Chapter 1
VIEW FROM THE TOP
The Civil War`s chief legacy to the Medical Department was an increase in the traditional peacetime burdens of the Surgeon General`s Office. In the years that followed the surrender at Appomattox, the office would be asked to create both a medical museum and a medical history, using specimens and case histories gathered during the conflict; in response to a congressional mandate, to provide Civil War veterans with prostheses and the information needed for pension applications; and, for a brief period, to manage the medical care of freed slaves. As a result, for decades after the end of the conflict, the Army`s surgeon generals dealt with war-related challenges while carrying out the department`s historic mission of guarding the Army`s health.1
The Surgeon Generals
All seven of the officers who headed the Medical Department from 1865 to 1893 were Civil War veterans. Six of them had also served in the prewar Army and thus were familiar with many of the difficulties their subordinates would face after the war. With their roots firmly embedded in a period when germs were not recognized as the cause of disease and infection, all were to varying degrees unsure of the significance of the medical revolution then beginning to gather force across the Atlantic. They left the task of leading their organization to a prominent position in the era of modern medicine to the man who would become surgeon general in 1893.2
The first postwar surgeon general, Brig. Gen. Joseph K. Barnes, came to office in August 1864.3 A man of diplomacy and determination, Barnes was known for his good judgment, hard work, and insight into the problems and personalities he encountered. Assigned to Washington in May 1862, he had quickly formed a strong friendship with Secretary of War Edwin M. Stanton. Until his resignation from office in May 1868 as part of the power struggle that led to President Andrew Johnson`s impeachment, Stanton supported Barnes in all his undertakings, even when they involved activating projects he had previously disapproved. After holding office for almost eighteen years, Barnes was the first surgeon general to whom a new law mandating retirement at sixty-four applied. Already in poor health when he left the department in June 1882, he died a year later.4
Death or mandatory retirement because of age curtailed the time in office of the next six men to serve as surgeon general. Barnes` immediate successor, Brig. Gen. Charles H. Crane, was head of the department for only fifteen months. An obvious choice, the 57-year-old Crane had worked
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closely with Barnes, functioning as his assistant surgeon general. Crane was highly regarded because of his experience and skill as an administrator, for his good judgment, and for his encouragement of competent subordinates. Unfortunately, he never realized his full potential. A sudden hemorrhage from a malignant growth that appeared in his mouth soon after taking office proved fatal in October 1883.5
The short terms served by Crane`s successors precluded any significant easing of the rivalry that existed among the Medical Department`s senior officers. Prominent in the jostling that followed Crane`s death was the bright and very ambitious Col. Jedediah H. Baxter, who as the chief medical purveyor bore the ultimate responsibility for obtaining Medical Department supplies. President Andrew Johnson`s appointment of this highly controversial Civil War volunteer medical officer to the department as a lieutenant colonel in 1867 without the examination that was required of all others had aroused much resentment. It may have been responsible for his exclusion in 1881 from the bedside of the dying James A. Garfield, despite the fact that the president had for a time after his election been Baxter`s patient. His ambition was thwarted after Crane`s death when, once again, an assistant surgeon general was promoted to the Medical Department`s leading position.6
In November 1883 Brig. Gen. Robert Murray began his tenure as surgeon general. At the time of his appointment Murray, then the department`s senior officer, was only three years short of mandatory retirement. Although he had at one time served under Baxter, his selection was not inappropriate. His military career had begun in 1846, long before Baxter entered the Army, and he had been so successful that mem-
9
bers of the department pronounced him to be "in every respect a most estimable gentleman" who, like Crane, possessed "exceptional administrative capacity."7
The fact that Murray would have to leave the Army in three years was known at the time of his appointment. Nevertheless, when that day came in August 1886, no decision had been made concerning his successor. Baxter was again a strong contender; he was now the department`s senior surgeon, given his time in rank, and was serving as acting surgeon general until the position of surgeon general was filled. Both Baxter and his chief rival, Col. Charles Sutherland, who had served fifteen years longer in the Medical Department than Baxter and was eight years older, lost out when President Grover S. Cleveland appointed an officer who was "politically of the same faith as" himself. The new surgeon general was Brig. Gen. John Moore, who had been Sherman`s medical director in the last months of the Civil War. Compared to Baxter, Moore was eleven years older and had been a member of the department fourteen years longer. At sixty he was only four years short of retirement.8
When Moore retired in August 1890, however, Cleveland was no longer in office. Baxter benefited from the fact that the new president, Benjamin Harrison, was both a friend and a patient; thus he triumphed over Sutherland, his long-time rival for the position of surgeon general. In becoming head of the Medical Department and attaining the rank of brigadier general, Baxter reached a goal long and energetically sought, possibly ever since he first gained favorable attention during the Civil War as a result of his assignment as chief medical officer in the Provost Marshal General`s Office in 1862. Except for a few months in 1861, his responsibilities
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during the Civil War kept him in Washington, where his accomplishments included compiling the highly regarded Medical Statistics of the Provost Marshal General`s Bureau. While fulfilling his military duties after his appointment to the Medical Department in 1867, he cultivated important friendships. He also acquired a law degree and amassed a collection of photographs of department officers so complete that he could eventually greet each member of the department by name.9
Unlike Murray and Moore, at fifty-three Baxter was still a relatively young man who could reasonably expect to serve many years as surgeon general. In the late summer of 1890 his plans for the department apparently included encouraging promising medical officers in their scientific pursuits, even though when serving as the department`s chief medical purveyor, he had shown a significant lack of enthusiasm for supplying such men with microscopes. His greatest achievement as surgeon general may well have been assigning young Capt. Walter Reed to Baltimore long enough for Reed to take a seven-month postgraduate course in bacteriology and pathology at Johns Hopkins. Once ensconced as surgeon general, Baxter also reportedly began to occupy himself with taking revenge upon those who had annoyed him before he reached the top in the Medical Department. Among the unfortunates on his list was at least one medical officer whose only apparent crime had been insisting upon being provided with a microscope. Baxter`s relative youth, his ambition, and the controversy in which he had already been involved suggest that he would have been a memorable and colorful surgeon general, but his health was no longer robust. On 2 December he suffered a stroke, and on the
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fourth, after less than four months in office, Jedediah Baxter was dead.10
On 23 December 1890 Charles Sutherland at last became surgeon general, thus attaining also the rank of brigadier general. No reason for his failure to reach this position earlier is evident, other than his apparent lack of powerful political friends. He was highly regarded both as a medical officer and as "a most delightful companion," of "a most amiable disposition." As surgeon general he was considered by some to be "poor, weak, [and] old," but he apparently was a capable administrator. His age made his retirement mandatory in May 1893, after forty-two years in the department but less than three as surgeon general. With Sutherland`s retirement an era came to an end. Unlike his predecessors in the immediate post-Civil War period, the next surgeon general would not be content merely to observe the medical revolution from afar.11
Demobilization
For both the Army and the Medical Department, the return to peacetime size was rapid. Although the demands of Reconstruction and the need to discourage the spread of French ambitions in Mexico delayed total demobilization for a few months, the million wartime volunteers of May 1865 had become 11,000 by November 1866. Few even of that number remained after the fall of 1867. Since the war left much of the nation convinced that large-scale conflict was for the United States a thing of the past, Congress reduced the number of regular troops as well, from 54,000 in 1867 to 26,000 in the late 1870s, when Reconstruction came to an end.12
During the year after the Civil War ended, much of the Medical Department`s time was devoted to processing departing medical personnel, to settling their accounts, and to closing facilities. Most of the doctors leaving the Army by the end of 1866 were volunteers, who were mustered out on an individual basis as soon as their services were no longer needed. The department reduced the number of contract surgeons to 1,997 by July 1865, to 262 a year later, and to 187 by 1870. Twelve regulars resigned soon after the end of the war, and six more died within the year. The hospital chaplains attached to wartime hospitals were dismissed as these facilities were closed. With the departure of the victims of that conflict, the department closed all general hospitals. The office of superintendent of women nurses was also abolished in the fall of 1865, when all female nurses were discharged.13
Of the 65,000 patients in general hospitals in June 1865, only 97 remained a year later. The rapid decrease in the number of patients led to a corresponding decrease in the amount of medicines and supplies needed for their care and in the number of facilities designed to shelter them. Surgeon General Barnes was called upon to disband the ambulance corps; to close supply depots; and to sell or otherwise dispose of hospital transports, hospital trains, and general hospitals. Some institutions were turned over to individual states for use as homes for wounded veterans, and others were returned to their original owners. By the end of the fiscal year 1866 the Medical Department had received more than four million dollars from the "sales of old or surplus medical and hospital Property." By the summer of 1866 only the depots at New York, Philadelphia,
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St. Louis, New Orleans, San Francisco, and Washington, D.C., remained open.14
The Peacetime Organization
In 1866, with the worst of the demobilization problems resolved, Congress moved to officially establish a peacetime Medical Department. At the outset the new organization closely resembled the old in structure, size, and function. The new law retained the position of surgeon general with its rank of brigadier general and that of the assistant surgeon general with its rank of colonel. It also made custom into law by requiring that the surgeon general be appointed from within the Medical Department. But the responsibility for managing the purchase and distribution of the department`s supplies was no longer one that the surgeon general could assign to any medical officer he chose. Medical purveyors were now to be appointed by the president, subject to the Senate`s approval. They would, as in the past, be ordered to post bond. Congress also required them to remain available for work as surgeons should the need for their services arise. The chief medical purveyor would hold the rank of lieutenant colonel, as would his four assistants. The wartime positions of medical inspector general and medical inspectors were eliminated.
