen R.: Lincoln Memorabilia in the Medical Museum of the Armed Forces Institute of Pathology. Bulletin of the History of Medicine 32: 68-74, January-February 1958. Miss Purtle's article discusses interestingly the various Lincoln items in the Museum, and gives an account of the acquisition of each one, which was mostly by gift. (2) Original sketch was presented on 30 January 1933, by Erwin F. Faber, son of Hermann Faber, to the Army Medical Museum. Letter on file in historical records of AFIP.
* ↑ Lamb, op. cit., p. 35.
* ↑ Roscoe, Theodore: The Web of Conspiracy. Englewood Cliffs, New Jersey: Prentice-Hall Inc., 1959. pp. 334. 335.
* ↑ 34 (1) Purtle, op. cit., p. 74. (2) Medical and Surgical History of the War of the Rebellion. Surgical History. Washington: Government Printing Office, 1870, pt. I, vol. II, p. 453.