.

Civil War Hospital Ship

The U.S.S. Red Rover, a captured Confederate vessel, was refitted as a hospital ship.

Evolution of Civil War Nursing

The evolution of the nursing profession in America was accelerated by the Civil War.

The Practice of Surgery

Amputations were the most common surgery performed during the Civil War.

Army Medical Museum and Library

Surgeon-General William Hammond established The Army Medical Museum in 1862. It was the first federal medical research facility.

Civil War Amputation Kit

Many Civil War surgical instruments had handles of bone, wood or ivory. They were never sterilized.

Sunday, October 9, 2011

Civil War Medicine Vocabulary

AMPUTATION

A surgical operation to remove an arm, leg, hand, foot or digit of the body. Amputations were the most frequently performed surgeries in the Civil War. Massive damage was done to bones and tissue by the new ammunition, the Minié ball. Amputation was the fastest way for doctors to save a life, and 75 percent of the amputees survived their surgeries.

ANEMIA

A condition characterized by weakness and pallor. It is a reduction of hemoglobin in the red blood cells, and also a reduction in the number of red blood cells in most forms of anemia, resulting in a deficiency of oxygen. During the war, it was twice as common among black soldiers from the southeastern states. It was discovered many years later that intestinal parasites are usually the cause.

ANESTHESIA

A loss of feeling, awareness or sensation; loss of the ability to feel pain.

ANESTHETIC

A drug used to make patients unconscious and insensitive to pain. It is administered before surgery and allows surgeons to perform more extensive procedures. Anesthesia, in the forms of ether and chloroform, was used most commonly by dentists before the Civil War. President Lincoln brought his own supply of chloroform to a dental appointment in 1862. It was adopted by and available to military surgeons of both armies and used for almost all Civil War surgeries.

ARTILLERY

Large weapons including cannons, mounted projectile-firing guns or missile launcher; or the branch of an army using artillery.

BARK JUICE

A slang term for liquor.

BAYONET

A dagger-like weapon attached to the muzzle of a gun for hand-to-hand combat. Civil War bayonet wounds were far fewer than in previous wars, as the new guns and ammunition allowed for combat at a longer range.

BEDROLL

Blankets or bedding carried by troops. They were rolled for storage and transport and usually contained a soldier’s personal belongings.

BLOODLETTING

The ancient practice of withdrawing quantities of blood to aid the body’s healing. Considered a “heroic therapy”, bloodletting had been practiced for almost 2,000 years before the Civil War. By the 1830’s it was much less common in America, although some bloodletting through the use of leeches was practiced during the war.

BLUE MASS (BLUE PILLS)

Calomel or mercurous chloride, was a clay-like compound of mercury and chalk. “Blue Mass” was administered to troops suffering diarrhea, dysentery, typhoid fever and other ailments. “Blue Pills” contained mercury, licorice, rose water, powdered rose, honey and sugar. President Lincoln used Blue pills to treat his constipation. The recommended dose contained more than 9,000 times the amount of mercury considered safe by today’s standards. Some soldiers died from mercury toxicity.

BONESAW

A surgical tool for amputations. Many Civil War bonesaws resemble hacksaws; some were flexible chainsaws. Before the war, bonesaws had been imported from France and England. The Chief Medical Purveyor for the United States Army requisitioned 4,900 amputating and general operating instrument cases from American manufacturers during the war.

CAMP ITCH

A highly communicable skin disease usually caused by scabies. It was easily spread among soldiers in crowded camps and is caused by a mite, Sarcoptes scabiei.

CAVALRY

Troops or groups of men who fight from horseback.

CHISOLM INHALER

A device for the administration of anesthesia. Invented by Confederate physician Dr. John Julian Chisolm, the inhaler provided a more controlled dosage to the patient and less exposure to drug fumes by doctors and nurses. Previously, most anesthesia was administered with a soaked cloth.

CHLOROFORM

A colorless, heavy, sweet-smelling liquid used as a solvent and administered widely as anesthesia during the Civil War. Chloroform was preferred over ether, as it was not explosive and had less bulk to transport.

CONSUMPTION (Pulmonary tuberculosis)

Progressive wasting of the body, usually through pulmonary tuberculosis. It is a contagious bacterial infection that involves the lungs, but can also spread to other organs. Caused by the bacteria Mycobacterium tuberculosis, it is spread by breathing air droplets from the cough or sneeze of an infected person. It was one of the most deadly wartime diseases.

DIARRHEA

An intestinal disorder that is characterized by frequent and fluid bowel movements. Chronic diarrhea was one of the top killers in the Civil War. Diet, poor sanitary practices, spoiled food and contaminated water all made the disease epidemic throughout both armies. Sometimes the terms “diarrhea” and “dysentery” were used interchangeably by the doctors; sometimes the distinction was made that “dysentery” indicated blood in the stool. The phrase “He hasn’t got the guts to stand it” was coined by Civil War soldiers.

DRESSINGS

Material to dress or bandage a wound. Physicians used any fabric available, even re-using bandages from previous patients. Wounds were frequently packed with lint. Dressings were commonly coated with cerate, a soothing ointment made of beeswax.

DYSENTERY

An infectious disease of the large intestines which causes severe diarrhea. Chronic dysentery and diarrhea killed more Civil War soldiers than any other disease.

EPIDEMIC DISEASE

A widespread or highly contagious disease that affects many individuals at the same time. Civil War doctors contended with deadly epidemics including smallpox, yellow fever, measles, mumps and chickenpox. Typhoid fever was the biggest killer among the epidemic diseases.

ERYSIPELAS

A severe skin infection characterized by redness and tenderness. It can spread quickly beneath the skin, destroying tissues, and sometimes passes into the bloodstream. It had a very high death rate.

ETHER

Widely used during the war as an anesthetic, ether is colorless and highly volatile. It was less unpredictable than the more popular but occasionally more deadly chloroform, but had greater bulk to transport and could be explosive.

FEVER

An abnormally high body temperature.

FIELD HOSPITAL

A temporary facility in the field staffed by medical personnel for the support of troops in battle. Locations were carefully selected near available shelter. Clean water, wood and a dry and even surface were the ideal prerequisites. Arrangements were established for transportation of the wounded, maintaining supplies and burying the dead.

FIELD TOURNIQUET

A device to stop bleeding by compression. Soldiers were advised to carry a stick of wood and a handkerchief or piece of cloth to create a tourniquet for a wounded limb.

GONORRHEA

A common venereal disease among Civil War soldiers, known since Biblical times. Civil War doctors used the term “gonorrhea” to diagnose all types of urethral discharges.

GRAYBACKS

A slang term for Southern soldiers or for lice.

HOMEOPATHY

A method of treating disease by administering minute doses of drugs that in a healthy person would produce symptoms similar to those of the disease. In the Civil War, homeopathic treatments were sometimes utilized as a more mild alternative to procedures like bloodletting.

HORNETS
A slang term for bullets.

HOSPITAL GANGRENE

One of the most feared and deadly wound infections, it was highly contagious. It destroys tissue and can spread through the bloodstream to other parts of the body.

INFANTRY

The branch of an army composed of soldiers who fight on foot.

INTESTINAL WORMS

Parasites that can cause mild itching, diarrhea, vomiting or extreme abdominal pain. Black soldiers who had been in slavery in the southern states showed a higher incidence of intestinal worms.

JAUNDICE

A yellow discoloration of the skin and whites of the eyes, due to an increase of bile pigments in the blood. Jaundice is characteristic of the disease yellow fever.

JOY JUICE

A slang term for liquor

LAUDABLE PUS (See also “PUS” and MALIGNANT PUS)

Civil War physicians welcomed the sight of thick, creamy pus, believing that it was a necessary part of the body’s healing process. They did not know that it was a sign of infection owed to the staphylococci bacteria.

LEECHES (See also BLOODLETTING)
A bloodsucking annelid worm once used for bloodletting.

LIGATION

One of the few clinical advances attributed to Civil War surgeons is “arterial ligation”, the tying off of a major artery to constrict blood vessels and stop hemorrhaging. It was not widely known or used during the first part of the war, but by the second half, surgeons had improved and shared their techniques for this life-saving procedure. The veins or arteries were usually tied off with wire or silk thread.

LINT

Minute shreds or ravelings of yarn or cotton fiber. Lint was commonly used to pack and dress wounds. Women volunteers scraped their sheets and tablecloths to gather lint for dressings.

LYMPH

Liquid taken from the lesion of a cow infected with cowpox, or a person infected with smallpox. It was inserted into a cut on a healthy person to create a crude vaccination.

MAGGOTS

The soft-bodied, legless larva of certain flies. Soldiers were tormented by the appearance of maggots in their wounds. Some physicians realized that the insects only ate the dead tissue, cleaning the wounds effectively and painlessly. The use of maggots continues to be explored in the 21st century.

MALARIA

A disease named after the Italian “Mala Aria”, or “bad air”. Debilitating and recurring chills, fever and sweating are its usual symptoms. Almost a million cases of malaria or “intermittent fevers” among Union soldiers were recorded, and it is thought that even more Confederate troops may have suffered. The disease was thought to be caused by “miasmas” or vapors that rose from swamps, although it was later found to be transmitted by the anopheles mosquito.

MALIGNANT PUS

Pus that is watery and bloody, usually attributed to the streptococci bacteria. Malignant pus spread rapidly, and frequently had a fatal outcome due to pyemia or “blood poisoning”.

MALINGERING

Pretending to be ill, especially in order to shirk work or duty. Some soldiers feigned disease or injury in order to obtain a Medical Certificate of Discharge. Known malingerers were sometimes called to duty as stretcher-bearers.

MEASLES

A highly infectious disease characterized by fever, small red spots and cold-like symptoms. The rash was frequently accompanied by pneumonia, making measles very deadly. It ravaged the young troops from rural areas, who had minimal exposure to disease and few immunities. It is estimated that in the Union army, measles were fatal in 6% of white troops and 11% of black troops. Measles epidemics were lethal in Confederate camps, sometimes necessitating the temporary disbanding of companies, battalions and whole regiments.