Congress continued at this time to classify all other Army physicians as either surgeons, who were ranked as majors, or assistant surgeons, who were lieutenants or captains. The legislature kept at 60 the number who could hold the rank of major and limited the number of assistant surgeons to 150. The total of 217 regular medical officers in the department, while inadequate given the number of posts that needed coverage, was an increase of 28 over the number of regulars in the Army at the end of the Civil War. Congress required the Medical Department to give preference in choosing new assistant surgeons to those who had served with the Union Army as volunteers, excepting them from the usual age limit of twenty-eight by permitting them to subtract the number of years served in the Civil War from their actual age. The time they had served in the Civil War was also credited to them in determining their rank. Like all other applicants, they had to pass an entrance examination. Five medical storekeepers-who were shortly thereafter given the official rank of captain-remained in the department.15
Under the new organization, Army surgeons continued to serve both in the field and in Washington. In 1872, according to a medical officer working in the Surgeon General`s Office, 3 medical officers, including Crane, worked with Barnes in the Surgeon General`s Office, with 15 or so civilian clerks and perhaps 100 hospital stewards. In the wake of the Civil War Barnes began officially delegating some of the responsibilities of his office to his subordinates, establishing first a finance division-the exact date of the establishment of this division is unclear, although the records remaining from it date from 1873-and, in 1874, a property division, with Baxter, as chief medical purveyor, at its head.16
Most of the professional staff were assigned to positions outside Washington, D.C. A few medical officers functioned as medical purveyors at medical depots, and the senior surgeon of each command was its medical director, managing medical personnel, hiring and firing contract surgeons and hospital stewards, and granting leave to subordinates. The commanding officer of each military department deter-
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mined how many physicians were needed at each post and until 1892, when this responsibility was given to the secretary of war, gave them their assignments. Those in charge of general hospitals would, should such facilities ever be established, order supplies through the surgeon general. Otherwise, Army surgeons sent their requisitions through their medical directors to the medical purveyor at the designated supply depot. Veterans also sent their requests for artificial limbs through the nearest medical director. As necessary, medical directors were also called upon to inspect sanitation at the various posts. Basically, however, the Medical Department was no exception to the rule that in this period "the most minute details" of matters "in the smallest and most distant garrisons were regulated and handled" by the Army`s bureaus from Washington.17
During Reconstruction the organization of the Department of the South into five military districts required the naming of five district medical directors. These officers apparently reported directly to not only the surgeon general but also the medical director for the Department of the South at Atlanta. Each district director was initially responsible for the care provided the garrisons at both temporary and permanent posts. He also had to send physicians with units leaving the South as the occupation force was gradually reassigned.18
By 1868 the Medical Department was expected to cover 289 garrisons, and many detachments also needed medical attendance, among them those sent to watch over the polls in the South at election time. To meet the challenge imposed by this requirement, Barnes supplemented a small but elite corps of medical officers with contract physicians (also referred to as acting assistant surgeons) as needed.19
To guarantee that this elite corps remained elite, the Medical Department held the regular surgeons and assistant surgeons who remained in the Army to high standards. Meeting this goal proved difficult. Although a Medical Department position might appear to be a better alternative to a young physician without prospects of joining a lucrative city practice, the slow advancement and low pay that characterized the peacetime Army had serious effects upon morale. A medical journal suggested that regular medical officers-who, unlike their civilian counterparts, had had to pass extensive examinations to establish and reestablish their competence-"could surely do much better" as far as pay was concerned "in civil practice." Many medical officers apparently agreed with the article, for while the number taking the entrance examinations was considerable, resignations were frequent-forty-eight medical officers resigned from 1865 to 1874.20
These exams weeded out those who did not meet the department`s standards, but for those who did pass, they also laid out the path to be taken for improvement. In theory, at least, they required proficiency in scientific and medical topics and in literature and history as well. Candidates might be asked the cube and cube root of 3.6; the capitals of such political entities as Saxony, Bavaria, and Switzerland; the principal Roman deities, giving also the corresponding names used by the Greeks; or Newton`s first law of motion. Other questions might involve the chemistry of glassmaking, the differences between gastric and pancreatic digestion, the pathology of uremia, or the effects of exercise on the lungs. Weaknesses in any of the areas of questioning were brought to the attention of those passing, who were expected to remedy them. The proportion of those taking the examina-
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WILLIAM H. ARTHUR`S CARICATURE of an examining board in action. Arthur immortalized himself as the candidate in the hands of the inquisitors.
tions who passed varied widely, from as few as one-twelfth to as many as one-third, with perhaps a fifth or more failing to qualify for physical reasons. At least one medical officer whose military career was successful questioned the validity of the examinations. Brig. Gen. William H. Arthur commented years after passing his tests that many of those who did well on them did not make good Army surgeons.21
Since no knowledge of the way in which medicine was practiced in the Army was required to pass these exams, Surgeon General Barnes decided that a newly commissioned assistant surgeon should initially be assigned to one of the few posts large enough to need the services of more than one medical officer. Here an experienced surgeon could teach the neophyte the fundamentals of military medicine and Army routines. On some occasions, when no opening was immediately available, the successful candidate would be hired on contract and in that capacity sent to work with a senior surgeon until there was an opening for him. When he became eligible for promotion after three years, he was tested again to determine whether the required remedial study had been done and whether he had been keeping up with the latest developments in his profession. Those who failed this promotion exam might, if the surgeon general believed there were extenuating circumstances, be permitted another try, but a second failure brought a request for resignation, with a threat of dire but unspecified steps to be taken if it were not immediately forthcoming. Some doubt existed whether the department could legally drop an assistant surgeon merely because he did not pass his promotion exam, but apparently none of
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those who failed this test ever challenged the department`s position. In new legislation concerning the Army in 1878, Congress ruled that those seeking to be promoted to the position of surgeon, or major, must also pass an examination.22
The quality of the Army`s contract surgeons, on the other hand, was not so easily controlled. These physicians did not have to take examinations, being required only to be graduates of reputable medical schools, of good character, and in good health. Their contracts, usually arranged by a local medical director on an annual basis and calling for a year of service, brought them as a rule $1,200 to $1,500 a year, at a time when the average civilian doctor was earning $1,000 a year. Because the agreement could be canceled whenever the department determined that their services were no longer needed, contract surgeons might be hired for the duration of a campaign or expedition. If their work or habits proved unsatisfactory, they need not be rehired. In the South, physicians eligible for contracts were difficult to find because few could take the required oath that they had never voluntarily borne arms against the government. Nevertheless, the disadvantages involved in hiring civilian physicians who might have no military experience were counterbalanced by the great flexibility the system gave Barnes in meeting the Army`s needs.23
The passage of time did not improve Congress` appreciation either of the Army in general or of the caliber of the Army`s regular medical officer and the nature of the demands placed upon the Medical Department. Thus the problems engendered by low rank and inadequate numbers remained unresolved. In 1869, when only 168 medical officers were serving in the Army and 239 posts and innumerable detachments needed medical attendants, the legislature, with its enthusiasm for using the Army as a police force in the South waning, included the Medical Department among those organizations in which no more vacancies were to be filled at any level and no promotions made. As a result, by 1871 the department had 54 vacancies, one of which was the position of chief medical purveyor. The number of posts to be served had also dropped from the 1869 level, but only by 33. In reporting to the secretary of war on these problems, Barnes pointed out that naval medical officers held higher rank than Army surgeons, even though, in his opinion, they performed less arduous duties.24
When Congress reorganized the staff corps of the Army in June 1874, it was still of a mind to reduce expenses. Having forbidden recruiting beyond 25,000 men, the legislature went on to cut the budgets of departments supporting the Army. Although other departments also suffered because of the economy drive, no other bureau chief, with the possible exception of the quartermaster general, reported to the secretary of war as serious misgivings about its effect upon personnel as did the surgeon general. New legislation reduced the number of lieutenant colonel slots in the Medical Department from 5 to 2 and that of majors from 60 to 50, thus effectively preventing promotions for years to come. Congress did remove the restriction on filling vacancies within the department and increased the rank of the chief medical purveyor to colonel. Reductions in rank were to take place through attrition only. The legislators also refused to allow hiring more than 75 contract surgeons and abolished vacant positions at the grades of surgeon, medical storekeeper, and assistant medical purveyor. The only way in which Surgeon Gen-
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eral Barnes could now meet the need for medical officers was by paying private physicians on a fee-for-visit basis to care for those patients who would otherwise receive no medical care. Six months later Congress suspended the limitation on the number of contract surgeons to be hired, but the legislators remained unhappy with the department`s use of so many.25
Civilian colleagues reacted with outrage to the treatment accorded the Army`s medical officers. The editors of the Medical Record exclaimed that they were "in fact, astonished at [the bill`s] provisions, and thoroughly disgusted at the fact of its final passage." The American Medical Association, to whose meetings the Army had been sending a representative since 1850, stressed in an 1874 petition to Congress that 1 in 18 officers in the Ordnance Department was a colonel; in the Engineers, 1 in 16; and in both the Commissary and Quartermaster`s Departments, 1 in 13. But in the Medical Department only 1 in 102 was a colonel, and an officer might serve thirty to forty years without rising above the rank of major. In support of its argument that the U.S. Army surgeon deserved better treatment, the petition quoted from an address given by the famous German pathologist Rudolph Virchow that same year: "Whoever takes in hand and examines the comprehensive publications of the American Army Medical Staff will continually have his astonishment excited anew by the riches of the experience which is there recorded." The American Medical Association also emphasized that the ratio of 1 medical officer to every 200 or so men contrasted unfavorably with the 2 to 120 ratio characteristic of the British Army.26
In 1876 Congress relented somewhat concerning promotions for medical officers, doubling the number of positions for lieutenant colonels and adding 3 more for colonels. But it reduced the number of openings for assistant surgeons from 150 to 125 and even slashed the department`s appropriation for the fiscal year ending 30 June 1877, forcing drastic cuts in the number of contract surgeons and hospital stewards. When the original number of positions was restored the following March, the department`s troubles were not at an end. After several years of dwindling appropriations, funds for the Army for the following fiscal year were not voted until November 1877. This failure, which forced soldiers to go for many months without pay, can be blamed at least in part on the desire of southern congressmen to encourage the complete removal of the Army from their states. The persistent uncertainty forced Barnes to reduce the number of contract surgeons hired. In February 1877 he urged each medical director to annul contracts whenever he could, relying instead upon "local physicians . . . employed by the visit." He also ordered that no leave be granted regular medical officers. Although the usual appropriation was finally voted, difficulties caused by the shortage of physicians remained, Barnes` pleas for more assistant surgeons having been made in vain.27
Undaunted, Barnes continued his efforts in behalf of the department, taking advantage, as was his custom, of the familiarity with the ways of Washington that his years of service and his position as long-term bureau chief had given him. In attempts to head off new measures he considered harmful, he approached congressional leaders concerned with the affairs of the Medical Department. Nevertheless, when age forced Barnes` retirement in June 1882, the basic problem remained: 185 of the Army`s posts were large enough to re-
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quire the services of at least one physician, but only 183 of the 192 positions for regular medical officers in the department were filled.28
Congress made a few minor adjustments in the organization of the Medical Department after Barnes` departure, in 1883 downgrading the position of assistant surgeon general. The physician filling this slot, once the only medical officer with the rank of colonel, no longer served as the second in command in the department, but became "simply one of the colonels in the Medical Corps." In 1892 another change gave all colonels the title of assistant surgeon general and all lieutenant colonels that of deputy surgeon general. Although Congress enacted no law at this time to change the way in which medical officers were addressed, from 1890 onward the surgeon general`s annual report referred to regular medical officers by rank rather than as surgeon or assistant surgeon.29
Such changes had no effect on the chronic shortage of medical officers. The effects of a legal limitation on the number of Army officers who could be retired for disability were felt more intensely with the passage of time as the retention of an increasing number of disabled surgeons on the active duty list blocked the appointment of replacements. By 1890 fifteen medical officers, one of whom had been disabled for thirteen years, could not perform their duties. Seven more were in such poor health that their usefulness to the department was limited. Fortunately, because of the constant expansion of the railroad network in the West and the confinement of Indians to reservations, the concentration of troops at a few large posts-the Army closed 25 percent of its posts in the period 1890-1891-was gradually reducing the demand for post surgeons. New needs developed as requests for advice and assistance from the National Guard increased and as medical officers were given such added duties as teaching military hygiene at the new U.S. Infantry and Cavalry School at Fort Leavenworth, Kansas. This latter assignment was particularly significant because of the opportunity to impress line officers with the importance of taking medical advice seriously.30
In February 1891 Congress finally removed from the limited retirement list-which contained the names of officers retired for disability or length of service rather than age-all who were more than sixty-four years old. Because of the new openings on the limited list that resulted, six disabled medical officers could retire almost immediately, and two more left the department in midsummer. Surgeon General Sutherland`s first annual report recorded that only two medical officers who were permanently unable to perform their duties remained in the department.31
The openings produced by the new retirements seemed especially desirable to young physicians who had just completed their professional education. As civilians beginning their careers, few could hope to match the Army`s $1,500 a year starting salary and the 75 percent of active-duty pay medical officers could expect when retired, whether for disability or age. Although the department did not suffer from a shortage of applicants, traditionally many who passed the exam were recent and untried graduates of medical school. The opening of many positions in the department only exacerbated a problem that had existed for decades. Barnes` approach to the problem, an informal apprenticeship system for fledgling assistant surgeons, was expanded by his successors to include
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those who were serving as contract surgeons while awaiting assignment. Surgeon General Moore attempted to reduce the magnitude of the problem by ordering that those with experience "in hospital and dispensary practice" be taken into the department first.32
The pleas for more openings for regulars proved fruitless. Consequently, the need for large numbers of contract surgeons, whether or not they had passed the department`s examination, did not abate. Crane pointed out that because the Army`s demands fluctuated, the surgeon general should determine the number of contract surgeons to be employed. Nevertheless, Congress insisted on setting the limit, renewing in 1883 the reduction of the number of contract surgeons from 125 to 75 that had been suspended nine years earlier. From this time onward, new contract opportunities for doctors other than those awaiting openings in the regular staff were rare, especially as the trend toward employing larger garrisons lowered the need for medical officers of any category. When Congress cut back the department`s budget in 1886, and further economies were necessary, the number of contract surgeons was once again reduced. Surgeon General Moore adopted an informal policy of limiting new contracts to those who had passed the department`s entrance examination, thus guaranteeing the Army superior contract surgeons and offering valuable experience to future regulars. In drawing up the budget for fiscal 1893, however, Congress voted no funds for new contracts, forcing the department to rely once again on fee-for-visit hiring. Some scientists working for the department lost their positions as acting assistant surgeons and continued their work as civilian employees.33
Creation of the Hospital Corps
The one significant change in the Medical Department in the period 1865-1893 involved the effort to obtain and retain competent enlisted men to assist medical officers in the performance of their duties. The problem was as old as the U.S. Army itself. The tradition of detailing the dregs of a unit to assist surgeons in their work had lasted until five years before the start of the Civil War, when Congress made hospital stewards permanent members of the Medical Department. After the war as before, the legislature persisted in ignoring the argument that placing stewards in a permanent corps would make it possible to use them more effectively.