MINIÉ BALL

The Minié ball caused most of the Civil War wounds. Invented by a French army officer and adapted by American manufacturers, the large conical lead missile was a radical advance in ammunition. It was used in the new rifled weapons and caused massive damage to bones and tissue.

MORPHINE

An addictive narcotic obtained from opium, morphine is used as a powerful pain-killing drug or a sedative. Civil War surgeons frequently dusted morphine powder directly into wounds, sometimes applying it with a moist finger.

NEUROLOGY

The branch of medicine that deals with the nervous system. The large numbers of nerve injuries in the war wounded led to the founding of a specialty hospital called Turner’s Lane in Philadelphia. The medical team was led by Dr. Silas Weir Mitchell of Philadelphia, who had begun to study the phenomenon of “phantom limb” in amputees. Dr. Mitchell gathered valuable data and experimented with treatments, including electrical. He is regarded as one of the founders of American neurology.

NOKUM STIFF

A slang term for liquor

OPTHALMOSCOPE

An instrument utilizing a series of lenses to see inside the eye. Early models used sunlight or an oil lamp as a light source. During the war, both the Federal and Confederate armies established specialty hospitals to treat eye injuries.

PAVILION HOSPITALS

Long, narrow, well-ventilated wooden buildings, commonly built like spokes on a hub. By 1862, Union and Confederacy favored the newly designed “pavilion hospital”. Specialized areas at the hub included operating rooms, kitchens, offices, supply rooms and “dead house”. Although overall sanitation was still poor, pavilion hospitals were usually equipped with rudimentary toilet facilities. Medications, food, laundry and supplies moved much more efficiently through the pavilion hospitals and the quality of convalescent care improved.

PEPPERBOX

A slang term for a pistol.

PHANTOM LIMB

The sensation experienced by some amputees that a missing limb is still attached. This phenomenon was noticed and studied during the Civil War by Dr. Silas Weir Mitchell, now considered one of the founders of the field of neurology.

PHOTOMICROSCOPY

The creation of a photographic reproduction of an object as viewed through a microscope. The Federal Surgeon General’s Office purchased a compound microscope in 1863 for the use of Dr. Joseph Janvier Woodward, an international pioneer in the field of photomicroscopy. Dr. Woodward led the research being conducted by the Army Medical Museum.

PLASTIC OPERATIONS (PLASTIC SURGERY)

A medical specialty focused on the correction or restoration of form and function. Facing many serious head and facial wounds, Civil War surgeons began to attempt some major facial reconstructions. The surgeries were done in multiple steps and used flaps of skin and cork to repair structural damage. Union army records list 32 “plastic operations”.

POULTICES

A soft, moist, mass of cloth, meal, or herbs that was applied to wounds. They were frequently made of bread or flaxseed. Yeast poultices were commonly applied to suppurating wounds in the belief that they would stop infection.

PROBE (NÉLATON PROBE)

A long, thin, flexible metal wand with a ceramic tip. Invented by a French military surgeon named Nélaton, it was used to detect the presence of a bullet in a wound. The probe was never sterilized, and probably carried germs deep into the body. President Lincoln’s fatal head wound was examined with a Nélaton probe.

PURGATIVES

Cleansing or purging, usually by inducing evacuation of the bowels. Civil War doctors used purgatives to draw fluids into the gastrointestinal tract, in the belief that they were draining the fluids from other areas of the body. They also used emetic agents to induce vomiting.

PUS (See also “LAUDABLE PUS”)

A yellow-white viscous substance composed of bacteria, white blood cells and dead tissue. It is characteristic of infected wounds. Civil War physicians believed that it was part of the healing process.

PYEMIA

Infections that spread throughout the bloodstream, also known as “blood poisoning”. During the Civil War, the death rate of soldiers with this condition was 97%.

QUICK-STEP

A slang term for diarrhea, one of the deadliest ailments of the war.

QUININE

A drug made from cinchona tree bark, whose active ingredient is the alkaloid “quinine.” Spanish missionaries observed its use in South America in the 1500’s. It was an effective treatment for malaria and widely used by Civil War doctors.

SAWBONES

A slang term meaning “surgeon”.

SCALPEL

A small, usually straight knife used in surgery to cut through skin and other soft tissue.

SCURVY

Scurvy is a disease related to dietary deficiency, known during the Civil War as a “dietetic disease”, their term for malnutrition. It is caused by a lack of vitamin C and other nutrients. It is a debilitating disease, frequently characterized by swollen and bleeding gums and livid spots on the skin. The effectiveness of the military was sometimes severely affected by the widespread nature of this affliction in some units. Scurvy remained a problem in the U.S. military through World War I.

SMALLPOX

A viral disease characterized by fever and pustular eruptions of the skin. The fatality rate was 20-40%. Those who survived usually bore its scars. Smallpox was known to be highly contagious, and separate hospital units, called “pest houses” were used to house those with the disease. Smallpox was one of the few diseases for which vaccinations were available, but not always enforced. President Lincoln suffered a mild case of smallpox in November, 1863.

SUPPURATION

The discharge or formation of pus. Also a term for pus.

SUTURES

Stitches that join the edges of a wound or vessel. Civil War surgeons used silk or cotton thread. When severe supply shortages affected the Confederacy, surgeons used horsehair that was boiled to make it more pliable.

SYPHILIS

A chronic infectious, usually venereal disease caused by a spirochete. Syphilis was not as feared as gonorrhea by Civil War soldiers, as the serious nervous system and cardiovascular system effects can take years to appear and were not well known until the late 19th century. Syphilis was sometimes transmitted through the smallpox vaccine when “lymph” from an infected person was transmitted to someone else.

TAR WATER

A slang term for liquor.

TENNESSEE TROTS

A slang term for ordinary (not chronic) diarrhea.

TOURNIQUET

Any device that is used to stop bleeding by compressing a blood vessel. A tourniquet can be a device that wraps around a limb, or even a bandage that is tightened by twisting.

TURPENTINE

A strong-smelling liquid frequently used as a paint thinner and solvent. It is distilled from a substance derived from coniferous trees. Civil War physicians used turpentine orally for chronic diarrhea and sometimes for typhoid fever. They used it topically on the skin in the belief that it would increase blood flow and reduce inflammation. It was sometimes applied to bandages to discourage maggot infestation in wounds.

TYPHOID FEVER

An infectious disease that is characterized by fever, general malaise and intestinal inflammation. It is spread by food or water contaminated with the bacteria Salmonella typhi. Such contamination was common in army camps and caused terrible epidemics. Thousands of soldiers died from Typhoid fever, the biggest killer among the epidemic diseases.

VACCINATIONS

The introduction into the body of a preparation of weakened or killed bacteria or viruses for the purpose of preventing disease by stimulating antibodies against it. Civil War physicians usually used material taken from a cow infected with cowpox (the term “vaccine” refers to the Latin word “vaccus”, meaning “cow”), or sometimes material taken from a patient with a mild form of smallpox. Sometimes, during an outbreak of the disease, mass inoculations were carried out.

WOUND

An injury, usually one that involves the cutting or tearing of tissue.

YELLOW FEVER

A form of fulminating viral hepatitis usually found in warm climates. It is characterized by fever, hemorrhages, and jaundice, which turns the skin yellow. The disease is carried by the Aedes aegypti mosquito, which transmits it from person to person. Outbreaks of yellow fever were greatly feared, and there was no effective treatment at the time; there is still none today.

© 2011 JAMCO Films. All Rights Reserved.

Sunday, September 4, 2011

Crossroads of the Civil War



Find out why Frederick, Maryland is an important place in American Civil War history. From the Museum of Civil War Medicine's Executive Director George Wunderlich.

To learn more about the National Museum of Civil War Medicine, visit - www.civilwarmed.org

Saturday, September 3, 2011

Frontline Pharmacies

by Robert Hicks /

Ambulance train, early 1860s. New York Public Library.

A few months after the Civil War began, on July 4, 1861, a group of patriotic young volunteers stood in the shadow of the Capitol, waiting to be sworn into the Union Army on a 90-day enlistment. Among them was William W. Keen. Less than three weeks later, and with only nine months of medical training, Keen stood clueless, in his blue uniform with the green sash of a medical officer, near the battlefield at Bull Run in Virginia.

“It was an exceedingly hot day, and we marched and halted in the thick dust under a broiling sun until about noon. . . . During the entire engagement, I never received a single order.” Inside a church he and fellow soldiers placed two boards on boxes in front of a pulpit for an operating table. Hearing that the Confederates were about to overrun the makeshift hospital, Keen’s patient, a soldier with a fractured humerus from a Minié ball (a powerful new rifled bullet), jumped up and ran for the woods, his bandage unraveling from his arm as he went. Keen later wrote, “My experience in this battle is a good illustration of the utter disorganization, or rather want of organization, of our entire army at the beginning of the war.”

Had Keen received an adequate briefing before battle, he would still have been left frustrated with a medical infrastructure unchanged in its essentials since the Mexican War of the 1840s. His experience typified the Federal government’s lack of preparedness in wartime. In fact, the lack of infrastructure, particularly ambulances, meant that many Bull Run casualties waited for days on the battlefield before soldiers or civilians removed them to hospitals.

At Bull Run, Keen received a crash course in misery. Battlefield hospitals were triage centers: stacks of amputated limbs marked the surgeons’ tents. Soldiers with severe abdominal or chest injuries were left to die: no surgical intervention was possible without the sure consequence of infection. The soldier’s life may have been punctuated with combat terror, but disease and illness afflicted far more troops than did battlefield wounds. Germ theory and antisepsis entered medicine only after the war. Counting deaths from wounds or disease, the war claimed between 600,000 and 700,000 lives, more than the number of soldiers killed in all other American wars combined. Beyond battlefield wounds, soldiers suffered malnutrition (including scurvy), dysentery, typhus, typhoid, respiratory illnesses, rheumatism, and outbreaks of malaria, yellow fever, and even smallpox (despite the prevalence of vaccination).