Female nurses were not part of the solution to this problem. No formal nursing schools existed in the United States until 1873, and the qualifications of women willing to care for the Army`s sick and injured were not particularly high. Thus the Army, having no real reason to hire women as nurses, employed none between the end of the Civil War and the beginning of the Spanish American War more than thirty years later, even though the law permitted them to be engaged at 40 cents a day for work in general hospitals, whenever they might be established. The law also permitted women to work in hospitals as matrons (that is, civilian housekeepers), whose chief duties were those of laundresses, for a monthly salary of $10. Matrons were few in number, 169 being in service as of 30 September 1887, and were hired only at the larger posts and recruiting depots.34
By 1865 most stewards were competent men whose assistance to surgeons included working as pharmacists, performing minor surgery and simple dentistry,
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keeping records, and managing the post hospital. Some were themselves physicians, and at least one functioned as a full-time dentist. Nevertheless, their pay was less than half that paid their counterparts in the U.S. Navy, and, as enlisted men, they never received the respect to which their professional attainments might otherwise have entitled them.35
In 1874, eight years after voting to allow the appointment of as many hospital stewards as the surgeon general believed were needed, Congress voted to limit the number to 200. To his dismay Surgeon General Barnes discovered that the adjutant general, who controlled personnel procurement for the Army, could be a greater problem than the legislature. Ignoring the law, the adjutant general limited the number the department could hire to a significantly lower figure. In its 1878 legislation concerning stewards, Congress divided them into three classes, with the first to be paid $30 a month; the second, $22; and the third, $20. It also made them eligible for the same small salary increases that other enlisted men received as rewards for length of service or reenlistment and forbade appointing any civilian as first-class hospital steward unless he had previously served in that position. This new systematization in the management of Medical Department enlisted men gained many admirers in Europe.36
Nevertheless, problems were many. Stewards were scattered among the posts and never practiced together, and thus the Army was still unable to train teams to move wounded from the battlefield until hostilities started. As a result, if a war should break out, able-bodied combatant soldiers would leave the battlefield to escort wounded comrades, just as they had in the Civil War, possibly never to return to the conflict. Nurses would have to be gathered and instructed in the care of the wounded after the first of the injured had started pouring into hospitals. First-class stewards, often capable and intelligent, were so few in number that in 1886 Surgeon General Murray had to place restrictions on their leave. Department spokesmen continued to urge the creation of a permanent body of "able-bodied and intelligent men," to number approximately 2 percent of the fighting strength and to be thoroughly trained to work as nurses, cooks, and ambulance attendants.37
At this juncture the dwindling likelihood of further hostilities with the Indians was, according to military historian Russell F. Weigley, encouraging "a few preparations for possible foreign war." An entire regiment gathered to train as a unit in 1887, and the belief that the Army should be readied for war, rather than for the work of a constabulary, was beginning to grow. With it grew the belief that in such a force, a permanent corps of enlisted men with centralized and systematic organization and training should serve each staff bureau. When he became surgeon general in November 1883, Murray began urging in his annual reports to the secretary of war that some way be found to create such a corps for the Medical Department so that the department`s enlisted men could be trained together in the performance of their duties. His goal was an organization of men who "shall be thoroughly instructed and trained in all the details of hospital service, . . . thus preparing the Department for any emergency of peace, war or epidemic."38
A few months after Murray`s retirement in August 1886, the legislature passed a law creating the Hospital Corps, an organization of men who could be systematically trained to function as hospital attendants. The new corps was to be composed of hos-
20
pital stewards, acting hospital stewards, and privates, their exact numbers to be determined by the secretary of war. First-class stewards would now be designated hospital stewards and those of the second class, acting hospital stewards (the category of third-class hospital steward had been abandoned in 1885). Soldiers who were not members of the Hospital Corps could no longer be detailed to serve as nurses. Corpsmen would perform all "hospital services in garrison and in the field" and in wartime would manage the ambulance service as well. They would serve as wardmasters, nurses, cooks, and assistants to others serving in these capacities, and also as orderlies who accompanied surgeons during marches and in battle.39
In implementing the new law, the Army tried to establish a regular upward path for those who demonstrated an aptitude for Hospital Corps work. The plan called for four men in each company to be selected as litter-bearers, with possible transfer to the Hospital Corps in mind. While remaining in the line, these men would be trained in first aid and the duties of the litter-bearer for at least four hours a month. After a minimum of a year`s experience, they could take an examination that would make them eligible for selection as Hospital Corps privates. After a year of service and upon the recommendation of his command`s senior medical officer, a corps private could be detailed by the surgeon general to serve as an acting hospital steward. After a year`s satisfactory service in this probationary capacity and the passage of yet another examination, he could become a hospital steward. Previous service in a similar capacity counted in the computation of the time required for promotions.40
Medical officers tended to regard this plan with some skepticism. The lot of the enlisted man had started to improve in the 1880s, but his character was still not highly regarded. The assumption that the opportunity to transfer to the Hospital Corps would prove attractive to litter-bearers was "a proposition scarcely worth discussing," according to assistant surgeon Capt. John van R. Hoff, who believed that the new organization offered "no inducement to the average soldier to transfer-the sanitary soldier if required to do his full duty must work harder than any line soldier-and there is nothing a soldier abhors more than work, except it be drill-hence it is that the detail of company bearers is regarded as a punishment because it is additional duty." Furthermore, Hoff doubted that the Army contained 800 men physically and mentally capable of handling Hospital Corps responsibilities. Another assistant surgeon remarked that the bearer drill was "as a source of amusement to the rest of the com-
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mand, . . . a great success-but in all other respects, . . . a great failure and productive of no good." The pay was initially certainly not tempting-only in July 1892 was the hospital corpsman given the supplementary pay that had previously rewarded such "often exceedingly trying and very dangerous" work, a sum that might tempt him to brave drill, disease, and ridicule.41
As Hoff had predicted, the Medical Department experienced difficulty both in filling openings in the Hospital Corps and in keeping them filled. By mid-1888, 135 of the corps` 739 positions remained vacant. Some who had been hospital stewards before 1887 had not been able to pass the examinations for steward in the Hospital Corps, although considerable leeway was given to candidates who might reasonably be expected to remedy their deficiencies by further study. Great difficulty was also experienced in finding qualified men to serve as cooks. The ten openings for enlistees from civilian life were restricted to graduates of schools of pharmacy and veterans who had done Hospital Corps-type work while in the Army. Although the corps` desertion rate of 2 percent in 1889 contrasted favorably with the Army`s average of 10.3 percent, low reenlistment rates made it difficult to keep a trained staff. Thus, while the creation of the Hospital Corps made systematic training possible, many problems concerning the Medical Department`s enlisted personnel remained to be solved.42
Problems of Victims of War
New responsibilities resulting from the need to assist the victims of the Civil War-among them refugees, newly freed slaves, and veterans-increased the expenses of the Medical Department in the aftermath of that conflict and for a time threatened to ensnare it in an unending tangle of administrative complexities. The requirement to provide the medical care that the Bureau of Refugees, Freedmen, and Abandoned Lands offered those it assisted was short lived. Established within the War Department in March 1865, the bureau operated forty-six hospitals by the fall. When Congress appropriated no funds for the bureau`s medical division for fiscal year 1866, apparently as the result of oversight, the secretary of war ordered the Medical Department to fill the gap. That year alone, this assistance cost $267,391.92, a sum that paid for medical supplies and, seemingly, the cost of contracts for civilian surgeons. The department also provided the services of medical officers, eighteen of whom were detailed to the bureau for the period 1 June through October 1865; one of them, initially a volunteer, headed the bureau`s medical division from the time of its creation until its dissolution in 1872. The number of those in need decreased. Medical Department assistance rapidly dwindled, and the bureau began to hire its own contract physicians. By 1 September 1866 it needed the services of only nine medical officers. A year later they, too, had been reassigned, and by the spring of 1869 all bureau hospitals but the one in the District of Columbia had been closed. When the bureau`s operations ended and the District of Columbia became responsible for the expenses of the Freedmen`s hospital there, a medical officer was assigned to handle that institution`s finances.43
The responsibilities the Medical Department assumed for the veterans of the Civil War, on the other hand, brought it an enormous, persistently complex, long-lasting, and totally unfamiliar administra-
22
tive burden. In 1862, when Congress first required the Army to provide prostheses to veterans who had held the rank of captain or below, the department assumed the responsibility for testing, supplying, and overseeing the quality of these items. For decades after the war ended, it continued to pay for prostheses and for associated travel expenses. Surgeon General Barnes duly recorded that by the end of fiscal year 1866 the department had supplied almost 4,000 legs, more than 2,000 arms, 9 feet, 55 hands, and 125 other devices.44
Barnes` suggestion that provision be made to pay a monetary equivalent or commutation payment to those who qualified for an artificial limb but did not choose to order one was adopted by Congress in 1870, making it possible to compensate those unfortunates whose unhealed, inflamed, or abbreviated stumps could not accommodate a prosthesis. The legislature also permitted the Medical Department to replace prostheses or to make renewed commutation payments at five-year intervals. The money quickly became more popular than the prostheses it replaced. In 1872 the department was also required to provide either commutation payments or prostheses for Civil War veterans whose loss of the use of a limb had resulted from paralysis, as well as trusses for soldiers who suffered hernias while on active duty in the Civil War. Four years later it had to furnish prostheses, but not trusses, to all veterans in need of such aid, whether their service had been in the Army or in another branch of the military service.45
Although amputees died at a faster rate than their able-bodied comrades, the demands for prostheses did not materially diminish. Surgeon General Murray believed that much of the failure of requests for artificial limbs or their monetary equivalent to decrease in number should be blamed on the deterioration in wounded limbs that made prostheses necessary where they had not been before. Believing that a good artificial limb, if properly cared for, could last ten years, Murray protested a congressional move to reduce the replacement period from five to three years. He noted that since only a small number of crippled veterans requested limbs rather than commutation payments, "legislation . . . to secure more frequent payments seems to be, in my opinion, of doubtful utility or propriety." Nevertheless, in March 1891 Congress enacted the measure to which Murray had objected and added injury to insult by failing to grant the Medical Department more money to meet the increased expenses. The tendency to choose the payment over the limb continued. The artificial arm was generally regarded as useless, and 98.6 percent of those entitled to receive it chose the monetary equivalent; 78.1 percent of those entitled to the artificial leg also preferred the money, even though the prosthesis in this instance was helpful.46
Another reason for the failure of the demand to fall may have been private agents who worked to stir up business among the disabled so that they could claim 10 percent of the value of the commutation payment. These men concealed from the veteran the fact that he could easily deal directly with the Surgeon General`s Office himself. Surgeon General Moore was able to note in 1892 that by 1889 the campaign to eliminate the use of intermediaries between his office and the disabled had been successful.47
The medical care of veterans living in the Soldiers` Home in Washington, D.C., was another Medical Department responsibility. The new hospital at the Home was named after Barnes and designed by Capt. John Shaw Billings, a man of many and varied tal-
23
ents and much determination.48 Only a portion of the Home`s funds came directly from the government; but, as surgeon general, Barnes was a prominent member of the board. An Army medical officer, assisted by an Army steward, cared for the Home`s sick. This institution was but one among several, including the Columbia Hospital for Women and Lying in Asylum and the Providence Hospital, for which the Medical Department managed federal funds voted to support indigents, regardless of their status as veterans or non-veterans.49
The greatest of the Medical Department`s administrative burdens in the decades immediately following the end of the Civil War involved paperwork, especially the paperwork concerning the sick and injured that was required to enable the government to make decisions about pensions for Civil War veterans. The number of requests for the information necessary to prove eligibility for this form of aid grew in proportion to Congress` liberalization of laws regarding it, even as the documents to be searched deteriorated both from age and use.50
The Record and Pension Division of the Surgeon General`s Office, where hospital and burial records and monthly sick and wounded reports were sent and their data transcribed into permanent registers, was almost independent, from the outset seemingly as much a part of the Pension Bureau as of the Medical Department. Both the surgeon general and the secretary of war watched the division`s work closely. The staff of clerks was large, the number reaching 290 in 1883, and the sheer volume of work was impressive. In the year from July 1865 through June 1866 the department provided information in 26,589 cases to the Pension Bureau, 8,000 to the paymaster general, 10,623 to the adjutant general, and 4,000 to agents acting for various veterans. In that same period it also "examined and classified" 210,027 disability discharges.51
This information was contained in 4,000 registers. Their often faded or illegibly written entries, taken from the reports of medical officers serving in hospitals and in the field, were arranged in the worst possible way for the purpose of verification, by date of admission rather than alphabetically. The number of clerks and hospital stewards conducting these searches remained inadequate, and their enthusiasm for their work was scarcely overwhelming. As a result, a backlog of requests soon developed. At the end of fiscal year 1870 more than 3,000 requests remained unanswered, and by the end of the next fiscal year that figure had surpassed 9,000.52
The story of the next sixteen years was one of constant struggle. Employees were undisciplined, records deteriorating, and the memories of veterans concerning the details of their service fading, thus complicating searches. Even though Civil War records continued to be added to the Medical Department`s collection for many years, some clerks were still assigned to collecting and recording meteorological reports from various post surgeons, a responsibility that was not turned over to the Signal Corps until 1874. Congress and the secretary of war added and withdrew personnel as the backlog waxed and waned, motivated alternately by pressure from veterans groups and by a desire to reduce expenses. At times enlisted men had to be designated hospital stewards and detailed in that capacity to help in the work when funds to hire clerks were inadequate. Despite occasional direct intervention by the secretary of war himself, Surgeon General Murray`s instigation of an efficiency rating system for the department`s clerks, and, finally, pressure from the adjutant general,
24
the situation failed to improve. The head of the Record and Pension Division, Maj. Benjamin F. Pope, appeared to be totally overwhelmed by the administration of his organization. In 1886, after consultation with both Acting Surgeon General Baxter and the adjutant general, the secretary of war finally decided to replace Pope with Capt. Fred C. Ainsworth.53
Ainsworth, a remarkable and ambitious man whose talent for administration was unadorned by diplomacy, proved to be the solution to much of the confusion and inefficiency that had been plaguing the Medical Department in its attempts to deal with veterans and their records. He came to office in December 1886. Moore had been surgeon general a month and, in the course of pushing vigorously for increased discipline and order in the department`s management, was already setting up guidelines that would smooth Ainsworth`s path. Armed with new regulations calling for semiannual efficiency ratings and severe restrictions on leave, Ainsworth fired the lazy and incompetent and instituted improved procedures. Instead of dealing with the backlog by hiring new clerks for whom new work would have to be found if they were not to be left idle when it had been reduced, he required those already hired to work overtime to clear it up. Not content with increased productivity and the resultant marked reduction in the number of unanswered requests, he began supplementing records with information he obtained from private hospitals that had sheltered sick and wounded Union soldiers. He also took up the matter of the deteriorating records and decided upon a card catalog as the answer to the problem. When his work was complete, all the cards on each individual soldier were filed together and grouped by regiment. Ainsworth`s approach worked so well that the secretary of war ordered the consolidation of his organization with the various offices of the adjutant general that had been doing similar work and placed Ainsworth in charge of the new and independent Record and Pension Division that resulted.54
Left behind when the new division took over the Civil War personnel records were cards holding detailed descriptions of men who had taken the physical examination for entrance into the Army. This collection was valuable in identifying deserters. When post commanders reported desertions to post surgeons, their medical officers turned the information in to the surgeon general. Should a deserter or an undesirable then try to reenlist under another name, the Medical Department could usually identify him by means of the description on his card.55
Because the growing accumulation of records from the Civil War years was of
25
great value, its location was of considerable importance. In December 1866 the Medical Department found space in the former Ford`s Theater, where the medical records shared the second floor with the library, whose direction Surgeon General Barnes had placed in Billings` capable hands in 1865. This building was to a limited degree fireproof, but the roof was flammable and the walls were structurally weak. By the time of Barnes` retirement, Ford`s Theater was also badly overcrowded, and a movement was under way to find still larger and safer accommodations.56
Nevertheless, only in the spring of 1885, after much campaigning by both Surgeon General Murray and Billings, now a major, who became head of the Library and Museum Division when it was created in 1883,57did Congress authorize the construction of a new fireproof building. It was to be smaller than the Medical Department wanted and "very plain and simple." Even before the move into the new structure on what is now Independence Avenue had been completed in early 1888, the facility was too small for the purpose for which it had been built, and some records had to be housed elsewhere. It was, however, definitely a safer haven than Ford`s Theater, where during renovation in 1893 the floors collapsed, killing twenty-two people and injuring three times that number.58
State of the Art
Even before the Civil War had ended, the era of modern medicine was already dawning across the Atlantic, and by 1893 rapid progress was being made in the struggle against disease and infection. The age when miasmas were regarded as the cause of most sickness was rapidly coming to an end. In France Louis Pasteur was studying the role played by microscopic bits of living matter in the diseases of plants and animals, and in 1885 he introduced the first successful rabies vaccine. In Germany physician Robert Koch was developing an approach to obtaining pure bacterial cultures and refining the procedure by means of which these cultures could be used to establish the identity of a specific organism and the fact that it caused a specific disease. Although he was not the first to identify Vibrio cholerae, his work with cholera was responsible in large measure for the widespread acceptance of a small living organism as the cause of the much-dreaded Asiatic cholera and of its transmission through contaminated water. In England in 1867 surgeon Joseph Lister published On the Antiseptic Principle in the Practice of Surgery, detailing his successes in preventing the infection of surgical wounds. His approach proved unnecessarily complex and was not quickly accepted outside Europe; minimizing the exposure of wounds to germs by sterilizing surgical instruments and dressings soon proved more effective than spraying the operating room with disinfectants. Nevertheless, because of his work as well as that of those who followed him, surgeons would be able to undertake operations of a kind that would earlier have almost inevitably been followed by fatal infection.59
The significance of the medical revolution that was taking place in Europe was not initially appreciated by American physicians. More concerned with the immediate and the practical than their European counterparts, they were skeptical about the new scientific medicine and the germ theory. Moreover, medical education in the United States was traditionally not the kind that would stimulate an interest
26
in the scientific aspects of medicine. By the time Surgeon General Sutherland retired from the Medical Department in May 1893, however, the number of medical scientists following in the footsteps of the pioneers was rapidly growing.60
Despite their initial lack of enthusiasm about developments in Europe, the leaders of the Army Medical Department were eager to use the experiences of the Civil War to advance the science of medicine. During the conflict Barnes` predecessor, Surgeon General William A. Hammond, had encouraged the creation of what became the Army Medical Museum to house the legacy of the Civil War in the form of a collection of anatomical specimens obtained from the victims of that conflict. He had also supported the library, which became known as the Surgeon General`s Library, that had been started on a modest scale by the first surgeon general, Joseph Lovell.61 Hammond`s successors attempted not only to build upon their heritage by assigning some of their most respected medical officers to work with the specimens and reports collected during the war but also to make the library into a world-respected institution. Both the library and the museum would continue to grow and to contribute to the progress of medical science. But, as the scientific work being undertaken in Europe would demonstrate, the attempt to uncover the mysteries of disease merely by amassing statistics and anecdotal accounts could not succeed.62
The Surgeon General`s Library, the collection that would in 1956 become the National Library of Medicine, was arguably the Medical Department`s most valuable and lasting contribution to medical science developed in the decades immediately following the Civil War. As new developments in the world of medical science began to grow in number with great rapidity, the nation`s best-educated physicians came increasingly to rely on medical libraries, particularly the Surgeon General`s Library, for the information that kept them abreast of the work of their colleagues around the world. Much of the library`s growth in size and fame resulted from the work of Billings. Working aggressively and imaginatively to increase the library`s holdings, he made the most of the meager funds allotted that institution by astute buying and by trading copies of the departments various publications for the books, journals, reports, manuscripts, letters, pamphlets, and portraits he believed it should have. By 1875 the library had copies of about 75 percent of the available periodical literature and the largest collection of pamphlets in the country. To classify the collection, after some experimentation, Billings adopted a revised version of the system used by the Royal College of Physicians in London, employing a series of 5" by 7" cards to keep track of the library`s holdings.63
Because the library`s funds seemed to be in almost constant jeopardy, Barnes and Billings had to move shrewdly to further its interests. They arranged to have it regarded as "the medical section of the Congressional Library" and thus as especially deserving of congressional favor. Billings actively publicized the facility, and the number of those relying upon its service grew rapidly, particularly among civilians. He urged physicians to pressure Congress any time it seemed likely that it might cut the library`s funds, and he gave freely of the fruits of his own experience to advise those managing similar institutions. A vital part of his effort involved issuing catalogs that would inform the interested public, both in the United States and in Europe, of the library`s holdings. After Billings published
27
a sample catalog in 1876 and brought to bear whatever political influence he could garner, Congress, its enthusiasm dampened by the expense involved, voted a modest sum in February 1879 to print the first two volumes of the Index Catalogue, a volume of which appeared each year thereafter. Despite congressional misgivings, the publication was an instant success with the physicians it was intended to serve. One physician called it "a monument of useful labor, a time saving directory to medical literature, a delight and a blessing to the medical scholar," adding, "May the Lord save Dr. Billings to finish it."64
To compensate for the inability of the Index Catalogue to keep up with current literature, the surgeon general gave his permission in 1879 for Billings and an associate to list the most recently published medical literature throughout the world in a privately financed journal, the Index Medicus: A Monthly Classified Record of the Current Medical Literature of the World. Billings requested authors and publishers to send him their publications for listing in the Index Medicus, forwarding what he received to the library after they had been indexed.65
The library held copies of many books by Medical Department authors, among them two painstakingly detailed volumes by Billings-A Report on Barracks and Hospitals, With Descriptions of Military Posts (Circular No. 4), published in 1870; and A Report of the Hygiene of the United States Army, With Descriptions of Military Posts (Circular No. 8), published in 1875. In response to epidemics of two long-dreaded diseases, cholera and yellow fever, from 1864 through 1867 Billings, with the need for public support of the library obviously in mind, also prepared in pamphlet form bibliographies of the library`s works on those diseases. Surgeon General Barnes, meanwhile, assigned assistant surgeon Capt. Ely McClellan to conduct a study of cholera as ordered by Congress. The resultant report joined "A History of the Travels of Asiatic Cholera" by McClellan and a civilian physician, a report by Supervising Surgeon General of the Marine Hospital Service John M. Woodworth, and Billings` full-scale bibliography of works on cholera to become The Cholera Epidemic of 1873 in the United States, which the Surgeon General`s Office published in 1875.66
When Billings retired from the Army in 1895, the library contained more medical publications than the two next largest medical libraries in the United States combined. It may have already become the largest such facility in the world. Thousands of physicians benefited from its riches. The money that Billings obtained from Congress for the library also made it the wealthiest medical library in the world. Moreover, he established a pattern of donations to the Surgeon General`s Library, which permitted him to add significantly to the collection and thus to increase its value to the medical profession.