By the end of the war a radical reorganization of the medical field had occurred. The Medical Department could boast of an ambulance system, a sequence of care facilities from battlefield surgery to general hospitals, evacuation of the sick and wounded by train, and a nascent nursing profession. A new system—of government-funded pharmaceutical research and manufacturing—had taken hold. The demand for new chemical and botanical sources for medicines and for the production of reliable vaccines accelerated laboratory-based research and guided postwar pharmacology—including the growth of major manufacturing firms John Wyeth and Eli Lilly. In addition, Civil War pharmacology produced competing therapies and bitter disagreements that brought the Union Army surgeon general to court-martial and established the position of one of the most versatile and effective medicines of the late 19th century: quinine.

Hospital Systems

On July 21, however, Keen was unable to benefit from these future developments. During the fall of 1861 he went to Philadelphia to complete his formal studies, which at that time required a year of anatomy classes, which was then repeated and followed by several years of apprenticeship with an established physician. Keen returned to the army to find the medical service invigorated. The military had created a cadet corps, a comprehensive examination procedure, and a training school, and decided rank and assignments based on merit. Although Keen had a good knowledge of materia medica—pharmacy—the army’s organization of medicine might have impressed him with its diversity and complexity. Physicians generally relied on the Supply Table—the army’s standard table of drugs, their effects, and their preparation for use. During the war the army created a system that began with acquiring raw materials (eventually creating its own laboratories), included quality control, continued with the preparation and distribution of medicines to armies in the field or to hospitals, and went on to a method of prescribing and dispensing to ill soldiers.

Hand-colored lithograph of the Second Battle of Bull Run, August 29, 1862. Keen was present at the first battle—in 1861—as a volunteer medical officer. Library of Congress.

Initially, both the Union and Confederate armies immediately distributed any medicines purchased. Later, the Union Army purchased raw materials, such as cinchona bark for quinine, for processing at its own or contract laboratories. The South, with no drug-manufacturing centers, was forced to smuggle medicines, capture them, or invent alternatives. When Keen required medicine for his patients, medical purveyors—usually a military officer or physician—bought drugs on the market or obtained them from one of many depots, and then shipped them; medical storekeepers took receipt and stored medicines until needed; surgeons wrote prescriptions; and in the Union Army hospital stewards filled them. With a rank equivalent to a sergeant the hospital steward was an apothecary who supervised lesser hospital staff and occasionally performed minor surgery. As the war progressed, purveyors for the Union Army learned which wholesalers or companies delivered trustworthy and reliable products. The most influential laboratories serving the Union Army included Charles Pfizer and Company, Edward R. Squibb, Schief¬felin and Company, Powers and Weightman (many years later to become Merck), Rosengarten and Sons, and John Wyeth—many of which still dominate the industry today.

These developments formed the background of a desperate war. A year after Bull Run, Keen found himself back for the Second Battle of Bull Run. He set up a field hospital at nearby Centreville “and soon afterward began to distribute the instruments, blankets, medicines, stimulants, etc., I had brought. . .. Before I left Washington I had been directed to be rather sparing in distributing these, and I obeyed orders.” He regretted his parsimony when a regiment of Virginia Confederate Cavalry overran the field hospital. Keen was forced to hand over the key to the storehouse of “medicines, stimulants, operating cases, and . . . more valuable things that I had brought along—how their eyes widened and their faces were wreathed in smiles as the doctor, after a rapid survey of the boxes on the walls, turned to the colonel and said, with an expletive: ‘There is more good whiskey in this little smoke-house than there is in the whole city of Richmond!’”

Stranded with about 100 wounded men without supplies, Keen surveyed the misery. Some pitying Confederates even donated canned soup. He received important assistance from two Northern quasi-governmental relief organizations, the U.S. Christian and U.S. Sanitary Commissions, both of which showed up with food. While others prepared soup, Keen “took a bottle of morphine and [his] pocket penknife and did not worry over any superfluous exactitude in doling out the blessed relief which morphine brings to men in pain. All of this was done in total darkness, with two or three slim lanterns, in a drizzling rain, and in six inches of Virginia mud.” Keen faced rampant infections owing to severe internal injuries. “Wounds of the abdomen involving the viscera were almost uniformly fatal. . . . Opium was practically our only remedy [for abdominal surgery] and death the usual result.”

Pharmaceutical Development

In 1862 Jonathan Letterman, medical director of the Army of the Potomac, ordered Keen to commandeer two Washington, D.C., churches and convert them into hospitals in five days. Keen complied, but the army way of doing things remained obscure. “I was not lacking in ordinary intelligence and was willing to work, but I was utterly without training. . . . As to drugs I did not know whether to order six ounces or a gallon of laudanum, an ounce or two or a pound or two of opium.”

The pharmacopoeia at Keen’s disposal, which centered on the Supply Table, presented a sophisticated constellation of substances. Nineteenth-century understanding of the origins of disease is both familiar and strange; the restoration of balance within bodily systems, a relic of humoral theory (in which black bile, yellow bile, blood, and phlegm made up the humors), still informed much of medicine. The category of “fevers” represented a type of disease rather than a symptom. Some diseases, such as typhoid and typhus, were not easy to distinguish, and as a result received identical treatments.

In the hospital Keen wrote prescriptions in Latin, the universal custom, and gave them to the steward to compound. To a 21st-century pharmacist, some of the substances popular then, like Dover’s Powder and calomel—the former containing opium, the latter, mercury—have no recommended therapeutic purpose. Some, like antimony- and lead-based drugs, are downright dangerous, while others remain in use—such as iodine and quinine. With no laboratory methods available to establish drug usefulness through testing, no systematic antisepsis, and no germ theory, Keen worked within a system of medical knowledge based on observation of symptoms rather than causes.

Watercolor illustration from the 1860s of hospital gangrene. Hospitals, with their frequent and serious outbreaks of disease, could be as dangerous as battlefields. New York Public Library.

Many of the soldiers Keen saw at his Washington hospitals arrived not only ill or wounded but debilitated by poor nutrition and the harsh physical demands of campaigning. Keen was harrowed by the sight of sick soldiers. After the Second Battle of Bull Run he wrote: “I passed such a night as I had never before experienced in my life. Long trains of ambulances arrived, carrying our wounded from the field of battle. . . . Fifty poor, thirsty fellows were crying for water; fifty more were crying with the pain from a jolting ride [to Washington] of nine miles over a corduroy road. Most of them had had nothing to eat for one, two, or three days, save what they had obtained from the haversacks of poor fellows who were dead in their neighborhood. Some had such horrible wounds that they could absolutely go no farther, and must be got out on stretchers and taken into the hospital.”

Given the major role illness played in war, military strategy had to weigh the health of entire regiments; every soldier suffered diarrhea at least once, and many experienced dysentery. Patients at Keen’s hospital were fed a healthy, vegetable-rich diet. Calomel and opium were also favored treatments. He wrote later, “What we did not have in those days was almost more noticeable than what we did have. Among our blessings, however, were ether and chloroform. . . . We had, however, no antiseptics, for antisepsis was as yet even undreamed of.” He classified fevers as common, remittent, or intermittent, some of which accompanied dysentery or may have been symptomatic of typhus or typhoid, both of which flourished in the unhygienic camps. Keen prescribed quinine or cinchona for the fevers associated with both, just as he might have for malaria. Where Keen saw the most life-threatening respiratory disease, pneumonia (then recognized as an inflammation of the lungs), he may have prescribed tartar emetic or antimony, a therapy that became the focus of a controversy within the Union Army Medical Department.

Quinine proved the true medicinal miracle of the war. Malarial fevers were omnipresent during Southern campaigns, and the Union Army’s mandated prophylactic use of quinine prevented much illness, a benefit widely lauded by military commanders. Rosengarten and Sons, a major drug supplier to the Union Army in Philadelphia, excelled at producing quinine. The company employed French chemists versed in the techniques of isolating the alkaloid quinine, a process worked out 40 years before the war.

Hospitals were not always safe for patients. Keen worried about outbreaks of “hospital gangrene” owing to staphylococcus or other causes not known at the time. Gangrenous patients were immediately removed and isolated, and Keen may have ordered an effective treatment recognized during the latter part of the war: bromine. Mortality from these infections approached 97%. Worse than these diseases—from a military commander’s viewpoint—were epidemics. Yellow fever and smallpox epidemics afflicted both civilian and military populations in the North and South. Both armies required military recruits to be vaccinated for smallpox, but vaccine supplies were irregular and of uncertain quality. In the absence of vaccines some soldiers practiced the 18th-century technique of variolation, that of removing lymph from a smallpox-infected person and introducing it subcutaneously (with a knife) to others to engender a hopefully mild infection.

Army surgeons in front of a hospital tent in Petersburg, Virginia, 1864. Contrary to popular belief, most surgeries during the Civil War were performed under some kind of anesthesia—either ether or chloroform. Library of Congress.

The battlefield presented even more challenges. At Gettysburg, with almost 30,000 soldiers awaiting treatment, Keen probed a soldier’s gunshot wound near the upper shoulder and neck, trying to stop the bleeding. “The bullet had not emerged; its direction was unknown; the hemorrhage was profuse. . . . I etherized the man and proceeded to search for the wounded vessel.” Contrary to popular opinion, more than 95% of major Civil War surgeries were performed under ether or chloroform. Ether’s flammability, however, was yet another danger. “My only light was a square block of wood with five auger holes,” Keen continued, “in each one of which was placed a candle. . . . As the wound was so near the mouth, of course the light had to be near the ether cone [the mask placed over the patient’s face to receive the anesthesia]. . . . Suddenly the ether took fire and the etherizer flung away both cone and bottle. Luckily the bottle did not break or we might have had an ugly fire in a hospital constructed wholly of wood.”

Medical Victories

The chief medical achievements during the war were organizational. Apart from the banning of mercury, wartime medicines underwent little change until germ theory became understood. At first physicians applied medicines based on their own observations of the results, which created different philosophies of medication. The huge demand for drugs during the war allowed physicians to investigate and study the effectiveness of their pharmacopoeia more systematically and created the infrastructure for large-scale drug manufacturing and testing. As the federal government operated processing laboratories, government support and testing gradually became more important. Quinine and its various forms were abundantly tested, and their value was confirmed.

The distance in time between the beginning of World War II and today is equivalent to the time between the end of the Civil War and the beginning of World War II—not so long, but distant in medical ideology and practice. Keen’s wartime practice heeded the holistic perspective demanded by medical director Jonathan Letterman, who pointed out “that the duties of Medical officers are not confined to prescribing drugs, but that it is also their duty . . . to preserve the health of those who are well. . . . The prevention of disease is the highest object of medical science.”

Keen himself, the only physician to serve in uniform in both the Civil War and World War I, participated in the transformation of American medicine and therapeutics into the 20th century. He eagerly embraced antisepsis and germ theory, kept current with such new technologies as X-rays, and abandoned counterproductive medicines. Recollecting the War of the Rebellion, as he called it, “Only too sharply do we remember the dreadful things that we did do and the good things that we did not dare to do."

Robert D. Hicks is director of the Mütter Museum and Historical Medical Library of the College of Physicians of Philadelphia.

Reprint: Chemical Heritage Foundation - www.chemheritage.org

Thursday, September 1, 2011

The Minie Ball


Amputation was the most common surgery during the Civil War. Most amputations owed their unfortunate necessity to the minie ball.

The smoothbore musket had been the standard American infantry weapon throughout the 1850s. It fired a round ball and was reliable at close range in an era when the main military tactic was the massed infantry attack.
Civil War battlefields hosted a new generation of rifled weapons. Grooves inside the barrel of the gun gave the ammunition greater velocity, penetration and long-range accuracy. The ammunition of choice was the new, deadly minie ball.

Designed in France by Captain Claude-Etienne Minie, the ball was adapted by American manufacturers and was the most common ammunition used in the Civil War. The minie ball changed the face of warfare and of battlefield wounds.

The American version of the bullet was a large ellipsoid made of lead with a hollow cavity at its base. The cavity expanded when the powder was ignited, to fill the grooves of a rifled musket barrel. The grooves, or rifling inside the gun barrel caused the bullet to revolve as it left the muzzle.

The 0.58-caliber conical minie ball tore an enormous wound on impact, in part because the soft lead deformed, enlarging its dimensions. The ball was so heavy that head and abdominal wounds were almost always fatal; wounds to the extremities ripped through the tissues and shattered the bones.

As the missiles broke through the skin, they usually carried dirt, skin and fabric into the body. The wounds almost always became infected.

The minie ball caused massive tissue destruction and crushed the bones. This type of battlefield wound had never been seen before in America. Huge numbers of casualties and a lack of time, equipment, supplies and surgical experience made amputation the most rapid and effective technique to save the largest number of lives. Despite the frightening destructive power of the minie ball, an astonishing 75% of the Civil War amputees survived their surgeries.

Tuesday, August 30, 2011

Founding the United States Sanitary Commission


by Carole Adrienne /

The United States Sanitary Commission was a model of reform for the medical services, inspiring the Federal War Department to reorganize its medical policies. When the Civil War began, supplies presented a major problem. No quality controls existed. Uniforms were poorly made. There was extensive profiteering in food and horses. Surgeons and the wounded sometimes waited for days after a battle before supplies arrived, if they arrived at all.

The Sanitary Commission inspected the conditions at camps and hospitals and published reports, pamphlets, and circulars written by Commission Agents and physicians. They published a hospital directory with the names of over 600,000 hospitalized men, including the black soldiers, who were sometimes treated in segregated hospitals. The Commission advocated the adoption of sanitary principles by the United States Army.

By late 1863, the work of the Sanitary Commission had made remarkable improvements in the evacuation and treatment of the wounded, demonstrated at the Battle of Chattanooga.

The United States Sanitary Commission laid a foundation for discoveries that would be revealed after the war. They knew that cleanliness mattered, although they weren’t sure why. They knew that sanitary conditions led to fewer infections and slowed the spread of disease.

Louis Pasteur would later point out that living organisms did not arise spontaneously, but only from previous organisms. Joseph Lister provided the link to infection, and the Commission’s work paved the way for the acceptance of these discoveries.

Sunday, August 28, 2011

Daughters of Charity Nursed Wounded Civil War Soldiers at West Philadelphia Hospital

by Christine McCullough-Friend /

Women’s religious orders have served both Catholics and non-Catholics within the Philadelphia community since the establishment of the Diocese of Philadelphia two centuries ago. These women, who have and who continue to devote their lives to the betterment of society have played a pivotal role in social work, education and medicine.

As we begin to commemorate the 150th anniversary of the start of the Civil War, one example of this service that should be highlighted is the work of the Daughters of Charity (formerly Sisters of Charity) at Satterlee Military Hospital. The sisters ministered to thousands of wounded and dying Civil War soldiers from 1862 until the hospital closed in 1865.
Nurses and staff

The 12-acre site where the Satterlee Hospital was located in West Philadelphia, bounded roughly by 40th to 44th Streets, from Spruce to Pine Streets, was at that time very rural, far removed from the cramped and crowded conditions of urban Philadelphia. The ‘pure country air’ afforded the soldiers an opportunity to rest and recover from their wounds.


The hospital, initially called West Philadelphia Hospital, was renamed Satterlee Military Hospital in honor of Richard Smith Satterlee, a distinguished army surgeon. The surgeon in charge was Dr. Isaac Hayes, an Artic explorer before he joined the army. The hastily constructed buildings were completed in just over 40 days. The 2,500-bed facility was not quite finished when 22 Daughters of Charity arrived on June 9, 1862.

Initially, the hospital was fairly ill equipped, especially with regard to the accommodations for the sisters. Beverages were served in wash pitchers and the food in basins. The sisters ate their meals earlier than the officers, sharing just four eating utensils reserved for officers’ use. The chapel was so small that some sisters had to exit the room so others could enter and receive Holy Communion.

Satterlee Hospital became a self-contained city when a tent city was built on the grounds in 1863. The hospital increased its capacity to accommodate 4,500 wounded soldiers. A 14-foot high fence surrounded the property, which now sprawled south to Baltimore Avenue and west to 46th Street. On the grounds there was a post office, clothing store, laundry facility, carpenter shop, printing shop, dispensary, library, and three kitchens referred to as restaurants.

Although the official capacity of Satterlee was 4,500, the actual capacity exceeded this number. After the Battle of Bull Run, the wounded arrived by the hundreds. After the Battle of Gettysburg, they arrived by the thousands, swelling the hospital population to more than 6,000. During the Battle of Gettysburg which occurred during July 1863, the greatest number of wounded were admitted to the hospital in a single month. The following month of August saw the greatest number of deaths in any one month, averaging at least one per day. In just one year, patients consumed more than 800,000 pounds of bread, 16,000 pounds of butter and 334,000 quarts of milk.

During the war, more than 100 Daughters of Charity passed through the doors of Satterlee Hospital, ministering to the wounded soldiers’ spiritual and medical needs. The tiny chapel was soon expanded to seat 400 worshippers. Many soldiers often arrived several hours before mass to obtain a seat. Several wounded soldiers contributed generously to outfit the chapel properly, purchasing a set of stations of the cross and taking great pains to decorate the chapel for feasts and special occasions.

The hospital’s chaplain was Father Peter McGrane who was stationed at St. Patrick’s at 20th and Locust Streets. Every day, Father McGrane traveled from St. Patrick’s to Satterlee to say mass, hear confessions, instruct and baptize and frequently arrange for burial. He labored throughout the war ministering to the wounded and dying. Archbishop James Wood also visited Satterlee several times to confirm many adult converts.


Father Peter McGrane, no date

The practice of military medicine during the war was an eye-opening experience. The wounds caused by the new and improved artillery met the outdated medical practices of understaffed field hospitals, resulting in an epidemic of needless deaths. Conditions began to improve with the advent of permanent army hospitals like Sattelee, staffed by experiences surgeons and dedicated sisters.

During its four-year existence, more than 50,000 wounded soldiers were treated at Satterlee. The contributions made by the medical professionals and the Daughters of Charity who staffed the hospital are immeasurable.

PAHRC holds a copy of a diary kept by a Daughter of Charity at the hospital from 1862 to 1865.

Credit: Philadelphia Archdiocesan Historical Research Center

References:

Smith, Sara Trainer, ed. “Notes on Satterlee Military Hospital…from the journal kept at the hospital by a Sister of Charity.” Records of the American Catholic Historical Society of Philadelphia (Volume 8), no. 4 (December 1897): 399-449.

West, Nathaniel. History of the Satterlee U. S. A. Gen. Hospital, at West Philadelphia, Pa., from October 8, 1862, to October 8, 1863. The Hosptial Press, 1863. (Call# IC0135)

Friday, August 26, 2011

The First Women Nurses

The first women carried as nurses aboard a U.S. Vessel were Sister Mary Adela and Sister Veronica, nuns of the Order of the Holy Cross. They served throughout the war on the U.S.S. Red Rover, a captured Confederate vessel that was refitted as a hospital ship.

The health care challenges of the war changed the role of American women in medicine and in the military. For the first time in the United States, female personnel held responsible positions in traditionally male environments.

Thousands of women, North and South, volunteered as nurses in the hospitals and at the front. Many “Angels of the Battlefield” served throughout the war, lay women as well as Catholic nuns from orders including the Sisters of Charity, Sisters of St. Joseph, Sisters of Mercy and Sisters of the Holy Cross.

Unknown numbers of women simply showed up on the battlefields and helped to relieve the work load of the medical staff.

Tuesday, August 23, 2011

Civil War Dentists

The treatment of dental problems raised separate health issues. By 1860, there were about 5,500 dental practitioners in the United States. Most dentists trained by apprenticeship, but about 400 dentists had graduated from three American dental schools.