The museum displays were another legacy from the past, one that eventually, like the library, came under Billings` guiding hand. Even before the end of the Civil War, the museum laboratory had seen Lt. Joseph J. Woodward`s first pioneering experiments with microscopic photography. In the years after the war, Army scientists continued to prepare, examine, and photograph specimens of pathological anatomy and slides contributed by both civilian scientists and medical officers. As the museum grew, it played an increasingly important role in advancing the science of pathology. Skeletons, weapons, and other objects from Indian tribes, as well as spec-
28
imens from the animal world, also poured into the museum. The surgeon general noted in 1891 that among these oddities was a newly acquired section of femur fractured by a shot at Chancellorsville in 1863; in the twenty-eight years since the injury, the bone had healed, but a chronic infection remained to cause the long-suffering veteran`s death "from absorption of pus from wound."67
Work done in the museum laboratory was almost entirely limited to photomicrography and testing medical supplies. As late as 1879 Woodward clearly thought that the theory that germs caused disease was outmoded. In spite of the fact that three of the Medical Department`s most outstanding medical officers, Woodward, Billings, and Maj. George A. Otis, were at one time or another assigned to the laboratory, "almost none" of the department`s work, as medical historian Percy M. Ashburn has pointed out, "bore directly on the prevention of disease or the improvement of health." Ashburn also noted that "practically none of it was being done outside the office of the Surgeon General."68
In 1869, having failed in the attempts he and another medical officer made to discover whether a minute fungi could cause disease, Billings expressed disillusionment with the potential of the microscope and the development of cultures of bacteria for throwing light on the cause of disease. His interest in his microscope began to wane just when bacteriologists in Europe were beginning to discover the organisms causing such diseases as amebic dysentery, typhoid fever, malaria, leprosy, tuberculosis, cholera, diphtheria, tetanus, and one type of pneumonia. Although he made many significant contributions to the field of public health thereafter, Billings remained, as Fielding H. Garrison has put it, a member of "the older or philosophical school of hygienists" and "in no sense of the term a bacteriologist."69
As the years passed, the museum received from civilians an increasing number of specimens illustrating non-war injuries and diseases. This situation met with Billings` approval, since he saw the museum as performing a service for all doctors and believed that it should contain items of general medical interest. To add to the collection, superfluous items were exchanged with other museums, which were kept informed of the Medical Department`s holdings by means of catalogs and checklists. In less than fifteen months after the medical museum opened in Ford`s Theater, its exhibits drew more than 1,400 visitors, both American and foreign, and by 1870 European authors were illustrating their books with woodcuts made from museum photographs. The museum`s growing reputation led to its use by various organizations for their gatherings. Exhibits sent abroad showed foreign scientists how the United States Army handled hospitalization, evacuation, and patient care. Despite the international reputation of the museum, congressional support was not generous and came only in response to pleas from the surgeon general. Yet from the museum and the activities centered there would come the American Registries of Pathology, where thousands of cases of diseases were recorded for study, and, after World War II, the Armed Forces Institute of Pathology.70
The principal concern of museum personnel for many years after the end of the Civil War was transforming the mass of surgeon`s reports into the Medical Department`s major publication, the Medical and Surgical History of the War of the Rebellion, which made heavy use of museum specimens for its illustrations. The history, conceived by Surgeon General Hammond in
29
1862 "to advance the science which we all have so much at heart, and to establish landmarks which will serve to guide us in future," consisted of two volumes, one on medicine and the other on surgery, each of which was divided into three parts of 700 or more pages. A 350-page appendix containing reports of engagements, usually submitted by the medical directors involved, was added to the medical volume. The author-editors of the volumes were all medical officers. Woodward, an experienced pathologist, was responsible for the first two parts of the medical volume, published in 1870 and 1879, with the third published in 1888. The first two parts of the surgical volume were published in 1870 and 1876, the third in 1883. The entire history was finally completed after delays stemming both from Woodward`s prolonged illness and death and from the "pressure of current work at the Government Printing Office."71
The authors of these volumes detailed the medical and administrative problems faced by the Medical Department during the Civil War and the efforts made to resolve them. The illustrations, both photographs and drawings, were of exceptionally fine quality, and the case histories are even today a gold mine for anyone interested in learning how the arts of medicine and surgery were practiced during the Civil War. The discussions often contained histories of how the problems in question had been handled for centuries, but the masses of statistics were essentially only listings, with little analysis. The multitudinous tables merely grouped diseases by geographic area and race. The categories into which the various ailments were divided in the statistical tables showed that the authors still regarded vapors and fumes from decaying matter as the most likely causes for the spread of the diseases that traditionally posed the greatest threat to armies, among them malaria, typhoid, typhus, dysentery, diarrhea, and even measles.
Woodward`s lengthy effort to pin down the cause of the dysentery that had devastated the Union Army was not a scientific study in the manner of Pasteur and Koch but a history of attempts to solve the puzzle dating from the days of the Greeks. He even attacked those who suggested that "bacteria are in some way disease-producers" and who thus "permitted the survival in certain quarters, of the doctrine that dysentery is thus caused." Maj. Charles Smart, the author of the final medical volume, was more ready than Woodward to admit the possibility that something he sometimes called a germ (a term he used alternately with poison) might be the cause of typhoid fever, but he obviously did not think it likely. The instruments and the techniques that might have indisputably proven that bacteria caused the diseases and infections of the Civil War had not been developed when Woodward and Smart made their observations. The information their work might otherwise have revealed was unavailable even after more sophisticated microscopes and staining techniques had been devised. The pioneering work with wound antiseptics conducted during the Civil War and recorded in the Medical and Surgical History had no apparent impact on the work of Lister, which was under way before the publication of the first volume.72
When the Medical and Surgical History first appeared, it was greeted with enthusiasm throughout the Western World. In praising the publications of Army medical officers in 1874, Virchow undoubtedly had it principally in mind when he spoke of "the most extreme exactitude of detail, a
30
statistic careful even as to the smallest matters . . . here united in order to collect and transmit to contemporaries and to posterity with the utmost completeness, the knowledge purchased at so dear a price." Hammond`s hopes for the history were to a large degree frustrated, however. In the wake of the Civil War, as James H. Cassedy noted in American Medicine and Statistical Thinking, 1800-1860, "the laboratory effectively dominated medical research. Statistical analysis receded, temporarily but decidedly, into the background," to reappear only in the twentieth century, when "investigators [had gained] the competence in higher mathematics that was needed for statistics once again to play a major role in clinical and scientific studies." Thus, with the passage of time the Medical and Surgical History of the War of the Rebellion became recognized as "the world`s outstanding compilation on military medicine." Much of its value today lies in its detailed descriptions and illustrations of the plans used for Civil War general hospitals and ambulances, the discussions of the reasoning that led to the development of the various designs, and the reports of various medical directors concerning some of the major battles. The very inability of the medical officers responsible for these volumes to add significantly to the progress of medical science is revealing of an era that was coming to a close even as they wrote.73
The Medical Department`s major official contributions to medical science in the period 1865-1893 fell in the realm of preserving the past for the benefit of the present and the future. The work done in the museum and library in the 1860s and 1870s was, according to Billings in 1903, "in part merely incidental to the preparation of [the] medical and surgical story of the war, in part for the advancement of medicine, and in part for the pleasure of the young men engaged in it." The passage of time would reveal that its "direct results on the science and art of medicine were not great," even though "its indirect results have been . . . important."74
Few U.S. Army medical officers, whether they worked in the museum or in the field, appear to have been seriously interested in the new techniques Koch had developed. One exception was Maj. George M. Sternberg who, impressed by Koch`s work, visited the laboratory of the German physician and briefly worked with him in 1886, when the Medical Department sent him to Europe as the U.S. representative to the International Sanitary Conference in Rome. Although an article written in 1883 promoting an Army career for young physicians maintained that Army posts provided good microscopes, some senior Army physicians still disapproved of work with this instrument; in 1890 a medical officer working in the Surgeon General`s Office described Sternberg`s work with it as of no "earthly bit of good" to the department. Mindful of the problems that this attitude caused him, Sternberg noted with some bitterness that he had had to pay personally for the expensive equipment he needed to set up his own laboratory, even though "apparatus of the same kind, purchased with government money, [had] been for two years lying idle at the Army Medical Museum." Nevertheless, Sternberg continued his research, in 1892 giving a paper on practical accomplishments in the field of bacteriology and his own work in the field that produced favorable comment from the highly respected pathologist William H. Welch at Johns Hopkins.75
Although Lister`s work met with much skepticism for many years, the practical
31
value of what he was doing was more easily grasped than that of researchers with microscopes. Convinced after a visit to England in 1877 that Lister`s work had great merit, another young medical officer, Capt. Alfred C. Girard, informed Surgeon General Barnes: "Be the `germ theory` true, or partly true, or an absolute mistake, practically it matters not; for the present it is the best explanation we have for a most successful method and the best guide in its use." Barnes was sufficiently impressed by Girard`s report to have it sent out to all medical officers as a circular, but without any specific endorsement. Surgeon General Murray, in spite of his reputedly conservative temperament, openly accepted the notion of bacteria as a cause of infection and predicted a time when, because of Lister`s research, the world of surgery would be transformed by antisepsis. Murray`s annual report of 1884, issued when Lister`s work was still not fully appreciated in England, was the first such document to mention the use of antiseptics by Army surgeons during or following surgery.76
By 1893 the first traces of the changes that would profoundly affect the Medical Department in the years to come were already evident. The formation of the Hospital Corps would make training enlisted personnel for modern warfare easier, and post surgeons were less isolated than they had been in 1865. But most medical officers were still attached to small units that were scattered about the country, and the drive to prepare the Army for modern warfare was yet in its infancy. The Medical and Surgical History of the War of the Rebellion stood as an eloquent symbol of the dedication and the frustrations of the medical officers who could not yet accept germs as a cause of disease. Steeped in the older traditions and almost overwhelmed by administrative burdens, the surgeon generals of the period 1865-1893 left the challenge of leading the department boldly toward the new era of medical science to their successors while Army surgeons in the field continued to practice medicine as had their predecessors for generations. Change would come, but it would come only gradually.