The Confederacy required that every soldier have a dental exam. The shortage of men in the South meant that no one could be exempted from service because of problems with his teeth. Dentists were routinely assigned to the larger Confederate military hospitals.

The Federal government provided no official dental surgeons for its troops during the Civil War. Toothbrushes were not provided for troops.
Many dentists served in the Union Army, but any dental treatment they performed wasn’t in an official capacity. Most dentists simply enlisted in their state regiments as privates.

Confederate dentist James Baxter Bean and Union dentist Dr. Thomas Gunning developed almost identical and revolutionary methods of treating jaw fractures caused by gunshot. Imperfect healing of these wounds could be life-threatening and earlier treatments had proven uncomfortable and ineffective. Bean and Gunning used intraoral splints to preserve the alignment of the teeth and minimize any deformity. These new techniques were major advancements in the treatment of jaw fractures.

Monday, August 22, 2011

Civil War Veterinary Medicine


by Carole Adrienne /

The first veterinary facility in Europe was established at Lyon, France, in 1762, after centuries of wars, disease epidemics, livestock plagues and food shortages.

The United States, with a lower density of animals, had not faced any of the major animal epidemics that had periodically swept Europe. The first veterinary college in the country was established in 1862 in Philadelphia.

At the start of the Civil War, dozens of cavalry units were formed, requiring thousands of horses. A War Department General Order in May 1861 provided for one “veterinary sergeant” for every Union cavalry regiment, but listed no qualifications for the post. Only six veterinarians were on the rolls of the Union army.

In the course of the war, thousands of horses, mules, pigs and cows died of disease, battle wounds and overuse.

By mid-1863 both forces began to centralize the collection and distribution of horses. The largest Union depot was at Giesboro Point, in Washington, D.C., with 32 stables and 6,000 stalls. It had a veterinary hospital that could hold 2,650 animals.

Disease among animals could have a devastating effect on the course of a campaign, limiting transportation for food, supplies and artillery. Battles are thought to be won or lost because of numbers, weapons, tactics or courage; not because horses are sick.

The Civil War Medicine Story


Civil War Medicine: The Documentary Series, is the story of remarkable American heroism and ingenuity at a time when the technology of warfare exceeded the science of medicine.

Operating in the smoky fog of a brutal war, thousands of doctors began their practice of medicine overwhelmed and ill-equipped. They had no antibiotics, no sterilization, and sometimes, no supplies. But by the end of their war service, they had not only helped to heal a nation, they had established revolutionary systems for effective healthcare.

Those medical personnel and volunteers had created a legacy that extends not just to modern war zones, but to every medical school, emergency room and hospital in the world today. Civil War Medicine, a new documentary series now in production, brings a fresh perspective to one of the most revolutionary periods in war and in medicine.

In 1861, medical care in the United States was very limited:

• Most American physicians had never performed surgery or even seen gunshot wounds before.
• The Army had no ambulance corps, no nursing corps and no dedicated medical supply transport.
• Women were refused admittance to most medical schools.
• The health of the individual soldier was not regarded as the responsibility of government.

Civil War Medicine illustrates how remarkable leadership, innovative government policy and a huge volunteer effort changed the quality and nature of health care in America. By the end of the war, systems were in place for ambulances, supply transport, case histories and follow-up. Women appeared on battlefields, in hospitals and in business. The hospitals themselves were redesigned and specialty hospitals designated, including one for the new study of neurology.

Advancements in medicine during the Civil War were not all clinical. The true medical legacy of the war developed from a changing culture of health care: medical administration, record-keeping and governance. It came from the recognition of the importance of sanitation, hygiene and diet, evacuation systems and skilled nursing care. It came in the emergence of women in administrative roles, and in the form of the Geneva Convention and the International Red Cross.

The legacy of the war includes research and educational facilities. The compiled data, published in the six-volume Medical Surgical History of the War of the Rebellion, was regarded as America’s most important contribution to medicine in the 19th century.

Today, any American who has made a trip to the emergency room, been transported by ambulance or been attended to by a skilled nursing staff, has benefited from the legacy of Civil War medicine. Our modern health care systems evolved from this last great conflict fought without knowledge of the causes of disease or infection.

Graphic: Lisa Bollinger

About the Civil War Medicine Documentary Series


Civil War Medicine is the story of our once-divided country’s massive health crisis, its heroic relief efforts and the resulting revolution in the culture of health care in America.

Targeted for national television broadcast, four one-hour programs will feature 3,000 visual images and compelling dialogue from original letters, diaries, newspapers and rare memorabilia. More than 80 men and women who lived the medical and relief efforts of the terrible war lend their memories through voiceover roles.

Seven years of intense research has yielded valuable information, artifacts and perspectives contributed by scores of experts from across the country.
Civil War Medicine provides high-resolution access to beautiful, shocking and unusual art, photography, prose and ephemera from dozens of American museums, archives, libraries and private collections.

A music soundtrack including military, popular, classical, folk and children’s songs will be recorded from original sheet music. The instruments used will be a combination of authentic 1860’s instruments and meticulous reproductions, tuned and played in period fashion.

Civil War Medicine: The Documentary Series is sponsored by the Abraham Lincoln Foundation of the Union League of Philadelphia, a 501(c)(3) institution. The series has been endorsed by the Abraham Lincoln Bicentennial Commission of the Library of Congress, The Society of Civil War Surgeons and the Military Order of the Loyal Legion of the United States.

Sunday, August 21, 2011

Mutter Minute: Blue Mass and Dover Powder



This week Robert showcases two medicines. Blue Mass was made in the late 1800's and was used during the Civil War and it's active ingredients are opium and mercury. Blue was used for a variety of things from venereal disease to gastrointestinal problems. Dover Powder was also used in the Civil War with active ingredients opium and ipecac and was used for fevers.

To learn more about the Mütter Museum or The College of Physicians of Philadelphia, visit - www.collegeofphysicians.org

Saturday, August 20, 2011

Mutter Minute: Civil War Survey


Every Monday The Director of the Mütter Museum takes a minute to showcase an item from our collection. This week Robert showcases a Civil War survey from our historical medical library collection.

To learn more about the Mütter Museum or The College of Physicians of Philadelphia, visit - www.collegeofphysicians.org

Monday, August 15, 2011

Medical Advances Timeline: 1866-1899

1866
- 14th Amendment to the U.S. Constitution prohibits voting discrimination, denies government office to certain Civil War rebels and repudiates Confederate war debts.
- February 11: The United States Christian Commission, which raised and spent more than $6 to support its war relief work, goes out of existence.
- March 21: Mrs. Mary Ann “Mother” Bickerdyke submits her resignation to the U.S. Sanitary Commission.
- May: Official termination of the United States Sanitary Commission, and the formation of the American Association for the Relief of Misery on the Battlefield.
- September 29: George A. Otis, M.D. is breveted Captain and Major for faithful and meritorious service in the Medical Department and Lieutenant Colonel for faithful and meritorious service during the war.
- Alfred Nobel invents dynamite.
- Ernst Haeckel publishes his General Morphology, describing the law of biogenetics.
- Robert Whitehead, an English engineer, invents the underwater torpedo.

1867
- Federal Medical Department authorizes the purchase of 4,095 prosthetic legs, 2,391 arms, 61 hands and 14 feet. In the budgets of many former Confederate states, the largest single expenditure was for artificial limbs.
- Nebraska becomes a state of the U.S.
- Russia sells Alaska to the U.S. for $7,200,000.
- German professor of medicine Carl Wunderlich introduces thermometry to bedside medicine.
- June: The Autenrieth Wagon, adopted by the U.S. Army for the transport of drugs, surgical tools and supplies, is displayed in Paris, France, at the World’s Fair

1868
- Ulysses S. Grant is elected President of the United States.
- The Harvard Medical School catalogue first mentions the stethoscope, 30 years after its invention.
- Led by Dr. Elizabeth Blackwell, the New York Medical College for Women at New York Infirmary is started.
- A bill proposing to appoint dental surgeons to the Army and Navy fails, but dental surgeons were subsequently appointed to West Point Military College and the Naval Academy.
- The first teaching clinics on diseases of the eye were held in Baltimore. They were conducted by Dr. Russell Murdock, considered the first surgeon to perform unassisted surgical cataract removal. Dr. Murdock was also known for inventing new surgical instruments for eye surgery.

1869
- General Ulysses S. Grant is inaugurated as 18th President of the United States.
- The first state board of health established in Massachusetts.
- The Harvard Medical School catalogue first mentions the microscope, two centuries after its invention.
- First transcontinental railway is completed in America.
- The body of President Lincoln’s assassin, John Wilkes Booth, was exhumed from a temporary grave under the floor of a warehouse at the Washington Arsenal. Undertaker John H. Weaver staged an informal inquest with Booth’s family and friends. An effort was made to identify the body through its dental work, although the results were inconclusive.

1870
- Four medical colleges for women now exist in America.
- At a meeting of the Aid Society in Berlin, the use of American ambulance trains is described as a model for European armies.

1871
- Former U.S. Surgeon General William Hammond publishes Treatise on Diseases of the Nervous System, the first textbook on nerve diseases to be published in the U.S.
- G.A. Hansen discovers the leprosy bacillus.
- The Baltimore Eye and Ear Hospital is founded by Dr. Julian J. Chisolm.
- Population figures in millions:
German 41
U.S. 39
France 36
Japan 33
Great Britain 26
Ireland 5.4
Italy 26.8

1872
- Grant is re-elected President of the U.S.
- U.S. General Amnesty Act pardons most ex-Confederates.
- Billroth makes the first surgical resection of the esophagus.
- Brooklyn Bridge opens in New York.
- The first nursing school in the United States is established at Bellevue Hospital. Louisa Lee Schuyler, a passionate war volunteer from New York society, was instrumental in starting the school.

1874
- Billroth discovers streptococci and staphylococci.
- A.T. Still founds osteopathy in Kansas.

1875
- The London School of Medicine for Women is founded.
- American artist Thomas Eakins paints The Gross Clinic, portraying famous surgeon Dr. Samuel Gross.
- A Marine Hospital is built in San Francisco’s Presidio area.

1876
- Robert Koch discovers the anthrax bacillus.
- Philadelphia hosts an International Congress of Medicine. Reports were given on the state of American medicine. Foreign physicians praised the publications of the Surgeon General’s office and pointed out that France and Prussia had already adopted the “American ambulance” system.
- German medical journal Berliner Klinische Wochenschrift publishes a paper suggesting that salsalate could help control blood sugar in diabetics. The accuracy of the studies were confirmed by Harvard researchers in the 1990s.
- Alexander Graham Bell patents the telephone.
- Colorado becomes a state of the U.S.

1877
- Rutherford B. Hayes inaugurated as 19th President of the U.S.
- Robert Koch develops a technique that allows bacteria to be stained and identified.
- J. Friedrich A. von Esmarch introduces the antiseptic bandage.
- The Presbyterian Charity Eye, Ear and Throat Hospital in Baltimore is founded by Dr. Julian J. Chisolm.

1878
- First use of iodoform as an antiseptic.
- Researchers noted that “the most frequent cause of the opium-eating habit in females is the taking of opiates to relieve painful menstruation and diseases of female organs of generation.”
- Mannlicher produces a repeater rifle.
- An Act of Congress on March 15 restores William A. Hammond, as Brigadier General on the retired list, without pay or allowances.

1879
- William A. Hammond, M.D. is restored as Brigadier General on the retired list, without pay or allowances, by an Act of Congress in March 1878.
- Pheobe Yates Pember publishes A Southern Woman’s Story: Life in Confederate Richmond, detailing much of her work at Chimborazo Hospital.
- Louis Pasteur’s studies of cholera bacteria in chickens paves the way for the development of vaccines against many diseases.
- Thomas Edison invents the electric lightbulb.

1880
- Thomas Alva Edison and J.W. Swan independently devise the first practical electric lights.
- French army surgeon Charles Louis Alphonse Laveran identifies parasites in the blood of a malaria patient.
- Typhoid bacillus is discovered.
- Pasteur discovers a chicken cholera vaccine.
- New York streets are first lit by electricity.
- Railroad mileage in operation:
U.S. 87,800
Great Britain 17,900
France 16,400
Russia 12,200

1881
- Relief worker Clara Barton succeeds in her efforts to establish the American Red Cross and begins her service as its first president.
- Louis Pasteur and Robert Koch prove the germ theory of disease.
- The first vaccine for anthrax is created by Louis Pasteur.
- City population in millions:
London 3.3
Paris 2.2
New York 1.2
Berlin 1.1
Tokyo 0.8
St. Petersburg 0.6

1882
- The first organized veterinary group in Pennsylvania, the Keystone Veterinary Medical Association, is formed.
- The first vaccine for rabies is created by Louis Pasteur.
- Viennese physician Joseph Breuer uses hypnosis to treat hysteria.
- Thomas Edison designs the first hydroelectric plant in Appleton, Wisconsin.
- English engineer Hiram S. Maxim patents the recoil-operated machine gun.

1883
- The first skyscraper—10 stories—is built in Chicago.
- August 22: A group of twenty-two veterinarians formed the Pennsylvania Veterinary Medical Association. Their meeting focused on continuing education and the legislative actions of veterinary associations that had been successful in other states.

1884
- Grover Cleveland is elected U.S. President.
- German physician Arthur Nicolaier discovers the tetanus bacillus.
- Sir Charles Parson invents the first practical steam turbine engine.

1885
- Grover Cleveland is inaugurated as 22nd U.S. President.
- Louis Pasteur devises a successful rabies vaccine. Due to his vaccine, the death rate from rabies dropped to almost zero in three years.
- Sir Francis Galton proves the individuality of fingerprints.
- Dr. George E. Holtzapple of Pennsylvania treats a pneumonia patient with pure oxygen. Oxygen therapy became the only effective treatment for pneumonia until antibiotics became available in the 1940s.

1886
- Opium demand in the U.S. peaks, during a period from 1880 to 1889, when demand and import increased nine-fold.
- Ernst von Bergmann uses steam to sterilize surgical instruments.

1887
- Dr. William Williams Keen is the first surgeon in the Americas to successfully remove a benign brain tumor.
- The analgesic drug Phenacetin is discovered.

1888
- An English pediatrician identifies a gastrointestinal disorder, later known as celiac disease.

1889
- North Dakota, South Dakota, Montana and Washington become states of the U.S.
- Oklahoma is opened to non-Indian settlement.
- Benjamin Harrison inaugurated as 23d President of the U.S.
- Frederick Abel invents cordite.
- Von Mahring and Minkowski prove that the pancreas secretes insulin to prevent diabetes.

1890
- Idaho and Wyoming become states of the U.S.
- Rubber gloves are used for the first time in surgery by surgeon William Halsted at Johns Hopkins Hospital in Baltimore, MD.
- Emil von Behring announces the discovery of antitoxins and uses them to develop vaccines for tetanus and diptheria.
- Global influenza epidemics.

1893
- African-American surgeon Daniel Williams performs the first open-heart surgery on a patient in Chicago.

1894
- Yersin and Kitasato independently discover the plague bacillus.

1895
- November 8: German physicist Wilhelm Conrad Roentgen discovers X-rays and finds that they pass through matter. This property leads immediately to their use in diagnostic medicine.
- Marconi invents wireless telegraphy.

1896
- Johannes von Mikulisz-Radecki invents the gauze mask to be worn by surgeons when performing surgery.
- Michael I. Pupin of Columbia University takes the first diagnostic X-ray photograph in the U.S. to set a broken arm.
- The first vaccine for typhoid fever is developed.
- Utah becomes a state of the U.S.
- Niagara Falls hydroelectric plant opens.
- French physicist A.H. Becquerel discovers radioactivity.
- First modern Olympics held in Athens.

1897
- William McKinley is inaugurated as 25th President of the U.S.
- Ronald Ross discovers the malaria bacillus.
- Aspirin is invented in Germany.

1898
- Pierre and Marie Curie discover radium and polonium.
- Japanese bacteriologist Shiga discovers the dysentery bacillus.
- Bayer chemist Heinrich Dreser prepares diacetylmorphine and names it “heroin”. It was intended as a faster-acting and shorter-lasting pain reliever than morphine, producing less nausea and vomiting.
- A British officer in the Indian Medical Service, Ronald Ross, demonstrates that malaria parasites are transmitted via mosquitoes.

1898
- The mineral Thorium is found to be radioactive. It had been used by dentists to fill teeth for almost 60 years.

1899
- First Peace Conference held at The Hague.
- The cause of “progressive pernicious anemia”, common in the southern United States, is identified by Dr. Charles Wardell Stiles, a zoologist from Hartford, Connecticut. Dr. Stiles proved that a hookworm species, not a germ, was responsible for the condition.
- The Bayer company registers “Aspirin” as a trademark.
- Rutherford discovers alpha and beta rays in radioactive atoms.
- First magnetic recording of sound.