NOTES
1. War Department, [Annual] Report of the Surgeon General, U.S. Army, to the Secretary of War, 1866, pp. 2-3 (hereafter cited as WD, ARofSG, date). The fiscal year ran from July through June.
2. James M. Phalen, Chiefs of the Medical Department, United States Army, 1775-1940, pp. 47-69.
3. Barnes became surgeon general as the result of the court-martial conviction of his predecessor, the brilliant but tactless and occasionally arrogant Brig. Gen. William A. Hammond. Although the rank assigned to the position of surgeon general was brigadier general, on 13 March 1865 Barnes was brevetted major general because of his services in the Civil War. See ibid., pp. 48-49.
4. Ibid., pp. 48-50; Ltr, SG to Levi Maish, 3 Jan 1878, Entry 2, Record Group (RG) 112, National Archives and Records Administration (NARA), Washington, D.C.; L. D. Ingersoll, A History of the War Department of the United States. . . , pp. 233, 247 (hereafter cited as History of WD); William Q. Maxwell, Lincoln`s Fifth Wheel, p. 318; George M. Kober, Reminiscences of George Martin Kober, M.D., LL.D., p. 197.
5. James E. Pilcher, The Surgeon Generals of the Army of the United States of America, pp. 65-66; Phalen, Chiefs, p. 52.
6. Phalen, Chiefs, pp. 62-64; Pilcher, Surgeon Generals, pp. 64, 74-76.
7. First quotation from Ltr, J. S. Billings to Ezra M. Hunt, 13 Oct 1883, cited in Wyndham D. Miles, A History of the National Library of Medicine, p. 161 (hereafter cited as History of NLM); second quotation from Pilcher, Surgeon Generals, p. 68; ibid., pp. 67,69; Phalen, Chiefs, pp. 55-57; in RG 112, NARA: Ltr, Ch Med Purveyor to SG, 3 Nov 1873, vol. 17, Entry 10, and Surgeon General`s Office (SGO) Cir 3, 21 Apr 1885, vol. 7, Entry 63.
8. Quotation from Pilcher, Surgeon Generals, p. 70; Phalen, Chiefs, pp. 60, 63. Not long before his death at the age of 90, Brig. Gen. Jefferson R. Kean, who joined the Medical Department in 1884, recalled hearing that President Grover Cleveland had selected Moore by running down the names of medical officers in the Army Register and appointing the first one he reached for whom he had no letters of recommendation. See Kean Interv, p. 14, in folder Interview (1950), Ms C14, Jefferson R. Kean Papers, National Library of Medicine (NLM), Bethesda , Md.
9. Pilcher, Surgeon Generals, pp. 74-76; Ltr, SG to F. M. Cockrell, 23 Feb 1884, Entry 2, RG 112, NARA; [Jedediah H. Baxter], The Medical Part of the Final Report Made to the Secretary of War by the Provost Marshal General; Samuel C. Busey, Personal Reminiscences and Recollections . . . , pp. 303, 306-07, 308.
10. Pilcher, Surgeon Generals, pp. 75-78; Phalen, Chiefs, pp. 63-64; William B. Bean, Walter Reed, p. 45; Edward M. Coffman, The Old Army, p. 384.
11. First and second quotations from Pilcher, Surgeon Generals, p. 82 (see also p. 79); third quotation from Ltr, Jos. C. Bailey to SG, 31 May 1893, in Ms C100, George Miller Sternberg Papers, NLM; Phalen, Chiefs, pp. 66-69; "The New Surgeon General," p. 51.
12. Coffman, Old Army, p. 218.
13. WD, ARofSG, 1865, p. 4, and 1866, pp. 7-8; in RG 112, NARA: Ltr, Charles H. Crane to C. McCormick, 18 Jul 1865, Entry 7, and Ltrs, Crane to J. W Morrison, 3 Aug 1865, to Dorothea Dix, 11 Sep 1865, and to Henry A. Armstrong, 10 Oct 1865, and SG to Henry Watson, 17 Mar 1870, and J. S. Billings to Samuel A. Wood, 24 Sep 1874, Entry 2. In his capacity as assistant surgeon general, Crane relieved Barnes of much of the routine administration of the office.
14. Quotation from WD, ARofSG, 1866, p. 1; ibid., pp. 2, 5; in RG 112, NARA: Ltr, Crane to McCormick, 18 Jul 1865, Entry 7, and Ltrs, W. C. Spencer to O. P. Morton, 16 Nov 1865, Crane to Conrad Baker, 25 Nov 1865, Spencer to J. M. Richard, 25 Oct 1866, SG to W. W. Corcoran, 9 Nov 1866, Entry 2, and Telg, SG to C. Baker, 17 Jan 1866, Entry 2.
15. WD, ARofSG, 1866, p. 5; War Department, Surgeon General`s Office, Medical and Surgical History of the War of the Rebellion, 2-3:901; Ltrs, Crane to D. C. Pearson, 21 Apr 1868, to S. J. P. Miller, 16 Jul 1874, and to Thomas G. Maghee, 10 Sep 1874, and SG to J. M. Marvin, Entry 2, RG 112, NARA.
16. George M. Kober`s quoted comments, cited in Percy M. Ashburn, A History of the Medical Department of the United States Army, p. 109 (hereafter cited as History of MD); Preliminary Inventory of RG 112, pp. 28-29, NARA, which states that the Fi-
33
nance Division was in operation "from the time of the Civil War" (p. 28).
17. Quotations from Otto L. Nelson, Jr., National Security and the General Staff, p. 12; ibid., p. 13; Memo, J. M. Schofield to SG, 5 Oct 1892, John McA. Schofield Papers, Manuscript Division, Library of Congress, Washington, D. C.; War Department, Surgeon General`s Office, The Surgeon General`s Office, p. 224 (hereafter cited as WD, SGO, SGO); WD, ARofSG, 1874, p. 20n. For the responsibilities of medical directors, see, for example, in Entry 63: Instrs for Med Dirs, 14 Sep 1874, vol. 5, and Ltrs, Crane to "Sir" [All Med Dirs], 1 Aug 1876, vol. 5, and to Med Dirs, 3 Aug 1876, vol. 5, and 6 Jan 1877, vol. 6; in Entry 2: MD Form, 1868 (e.g., 17 Aug), and Ltrs, SG to E. L. Baker, 22 May 1877, to Med Dir, Div of Atlantic, 6 Sep 1877, to Med Dir, Dept of Arizona, 11 Nov 1878, among many others, and to G. W. Scofield, 6 Feb 1873, and also Crane to Med Dir, Dept of Gulf, 18 Apr and 10 Jun 1873, to Med Dir, Div of Atlantic, 24 Oct 1874, to Med Dir, Dept of Gulf, 6 Feb 1877, and to Med Dirs, Depts of South, Gulf, Dakota, Platte, Missouri, Texas, California, Columbia, 20 Feb 1877; and in Entry 12: Ltr, F. Branch to SG, 9 Feb 1868. All in RG 112, NARA.
18. Ltrs, John J. Milhau to SG, 18 Mar and 7 Oct 1868 and 25 Feb 1869, Thomas A. McParlin to SG, 5 May 1868, Ebenezer Swift to SG, 13 Jun 1868 and 19 Mar 1870, James Simons to SG, 30 Aug 1868 and 24 Feb and 19 Mar 1869, Andrew K. Smith to SG, 28 Oct 1868, William J. Sloan to SG, 11 Jun 1869, John Moore to SG, 9 Jul 1869, and to Capt L. V. Eziane [sp ?], 20 Sep 1869, and Charles Page to SG, 25 Jul 1869. All in Entry 12, RG 112, NARA.
19. WD, ARofSG, 1868, p. 6; in RG 112, NARA: Ltrs, SG to J. D. Cameron, 16 Oct 1876, and to Levi Maish, 3 Jan 1878, Entry 2, and Ltrs, J. J. Milhau to SG, 18 Mar and 7 Oct 1868, Entry 12.
20. Quotation from "The Army Medical Staff Bill," p. 150; Samuel L. Baker, "Physician Licensure Laws in the United States, 1865-1915," pp. 173-74.
21. Edgar Erskine Hume, "Admission to the Medical Department of the Army Half a Century Ago," p. 199; Ltr, Crane to Joseph B. Brown, 30 Aug 1875, Entry 2, RG 112, NARA. Arthur was promoted to brigadier general in the National Army on 5 August 1917.
22. Ltrs, Crane to Med Dir, Div of Atlantic, to Med Dir, Dept of Dakota, to C. B. Byrne, all 31 Jul 1875, to J. B. Brown, 30 Aug 1875, to E. E. Barnum, 23 Apr 1880, and to Med Dir, Dept of Arizona, 1 Sep 1883, D. L. Huntington to Charles M. Gandy, 22 May 1883, and SG to J. D. Cameron, 16 Oct 1876, and to A. E. Burnside, 26 Jul 1878, all Entry 2, and SGO Cir Info, 29 Jun 1897, Entry 66. All in RG 112, NARA.
23. John Shaw Billings, A Report on the Hygiene of the United States Army . . . , p. 106; Paul Starr, The Social Transformation of American Medicine, pp. 84-85; in RG 112, NARA: Ltrs, SG to G. W. Scofield, 6 Feb 1873, and Crane to H. S. Smith, 13 Jan 1876, and to Med Dirs, 4 Aug 1880, Entry 2, and Ltrs, A. K. Smith to SG, 28 Oct 1868, J.J. Milhau to SG, 25 Feb 1869, J. Simons to SG, 19 Mar 1869, Josiah Simpson to SG, 24 Jun 1869, and J. Moore to SG, 9 Jul 1869, Entry 12.
24. Also affected by the restriction were the Inspector General`s, Quartermaster`s, Adjutant General`s, Engineer, Commissary, Pay, and Ordnance Departments. See AGO GO 15, 11 Mar 1869. See also WD, ARofSG, 1868, p. 7, 1869, p. 10, and 1871, pp. 6-7; "Army Medical Staff Bill," p. 150.
25. James A. Tobey, The Medical Department of the Army, p. 23; Erna Risch, Quartermaster Support of the Army, p. 511; Robert M. Utley, Frontier Regulars, p. 15; WD, ARofSG, 1874, pp. 20-21; Billings, Report on Hygiene, p. 106; Ingersoll, History of WD, pp. 209, 286-87; in RG 112, NARA: Ltrs, Crane to Sutherland, 1 Oct 1873, and SG to William Windom, 1 Jun 1878, to H. Clymer, 5 Apr 1880, and to Joseph E. Johnston, 5 Apr 1880, Entry 2, and Instrs for Med Dirs, 14 Sep 1874, vol. 5, Entry 63.