Medical Advances Timeline: 1861-1865

1861
- Dr. Samuel D. Gross, prominent Philadelphia surgeon, teacher and author, publishes A Manual of Military Surgery for use by the young surgeons flocking into the army. A copy is later captured by Confederate troops and reprinted for the Southern physicians.
- French neurologist Paul Broca publishes a paper detailing the relationship of damage in the brain’s left temporal lobe to loss of speech.
- January 29: Kansas becomes a state of the U.S.
- February: The Washington Peace Convention tries to preserve the Union, but the Congress of Montgomery forms the Confederate States of America with South Carolina, Georgia, Alabama, Mississippi, Louisiana and Florida.
- February 25: Samuel Preston Moore a physician from South Carolina, resigns from the US Army. He will become Surgeon General of the Confederacy.
- March 4: Abraham Lincoln is inaugurated as the 16th President of the United States.
- April: John J. Chisolm, M.D. receives the first commission granted to a medical officer by the Confederacy. He attended the wounded at Fort Sumter.
- April 12: The flag is fired upon at Fort Sumter. Outbreak of the Civil War.
- Lincoln calls for the militia to suppress Confederacy.
- April 13: Fort Sumter surrenders.
- April 15: The women of Bridgeport, Connecticut organize the first Ladies Aid Society.
- April 15: President Lincoln calls out 75,000 state militia for assistance in retaking U.S. property that had been seized by Confederates.
- April 17: The State of Virginia votes for secession; President Lincoln calls for 90-day volunteers.
- April 19: Union blockades Southern ports; Confederate sympathizers in Baltimore attack the 6th Massachusetts Volunteers as they are en route to defend Washington, D.C.
- April 29: Dr. Elizabeth Blackwell organizes a meeting of socially prominent women in New York to form the Women’s Central Association of Relief of New York City. The Association soon established a program to train nurses for the Army.
- May: The U.S. Sanitary Commission is formed in New York City. The Women’s Central Association of Relief becomes a part of the larger organization.
- May 6: The Physicians and Surgeons of the Hospitals of New York and the New York Medical Association for Furnishing Hospital Supplies was organized in New York City.
- May 15: Dr. Clement A. Finley is appointed Federal Surgeon-General by President Lincoln. Robert C. Wood becomes his assistant.
- May 16: Four New York representatives of the newly formed United States Sanitary Commission met with the acting surgeon-general, Dr. Robert Wood. Wood refused to allow any formal relationship between the army and the Sanitary Commission.
- May 25: The War Department issues General Orders No.25, which directs state governors to appoint a surgeon and assistant surgeon for each regiment of volunteers.
- June 5: Confederate Dr. Gibson requests aid from the Sisters of Charity in Emmitsburg, Maryland, to help with the sick and wounded in Richmond, Virginia.
- June 9: The U.S. Sanitary Commission is approved by Federal Secretary of War Simon Cameron, who appoints nine men to serve as the first USSC commissioners.
- June 10: Dorothea Dix is appointed Superintendent of Female Nurses in the North.
- June 10: Surgeon William A. Spottswood is designated as head of the Office of Medicine and Surgery by the Confederate Navy Department.
- June 30: In Washington, D.C., Miss Lydia English’s Female Seminary is transformed into the “Seminary Hospital”, remaining in operation until June 14, 1865.
- July 3: A “Committee on Military Surgery” reported to the Surgical Section of the New York Academy of Medicine on “matters of practical interest which are not discussed in the ordinary books on surgery”. They noted that, historically during war, deaths from disease far outnumbered deaths from battle wounds.
- July 11: Union General George B. McClellan engages Confederate General Robert E. Lee at Rich Mountain, Virginia (now West Virginia).
- July 21: Confederate Victory at Bull Run, VA (First Battle of Bull Run—First Manassas). The Union surgeon-general chose to wait until the actual fighting began before preparing for casualties.
- July 27: General George B. McClellan is appointed commander of the Union Army, later renamed the Army of the Potomac.
- July 27: The New York Times publishes an editorial protesting the “inadequate provisions” for the care of the war wounded due to the “ancient and fossilized arrangements of the Medical Department”.
- July 30: Confederate President Jefferson Davis names a former U.S. Army physician from Charleston, Samuel Preston Moore, as Surgeon-General.
- August: General Robert E. Lee fails to recapture Virginia’s western counties, hindered in part by an epidemic of measles among the troops.
- August: Confederate Surgeon Julian John Chisolm publishes his book, A Manual of Military Surgery For the Use of Surgeons in the Confederate Army. The book went through three editions.
- August 3: John H. Brinton, M.D. and Frank H. Hamilton, M.D. are appointed Surgeon of Volunteers, U.S.A.
- August 5: Joseph J. Woodward, M.D. is appointed Assistant Surgeon, U.S.A.
- August 10: Joseph K. Barnes, M.D. is appointed Colonel/Medical Inspector, U.S.A.
- August 12: Dr. Charles Tripler is appointed medical director of the Army of the Potomac by Major General George Brinton McClellan.
- August 28-29: Union forces capture Forts Hatteras and Clark, North Carolina.
- September 6: Federal gunboats capture Paducah, Kentucky.
- September 11-16: Cheat Mountain campaign, western Virginia.
- September 16: The United States Sanitary Commission establishes its offices in the Treasury Building.
- September 12-20: Siege of Lexington, Missouri
- October: A wing of the U.S. Patent Office in Washington, D.C. is transformed into the “Patent Office Hospital” and operates there until March, 1963. Patient facilities were created within the walls of the Capitol and the “Reynolds Barracks Hospital” was erected on what is now the South Lawn of the White House.
- October 16: The United States Sanitary Commission establishes its central office in the U.S. Treasury Building, Washington, D.C.
- October 21: Battle of Ball’s Bluff, Virginia
- November 1: General George McClellan is appointed general-in-chief, relieving General Winfield Scott.
- November 7: Battle of Port Royal Sound, South Carolina, occupation of Hilton Head Island and Beaufort, South Carolina. Battle of Belmont, Missouri, the first engagement for General Ulysses S. Grant.
- November 14: Volunteer relief organization the U.S. Christian Commission is formed at a convention of the YMCA’s of the Union states.
- December: Frederick Law Olmstead, Executive Secretary of the U.S. Sanitary Commission, reports that upon inspection of 200 regimental hospitals, 105 were considered good, 52 were tolerable and 26 were bad.

1862
- Auguste Nelaton of Paris, a French physician and surgeon, invents his “probe”, a device to determine the location of a lead bullet or other hard body in a wound.
- R.J. Gatling patents a ten-barrel rapid-fire gun.
- Joseph Janvier Woodward, M.D., of the U.S. Surgeon General’s Office, publishes The Hospital Steward’s Manual: For the Instruction of Hospital Stewards, Ward-Masters, and Attendants, in Their Several Duties.
- The Confederate Congress passes a bill allowing for the enlistment of women into the Confederate Army as army nurses.
- Florence Nightingale opens a nurses’ training program at St. Thomas Hospital in London.
- Union Major Jonathan Letterman devises new ambulance and hospital supply systems. They will become the basis of modern rescue and health care services.
- Swiss humanist Jean Henri Dunant proposes the foundation of an international voluntary relief organization in his book “Souvenir de Solferino”. The International Red Cross would be the result.
- President Lincoln brings his own supply of the anesthetic chloroform to a dental appointment.
- February 6: Surrender of Fort Henry, Tennessee, to General Grant.
- February 8: Union forces win Battle of Roanoke Island, North Carolina.
- February 11: Union and Confederate soldiers wounded at the Battle of Fort Henry, Tennessee are sent north on the Union Army’s hospital ship City of Memphis.
- February 13-16: General Grant lays siege to and accepts surrender of Fort Donelson, Tennessee.
- February 15: Mary Ann “Mother” Bickerdyke assists in the removal of the wounded after the battle at Fort Donelson.
- February 21: Battle of Valverde, New Mexico Territory.
- February 25: Union troops occupy Nashville, Tennessee.
- March: General McClellan lands the Army of the Potomac on York Peninsula, Virginia.
- March 6-8: Battle of Pea Ridge (Elkhorn Tavern), Arkansas.
- March 9: Battle of the ship CSS Virginia (formerly USS Merrimac) with USS Monitor.
- March 12: The Western Sanitary Commission establishes the first Soldiers’ Home in St. Louis, Missouri.
- March 14: Union troops capture Newbern, North Carolina and New Madrid, Missouri.
- March 23: Battle of Kernstown, Virginia.
- March 26: Battles of Apache Canyon and Glorieta Pass, New Mexico Territory.
- April 6: Siege of Yorktown, Virginia begins.
- April 6-7: At the Battle of Shiloh (Pittsburg Landing), the first huge battle of the war, large 8-patient tents are issued to the U.S. Army Medical Corps for the first time, proving to be a successful installation for field hospitals. General Grant captures Island No. 10 in the Mississippi River in Tennessee.
- April 7: The U.S. Army hospital ship R.C. Wood, named for the Assistant Surgeon General, begins removing the wounded from the Battle of Shiloh.
- April 14: Colonel Clement A. Finley resigns as Surgeon General, U.S. Army.
- April 16: Jonathan Letterman is appointed Surgeon/Major, USA.
- April 25: U.S. Secretary of War Edwin Stanton appoints 33-year-old physician William A. Hammond Surgeon-General.
- April 27: Union field nurse Emma Edmonds visits soldiers in the temporary hospitals in Washington, D.C.
- May: The Army Medical Museum is established by Union Surgeon-General William Hammond.
- May: The first edition of Stephen Smith’s Handbook of Surgical Operations is published for the benefit of surgeons in the field.
- May 2: The New York City Ladies’ Home for Sick and Wounded Soldiers opens.
- May 3: Confederates evacuate Yorktown, Virginia.
- May 5: Battle of Williamsburg, Virginia. There were 1,866 Union and 1,570 Confederate casualties.
- May 21: Union Surgeon-General Hammond takes measures to secure more detailed and exact reports of sick and wounded, an important modification in the orders of medical officers.
- May 24: General “Stonewall” Jackson’s cavalry captures a Union supply train near Winchester, Virginia. They seized the medical stores, including 1,500 cases of chloroform.
- May 25: Battle of Winchester, Virginia. General “Stonewall” Jackson releases captured Union surgeons as “non-combatants”.
- May 30: Confederate General Pierre Beauregard commands Confederate forces to evacuate Corinth, Mississippi, due to disease. Union General Henry Halleck enters with troops and faces the same diseases.
- May 31-June 1: Battle of Fair Oaks (Seven Pines), Virginia; General Robert E. Lee assumes command of the Confederate army in Virginia.
- June: Federal authorities telegraphed the Order of the sisters of Charity at Emmitsburg, Maryland, to ask the nuns to provide sisters to work as nurses in Frederick City.
- June 6: Battle of Memphis, Tennessee.
- June 9: Battle of Port Republic, Virginia. The Union Surgeon-General’s Office announces its intent to prepare for publication the Medical-Surgical History of the War of the Rebellion.
- June 10: Union General George McClellan proposes to Confederate General Robert E. Lee that medical officers be viewed as “non-combatants” and that they not be held as prisoners of war.
- June 17: Confederate General Robert E. Lee agrees to McClellan’s plan for the neutrality of medical personnel.
- June 19: McClellan sends Lee a copy of General Order No. 60. It included the statement that all medical officers held by the Federal government would immediately be released.
- June 19: Jonathan Letterman, M.D. is appointed Medical Director of the Army of the Potomac. He replaces Surgeon Charles S. Tripler, who becomes Medical Inspector General of the U.S. Army.
- June 25: Peninsula campaign: Seven Days’ Battles begins.
- June 26: Peninsula campaign: Battle of Mechanicsville, Virginia.
- June 26: Confederate General Robert E. Lee issues a General Order that all imprisoned Federal medical officers be released.
- June 27: Peninsula campaign: Battle of Gaines’s Mill (First Cold Harbor), Virginia.
- June 29: Peninsula campaign: Battle of Savage Station, Virginia.
- June 30: Peninsula campaign: Battle of White Oak Swamp (Frayer’s Farm), Virginia.
- July: The Federal surgeon-general requests the Order of the Sisters of Charity of Emmitsburg, Maryland to provide 100 sisters to work as nurses in White House, Virginia, during the Peninsula campaign.
- July 1: Union Dr. Jonathan Letterman replaces Dr. Charles Tripler as medical director of the Army of the Potomac. Battle of Malvern Hill, Virginia.
- July 12: The Red Rover, a captured Confederate steamer that was refitted as a hospital ship in St. Louis, is put into service at Cairo, Illinois. It carried female nurses, nuns from the order of the Sisters of the Holy Cross.
- July 14: Federal Union General William Hammond issues a directive regarding the confrontational and difficult Superintendent of Nurses, Dorothea Dix. She was to retain the authority to choose and assign nurses, but the “control and direction” of all nurses, male and female, was put under the medical officer in charge. Throughout the war, 3,214 women would serve in Dix’s corps.
- August 2: Special Orders No. 147 is issued by General George B. McClellan, putting Jonathan Letterman’s ambulance plan into effect in the Army of the Potomac.
- August 9: Battle of Cedar Mountain, Virginia.
- August 26: Confederate victory at the Battle of Second Bull Run (Second Manassas).
- August 29: Secretary of War Edwin M. Stanton rejects Jonathan Letterman’s ambulance plan for adoption throughout the Union Army.
- September 1: The abandoned naval hospital at Norfolk, Virginia was reoccupied for the primary use of sailors from the North Atlantic Blockading Squadron.
- September 7: U.S. Surgeon General Hammond writes to Secretary of State Stanton, lamenting “the scarcity of ambulances, the want of organization, the drunkenness and incompetency of the drivers, [and] the total absence of ambulance attendants.”
- September 14: Battles of South Mountain and Crampton’s Gap, Maryland.
- September 17: Battle of Antietam (Sharpsburg), Virginia is the single bloodiest day of the war, with 23,000 casualties in 10 hours of fighting.
- September 22: Lincoln’s “Emancipation Proclamation” (effective January 1, 1863) declares all slaves held in the rebelling territories to be free.
- October 4: Union Major Jonathan Letterman institutes a system of “brigade supplies” in the Union armies. It specifies medical supplies and transport to be issued monthly for active field service.
- October 8: Battle of Perryville, Kentucky.
- October 27: U.S. General Order No. 357 is issued. It emphasized that all nurses were under the control of the senior medical officers in the hospitals where they served. The order was intended to emphasize that female nurses were no longer exclusively under the control of Dorothea Dix, Superintendent of Nurses.
- October 30: Jonathan Letterman, Medical Director of the Army of the Potomac, issued an order that required only the most experienced surgeons to make decisions about whether surgery should be performed on a given patient, and that only the most able surgeons assigned to perform it.
- December: Union Surgeon General William Hammond writes to the heads of American medical schools to request that students be taught hygiene and military surgery.
- December 1: Widow Phoebe Yates Pember, 39, became the chief matron of the Second Division at Chimborazo Hospital outside Richmond, Virginia. It was one of five divisions of what was thought to be the largest military hospital in the world.
- December 13: Union forces are defeated at the Battle of Fredericksburg, Virginia.
- December 31: Battle of Stones River (Murfreesboro), Tennessee.
- By late in the year, both Union and Confederate armies favored the construction of the new “pavilion hospitals”, a type of construction that continued to be used during both World Wars and the Vietnam era for temporary military hospitals.