26. First quotation from "Army Staff Rank," p. 373 (see also pp. 13-14, 136, 374); second quotation from American Medical Association (AMA), Petition of the American Medical Association to the Senate and House of Representatives in Behalf of the Medical Corps of the Army. . . , App., p. 19 (see also pp. 3-4, 11); "Army Medical Staff Rank," p. 311; Harvey E. Brown, The Medical Department of the United States Arrny From 1775 to 1873, p. 203; "Memorial of the American Medical Association," p. 72.
27. Quotation from Ltr, Crane to Med Dir, Dept of Texas, 8 Feb 1877, Entry 2, RG 112, NARA. In loc. cit., see his similar letters to Med Dirs, Depts of Platte, Missouri, Dakota, 8 Feb 1877, as well as those to Med Dirs, Depts of South, Gulf, Dakota, Platte, Missouri, Texas, California, Columbia, 20 Feb 1877, to J. D. Baynes, 5 Jun 1877, and to J. B. Downey, 7 Jul 1877; in Entry 63, see those to "Sir," 1 Aug 1876, vol. 5, to Med Dirs, 3 Aug 1876, vol. 5, to Med Dir, 6 Jan and 25 May 1877, vol. 6, and to Med Offs, 20 Feb 1877, vol. 6, plus SG to A. E. Burnside, 13 Jul 1878, vol. 7. See also James E. Sefton, The United States Army and Reconstruction, 1865-1877, pp. 250-51.
28. WD, ARofSG, 1882, p. 19; Jerry M. Cooper, The Army and Civil Disorder, p. 27; in RG 112, NARA: see, for example, Ltr, SG to A. E. Burnside,
34
13 Jul 1878, Vol. 7, Entry 63, and Ltrs, SG to James A. Garfield, 2 Jul 1868, to W. Windom, 1 Jun 1878, to Burnside, 16 and 26 Jul 1878, to J. E. Johnston, 5 Apr 1880, and to H. Clymer, 5 Apr 1880, Entry 2.
29. Although in 1890 the legislature required promotion examinations for all Army officers below the rank of brigadier general, the regulation was apparently not applied to the Medical Department. Quotation from Pilcher, Surgeon Generals, p. 69; John van R. Hoff, "Outlines of the Sanitary Organization of Some of the Great Armies of the World," p. 513; SGO Cir Info, 29 Jun 1897, Entry 66, RG 112, NARA. On the question of rank versus title for medical officers, the reader will note that while Army surgeons are generally referred to as surgeon or assistant surgeon in the 1888 and 1889 annual reports, they are consistently given their ranks in the 1890 and subsequent reports.
30. Edward M. Coffman, "The Long Shadow of the Soldier and the State," p. 80; Utley, Frontier Regulars, p. 47; Martha L. Sternberg, George Miller Sternberg, p. 91; WD, ARofSG, 1889, pp. 14-15, and 1890, p. 12; A Military History of the U.S. Army Command and General Staff College, Fort Leavenworth, Kansas, 1881-1963, pp. 5-7; Timothy K. Nenninger, The Leavenworth Service Schools and the Old Army, pp. 6-7; in RG 112, NARA: Telgs, Girard to SG, 24 Jun 1892, and C. H. Alden to Med Dir, Dept of Dakota, 26 Jun 1892, box 13, Entry 17, and Ltr, SG to James Laird, 20 Jul 1888, Entry 2, and Ltr, SG to SW, 15 Feb 1890, Entry 22.
31. WD, ARofSG, 1891, pp. 13-14; AGO GO 19, 26 Feb 1891, and GO 86, 26 Oct 1891 (pp. 41-43, 46-49); Coffman, Old Army, p. 232.
32. Quotation from Ltr, SG to Charles H. Alden, 27 Apr 1889, Entry 2, RG 112, NARA; in loc. cit., see Ltr, D. L. Huntington to C. M. Gandy, 22 May 1883. See also Raphael P. Thian, comp., Legislative History of the General Staff of the Army of the United States . . . From 1775 to 1901, p. 38; Morris J. Asch, "Army Medical Service," pp. 203-04; and the surgeon general`s annual reports for numbers of applicants to department.
33. AGO GO 55, 27 Jul 1883; Ltrs, Crane to William B. Allison, 16 Jan 1883, and D. L. Huntington to C. H. Miller, 16 Jun 1883, to Charles A. Sumner, 5 Jun 1884, to John Raymond, 8 Oct 1884, to W. E. Fisher, 22 Nov 1884, and to A. C. Mooreland, 28 Jun 1886, and SG to F. M. Cockrell, 26 Apr 1884, to C. H. Penrose, 11 Dec 1886, to Med Dir, Dept of Columbia, 2 Feb 1887, and to Joseph R. Smith, 17 Feb 1887, Entry 2, RG 112, NARA; Robert S. Henry, The Armed Forces Institute of Pathology, p. 154 (hereafter cited AFIP).
34. Erwin H. Ackerknecht, A Short History of Medicine, p. 194; AGO Cir 9, 6 Aug 1892; AGO GO 76, 16 Dec 1887; in RG 112, NARA: Ltrs, Charles R. Greenleaf to Fred C. Ainsworth, 24 Dec 1887, and to Post Surg, Davids` Island, 26 Mar 1888, Entry 2, and Ltr, Greenleaf to Stephania Mikulewicz, 14 Mar 1890, Entry 22.
35. "The Rank and Pay of the Hospital Stewards of the Army," pp. 670-71; Ltrs, Crane to Joseph Anderson, 21 Jun 1871, and to Med Dir, Dept of Gulf, 10 Jun 1873, Entry 2, RG 112, NARA; Paul R. Cutright and Michael J. Brodhead, Elliott Coues, p. 107; John M. Hyson, "William Saunders," p. 436.
36. John Shaw Billings, "Notes on Military Medicine in Europe," pp. 236-37; AGO GO 78, 6 Jul 1874, GO 30, 9 May 1877, and GO 47,15 Mar 1881; in RG 112, NARA: Ltr, AG to SG, 19 Sep 1872, vol. 16, Entry 10, and Ltr, SGO to R. Murray, 20 Feb 1880, vol. 1, Entry 16, and Ltr, SG to J. D. C. Atkins, 5 Feb 1877, Entry 2.
37. Quotation from WD, ARofSG, 1886, p. 35; ibid., 1885, p. 39; John van R. Hoff, "What is a Hospital Corps?," pp. 315-16; Junius L. Powell, "Some Observations on the Organization and Efficiency of the Hospital Corps . . . ," pp. 330-31; Coffman, Old Army, p. 381; AGO GO 62, 4 Jun 1885; in Entry 2, RG 112, NARA: Ltrs, D. L. Huntington to Bernard Persh, 13 Sep 1884, to Med Dir, Div of Atlantic, 24 Sep 1884, to H. C. Gesserer, 18 Jul 1885, to B. B. Gell, 7 Apr 1886, and to Andrew F. Peters, 22 Jun 1886, and SG to Med Dir, Dept of Arizona, et al., 21 Jun 1886, and SGO to E. L. Bragg, 15 Jan 1887, and C. R. Greenleaf to 2d Compt, Treas Dept, 13 Jul 1889.
38. First quotation from Russell F. Weigley, History of the United States Army, p. 290; second quotation from WD, ARofSG, 1885, p. 39; ibid., 1886, p. 35; Graham A. Cosmas, An Army for Empire, pp. 17-18; James L. Abrahamson, America Arms for a New Century, p. 61; Coffman, Old Army, p. 396. The motivation for the establishment of the Hospital Corps was not entirely identical with that for the service corps sought by other departments (see Risch, Quartermaster Support, pp. 561-62, 565) since the Medical Department had broken free before the Civil War of many of the problems caused by temporary detailing of civilians and enlisted men to serve as stewards (see Mary C. Gillett, The Army Medical Department, 1818-1865, pp. 129-30).
39. Ltrs, D. L. Huntington to Post Surg, Watervliet Arsenal, 5 Nov 1885, and C. R. Greenleaf to F. C. Ainsworth, 29 Apr 1887, to Med Dirs, 7 Jan 1889,
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and to 2d Compt, Treas Dept, 13 Jul 1889, and SGO Cir 1, 26 Apr 1889, Entry 2, RG 112, NARA; WD, SGO, SGO, p. 45. Unless otherwise indicated, all material on the Hospital Corps is based on AGO GO 56, 11 Aug 1887, from which the quotation is taken.
40. Ltrs, Charles Smart to G. W. Miller, 8 Jun 1888, and C. R. Greenleaf to Smart, 1 Oct 1888, Entry 2; Note [initialed CRG], 22 May 1890, Entry 22. All in RG 112, NARA.
41. First and second quotations from Ltr, John van R. Hoff to SG, 13 Oct 1888, Entry 17; third quotation from L.W. Crampton to Med Dir, Dept of Platte, 26 Sep 1888, Entry 17; and fourth quotation from Ltr, SG to C. E. Hooker, 21 Jan 1889, Entry 2. All in RG 112, NARA. In loc. cit., see Ltrs, Joseph K. Corson to Med Dir, Dept of Columbia, 8 Jul 1888, and C. Page to SG, 19 Nov 1889, Entry 17, and SG to Chair, MilAffs Cmte, HofReps, 24 Mar 1888, Entry 2. See also Charles Sutherland, "Organization of Hospital Corps," in Pan-American Medical Congress Transactions, 1:688; Jack D. Foner, The United States Soldier Between Two Wars, pp. 84-92.
42. WD, ARofSG, 1888, pp. 141-42, 1889, p. 9, and 1891, pp. 10-13; Ltrs, C. R. Greenleaf to George Dieffenbach, 1 Dec 1887, to E. P. Harrison, 6 Mar 1888, to Post Surgs, 7 Aug 1888, to William Everts, 27 Aug 1888, and to Harry J. Ramsey, 9 Sep 1889, and C. Smart to Charles H. Swan, 27 Mar 1888, Entry 2, RG 112, NARA.
43. WD, ARofSG, 1866, pp. 2-3; Paul S. Peirce, The Freedmen`s Bureau, pp. 44, 48-49, 87-89, 91-92; Message From the President to the Two Houses of Congress at the Commencement of the Second Session of the Fortieth Congress . . . , ed. Ben. Perley Poore (Washington, D.C.: Government Printing Office, 1867), pp. 472, 478, 480-82, 494; Message From the President of the United States to the Two Houses of Congress at the Commencement of the Third Session of the Fortieth Congress, ed. Ben. Perley Poore (Washington, D.C.: Government Printing Office, 1869), pp. 491, 499; George R. Bentley, A History of the Freedmen`s Bureau, pp. 76, 209; in RG 112, NARA: Ltr, SG to Freedmen`s Hospital, Wash., D.C., 19 Jul 1872, Entry 2, and Rpt, Samuel Jessop, 15 Jan 1869, Entry 51, Charleston, and AGO SO 435, 31 Aug 1866, and SO 266, 10 Jun 1867, Entry 57.
44. WD, ARofSG, 1866, pp. 3-4; Ltrs, Crane to J. D. W. Grady, 1 Aug 1865, and J. S. Billings to Monroe & Gardiner, 10 May 1867, Entry 2, RG 112, NARA.
45. WD, ARofSG, 1876, pp.4-5, 1877, p.4, 1881, pp. 4-5, and 1892, p. 7; Ltrs, Crane to Hugo Wangelin, 3 Aug 1879, and to Jay Gould, 6 Jan 1871, and SG to Com of Pensions, 15 Jun 1872, Entry 2, RG 112, NARA.
46. Quotation from Ltr, SG to John Findlay, 22 Jan 1886, Entry 2, RG 112, NARA; WD, AR of SG, 1891, p. 6, and 1892, p. 11.
47. WD, ARofSG, 1892, pp. 7-8, 10.
48. Among Billings` later designs was the Johns Hopkins Hospital.
49. Fielding H. Garrison, John Shaw Billings, pp. 278-335; Miles, History of NLM, p. 106; Paul R. Goode, The United States Soldier`s Home, pp. 28, 51, 91, 93-94, 97, 102; Constance McL. Green, Washington, p. 310; Billings, Report on Hygiene, pp. lv-lvi; in Entry 2, RG 112, NARA: Agreement, SG and Sister Loretta O`Reilly, 3 Dec 1868, and Ltrs, SG to Moses Kelly, 8 Aug 1868, to U.S. Sen and Hof Reps, 6 Dec 1869, to Pres of Sen and Speaker of H, 10 Dec 1870, to U.S. Sen and HofReps, 13 Dec 1872, and to Aprops Cmte, 5 Dec 1874, and Crane to Eds, Am Encyclopedia, 10 Mar 1876.
50. WD, ARofSG, 1883, p. 15, and 1884, p. 19; Mabel E. Deutrich, Struggle for Supremacy, pp. 22, 27, 32.
51. WD, ARofSG, 1866, p. 6; ibid., 1883, p. 15, 1886, p. 5, 1887, pp. 4-5, and 1888, p. 5; Deutrich, Struggle, p. 22; in RG 112, NARA: Orders, SW to SG, 21 Jun 1873, vol. 17, Entry 10, and Ltr, J. S. Billings to N. Van Clernam, 26 Jul 1879, Entry 2.
52. WD, ARofSG, 1870, p. 5; Deutrich, Struggle, pp. 27-28; in RG 112, NARA: Ltrs, SG to J. A. Garfield, 2 Jul 1868 and 23 Feb 1869, and to W. Windom, 10 Feb 1877, and Ltr, Crane to J. J. Woodward and to George A. Otis, 22 Aug 1870, Entry 8.
53. Deutrich, Struggle, pp. 21, 26-30; in RG 112, NARA: Orders, SW to SG, 21 Jun 1873, vol. 17, Entry 10, and Ltrs, SG to J. A. Garfield, 2 Jul 1868, to H. Williams, 11 Mar 1874, to Sol M. Merrill, 2 May 1874, to Com, IndAffs, 14 Jan 1876, to W. Windom, 10 Feb 1877, and to Div Heads (various), 9 Jun 1885, and Crane to Campbell Williams, 3 Jun 1877, to Post Surgs, 20 Jul 1881, and to Page, 25 Jul 1881, all Entry 2, plus SGO Cir, 27 Jul 1883, and Orders, SG, 3 Aug 1883, vol. 7, Entry 63. For more detail on this problem, see the surgeon general`s annual reports for the period.
54. WD, ARofSG, 1888, pp. 137-38, and 1889, p. 13; Deutrich, Struggle, pp. 30-34, 36-43; Ltrs, D. L. Huntington to T. T. Carson, 29 Jun 1887, and to Robert B. Vance, 2 Feb 1887, and Orders, SG, 25 Jun and 14 Jul 1887, Entry 2, RG 112, NARA.
55. WD, ARofSG, 1891, p. 15, and 1892, pp. 17-18; AGO Cir 6, 3 Jul 1891; SGO Cir, 9 Jul 1890, Entry 22, RG 112, NARA.
36
56. WD, ARofSG, 1867, p. 4, 1880, pp. 17-18, and 1881, pp. 16-17; Miles, History of NLM, p. 28; Henry, AFIP, pp. 54, 73-75.
57. The Library and Museum Division was part of the Surgeon General`s Office.
58. The library and museum had initially been separate organizations. Quotation from WD, ARofSG, 1885, p. 36; ibid., p. 35, and 1888, p. 140; AGO GO 31, 19 Mar 1885; Miles, History of NLM, pp. 163-64, 168; Henry, AFIP, pp. 79-80; in RG 112, NARA: Orders, SG, 28 Dec 1883, and Ltrs, D. L. Huntington to Edgar A. Means, 24 Jan 1884, and SG to William Mahone, 14 Dec 1883, to HofReps Mbrs, Conf Cmte, 12 Feb 1885, and to Chair, Sen Aprops Cmte, 1 Mar 1887, all Entry 2, plus Pamphlet, 1883, vol. 7, Entry 63.
59. John S. Chambers, The Conquest of Cholera, pp. 335, 344, 348; Peter Baldry, The Battle Against Bacteria, pp. 30-31, 37; Wesley W Spink, Infectious Diseases, pp. 7-8, 162, 165, 363, 428-29; Fielding H. Garrison, An Introduction to the History of Medicine, 3d rev. ed. and enl., pp. 620-21, 623-24, 633-35.
60. Garrison, History of Medicine, pp. 578-79; Richard H. Shryock, Medicine in America, pp. 29-31, 71; Ackerknecht, Short History, pp. 209-11; Kenneth M. Ludmerer, Learning To Heal, pp. 4, 18, 23-26, 83-84, 119, 178, 235, 245; William G. Rothstein, American Physicians in the Nineteenth Century, pp. 265-66, 285-94.
61. Before Joseph Lovell was appointed surgeon general in 1818, the Army had no permanent medical service, and although the title of surgeon general was sometimes used, it was not given to the head of any of the temporary medical services created to meet wartime needs. During the War of 1812 James Tilton was given the title of physician and surgeon general.
62. James H. Cassedy "Numbering the North`s Medical Events," pp. 232-33.
63. Dorothy M. Schullian and Frank B. Rogers, "The National Library of Medicine," p. 11; WD, ARofSG, 1872, p. 10; Ltr, Billings to William Wesley, 27 Jul 1867, Entry 2, RG 112, NARA; John Shaw Billings, "Who Founded the National Medical Library?," p. 299; idem, Selected Papers, pp. 4, 81; James H. Cassedy, Medicine in America, pp. 77, 85. For a detailed discussion of post-Civil War history of the Surgeon General`s Library, see Miles, History of NLM, on which, unless otherwise indicated, much of the material in this chapter concerning the library is based.
64. Publication of the Index Catalogue ceased in 1961. First quotation from Ltr, SG to Thomas Settle, 20 Aug 1872, Entry 2, RG 112, NARA; second and third quotations cited in Miles, History of NLM, p. 129. In Entry 2 above, see Ltrs, Billings to H. R. Spoffard, 12 Feb 1872, and SG to L. M. Morrill, 9 Feb 1872, to M. Wurtz, 22 May 1872, and to John Eaton, 25 Nov 1872. See also WD, ARofSG, 1874, p. 19, 1878, pp. 17-18, 1879, p. 17, 1881, p. 16, and 1882, pp. 16-17; Billings, Papers, p. 229.
65. Billings, Papers, pp. 229-30.
66. WD, ARofSG, 1875, pp. 15-16; War Department, Surgeon General`s Office, The Cholera Epidemic of 1873 in the United States; Orders and Ltr, SG to Ely McClellan, 7 May and 24 Dec 1874, Entry 2, RG 112, NARA.
67. Quotation from WD, ARofSG, 1891, p. 7; Henry, AFIP, pp. 36, 51-66; Ltr, D. L. Huntington to E. A. Means, 24 Jan 1884, Entry 2, RG 112, NARA; Esmond R. Long, A History of American Pathology, p. 167.
68. Quotations from Ashburn, History of MD, p. 134; WD, SGO, Medical and Surgical History, 1-2:374.
69. Quotations from Garrison, Billings, p. 342; ibid., pp. 152, 411; John Z. Bowers and Elizabeth P. Purcell, eds., Advances in American Medicine, 1:347; William D. Foster, A History of Medical Bacteriology and Immunology, p. 65.
70. The story of the museum and its transformation into the Armed Forces Institute of Pathology is told in detail in Henry, AFIP. See also Ltrs, SG to C. Cole, 15 May 1872, and D. L. Huntington to L. C. Pitcher, 4 Mar 1886, Entry 2, RG 112, NARA; SGO Cir 2, 4 Apr 1867; WD, ARofSG, 1866, p. 8, 1868, p. 6, 1870, pp. 9-10, 1873, pp. 8-9, 1874, pp. 15n-16n, 1876, pp. 17-18, and 1877, pp. 12-13; George A. Otis, "Notes on the Contributions to the Army Medical Museum by Civil Practitioners," p. 164; John E. Erichsen, "Impressions of American Surgery," p. 720; "Science Schools and Museums in America," p. 290; John Shaw Billings, "On Medical Museums," pp. 309, 311; M. C. Leikind, "Army Medical Museum and Armed Forces Institution of Pathology in Historical Perspective," p. 75; Long, American Pathology, p. 128.
71. First quotation from Henry, AFIP, p. 14; second quotation from WD, ARofSG, 1886, p. 33. See also ibid., 1888, p. 141.
72. Quotation from WD, SGO, Medical and Surgical History, 1-2:374; ibid., 336-47, 367, 651, 653, and 1-3:500-508; George H. Daniels, ed., Nineteenth-Century American Science, p. 177; Henry, AFIP, pp. 89-90; Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Surgery From Empiric
37
Craft to Scientific Discipline, p. 507; Cassedy, "Numbering Medical Events," pp. 232-33.
73. First quotation from address given by Virchow on 2 August 1874, cited in AMA, Petition, p. 19. (This quotation from Virchow is a popular one, although rarely reproduced at length. William G. Morgan`s assumption that Virchow was specifically referring to the Medical And Surgical History is apparently a common one. But in the address as published in "Summary," pp. 299-300, as well as in Kober, Reminiscences, p. 224, in the AMA, Petition, p. 19, and very briefly in William G. Morgan, "Contributions of the Medical Department of the United States Army to the Advancement of Knowledge," p. 781, Virchow refers only to Medical Department publications in general. Thus, since only one part of each volume of the Medical and Surgical History had appeared by 1874 and since medical officers were responsible for many other publications in the period 1865-1874, it seems likely that Virchow had more than the Medical and Surgical History in mind when he spoke.) Second and third quotations from James H. Cassedy, American Medicine and Statistical Thinking, 1800-1860, p. 238. Fourth quotation from Esmond R. Long, "The Army Medical Museum," p. 370. See also idem, American Pathology, p. 129; Cassedy, Medicine in America, p. 66; AMA, Petition, p. 20.
74. Billings, Papers, p. 264.
75. Sternberg became surgeon general in 1893. First quotation from Ashburn, History of MD, p. 148; second quotation from Sternberg, Sternberg, p. 88. See also ibid., pp. 67, 70-87, 91-92; John Mendinghall Gibson, Soldier in White, pp. 136-37; Asch, "Army Medical Service," pp. 203-04; Ltr, Sternberg to SG, 27 Nov 1883, Ms C100, NLM. In 1892 Sternberg provided a group of scientists with the details of his work producing immunity to smallpox in calves, to include data on an experiment that demonstrated the in vitro effects of immune serum on the vaccine virus. See George M. Sternberg, "Practical Results of Bacteriological Researches," pp. 68-86.
76. Quotation from SGO Cir Order 3, 20 Aug 1877, vol. 6, Entry 63, RG 112, NARA; Garrison, History of Medicine, pp. 588-91; Phalen, Chiefs, p. 56; WD, ARofSG, 1884, p. 32, and 1885, p. 27; Gert H. Brieger, "The Development of Surgery," in Davis-Christopher Textbook of Surgery, pp. 9-10.