1863
- New York and Philadelphia leaders in the field of veterinary medicine meet to establish the United States Veterinary Medical Association.
- A major pandemic of smallpox sweeps both armies.
- Almost all troops, North and South, are now armed with rifles.
- January 1: Lincoln issues his Emancipation Proclamation.
- January 2: Second day of the Battle of Stones River (Murfreesboro), Tennessee.
- January 2: Volunteer Mrs. Mary Ann “Mother” Bickerdyke reports to the Medical Director of Memphis, Tennessee.
- January 8: Mary Ann Bickerdyke organizes laundry services for the hospitals in Memphis, Tennessee.
- January 9: Confederate medical services take over the Exchange Hotel in Gordonsville, Virginia, as a receiving hospital.
- January 11: Union troops capture Fort Hindman, Arkansas.
- February 9: Joseph K. Barnes is appointed Lieutenant Colonel/Medical Inspector, USA.
- February 9: In Geneva, Switzerland, the International Committee of the Red Cross is formed. Influenced by his witness of the horrors of the Solferino battlefield, businessman Henri Dunant addressed the Geneva Society for Public Welfare and asked the members to form a volunteer society to aid wounded soldiers.
- February 10: The United States Sanitary Commission establishes a Free Pension Agency to handle the pension claims of wounded soldiers. It was later renamed the Army and Navy Claim Agency.
- February 13: The Western Sanitary Commission opens a Soldiers’ Home in Memphis, Tennessee.
- February 24: Arizona becomes a US. Territory.
- February 25: The Federal Congress passes the Conscription Act.
- February 29: The Western Sanitary Commission is authorized by Major General Grant in Special Orders No. 88, Department of Tennessee, to be provided with a government-furnished steamboat to provide transportation for Sanitary Commission materials and supplies.
- March 3: The National Academy of Science is founded in Washington, D.C. with the endorsement of President Lincoln.
- March 4: Idaho becomes a U.S. territory.
- April: The Federal Army establishes the Invalid Corps, providing less demanding roles for soldiers who were too injured or ill to return to active duty. More than 60,000 men served in the Corps.
- April 3: Bread riots in Richmond, Virginia.
- April 17: Union Colonel Benjamin Grierson begins a cavalry raid into Mississippi as a diversion from Major General Ulysses Grant’s main attack plan on Vicksburg, Mississippi.
- May 1-4: Confederate victory at Chancellorsville, VA. General Thomas Jonathan “Stonewall” Jackson is accidentally wounded by Confederate pickets and loses an arm to amputation.
- May 3: Second Battle of Fredericksburg, Virginia and Battle of Salem Church, Virginia.
- May 10: General Thomas Jonathan “Stonewall” Jackson dies of complications from pneumonia.
- May 12: General Ulysses Grant attacks Raymond, Mississippi as part of the Vicksburg campaign.
- May 14: The Federal Vicksburg campaign engages at Jackson, Mississippi.
- May 16: Battle of Champion’s Hill, Mississippi (Vicksburg campaign).
- May 17: Vicksburg campaign engages at Big Black River, Mississippi.
- May 18: Siege of Vicksburg, Mississippi begins.
- May 21: Siege of Port Hudson, Mississippi begins.
- June 9: Cavalry Battle at Brandy Station, Virginia.
- June 14-15: Second Battle of Winchester, Virginia.
- June 19: Despite the written and verbal protests of Medical Director Jonathan Letterman, the transportation of the Army of the Potomac’s Medical Department is reduced to two wagons per brigade.
- June 20: West Virginia becomes a state of the Union.
- July 1-3: Union victory at Gettysburg, PA. Improved medical transport and organization was apparent. All of the wounded from both sides were gathered from the field each night and taken to field hospitals.
- July 4: Confederate defeat at Vicksburg, Mississippi.
- July 7: U.S. Medical Inspector Edward P. Vollum arrives at Gettysburg and finds the need for drugs so urgent that he purchases supplies at local drugstores and sends the bills to the quartermaster.
- July 8: Confederate surrender of Port Hudson, Mississippi.
- August: The Confederate Association of Army and Navy Surgeons is established.
- August 24: General George Meade issues General Orders No. 85 putting Jonathan Letterman’s revised regulations for the Ambulance Corps into effect in the Army of the Potomac.
- September 20: Confederate victory at Chickamauga, Georgia.
- October 22: Union army defeats the Confederates at Chattanooga, Tennessee.
- October 27: The City of Chicago demonstrated support for the U.S. Sanitary Commission by closing, so that all its citizens could attend the huge Sanitary Fair. The purpose of the Fair was to raise funds to support the Commission’s work and send vegetables to the troops. Spearheading the organization of this first Sanitary Fair was volunteer Mary A. Livermore, a Chicago journalist.
- November: Joseph Janvier Woodward, M.D. of the U.S. Surgeon General’s office, publishes Outline on the Chief Camp Diseases of the United States Army as Observed during the Present War.
- November 5: Federal Army establishes Desmarres Hospital for the treatment of eye injuries, in Washington, D.C.
- November 19: President Abraham Lincoln delivers his “Gettysburg Address” at the dedication of a military cemetery.
- November 20: President Lincoln is diagnosed with a mild case of smallpox and is ill until mid-December.
- November 23-25: Battles for Chattanooga, Tennessee, including Lookout Mountain and Missionary Ridge.
- November 26: Mine Run campaign in Virginia begins.
- November 29: Confederate attack on Fort Sanders at Knoxville, Tennessee.

1864
- A special hospital ward for soldiers with eye injuries is set up in Forsythe, Georgia.
- “In God We Trust” first appears on U.S. coins.
- In France, Louis Pasteur develops his germ theory of disease.
- January: The first issue of the Confederate States Medical and Surgical Journal is printed and continues to be issued monthly in Richmond through March 1865.
- January 11: Assistant Surgeon John Shaw Billings presents his analysis of medical department operations to the Medical Director of the Army of the Potomac.
- January 14: Jonathan Letterman resigns as Medical Director of the Army of the Potomac. His replacement is Surgeon Thomas A. McParlin, U.S. Army.
- January 24: Volunteer nurse Louisa May Alcott returns to her home in New England to recover from typhoid fever.
- February 4: The Union Medical Director of the Department of the South was ordered to send his sick patients to the general hospital, turn in all excess medical supplies, and prepare to board steamers for the attack on Jacksonville, Florida.
- February 14: Federal troops capture Meridian, Mississippi.
- February 20: Battle of Olustee, Florida.
- February 24: The prison at Andersonville, Georgia, called Camp Sumter, opens. It was designed for 10,000 prisoners, but by July, 1864 it held 29,998.
- March 1: Congress passes a reorganization bill, making ambulance service fully operational.
- March 1: Union cavalrymen attempt to assault Richmond in the Kilpatrick-Dahlgren cavalry raid, which fails.
- March 3: An English branch of the United States Sanitary Commission is organized in a British tavern. Its purpose was to solicit relief funds from Americans living abroad.
- March 9: Ulysses S. Grant is commissioned lieutenant general and commander of all U.S. armies.
- March 11: U.S. Congress passes the Ambulance Corps Act in which Jonathan Letterman’s system is adopted throughout all the Union armies.
- March 11: Congress passes a bill reorganizing the medical department and creating an Ambulance Corps.
- March 12: Beginning of the Union’s Red River campaign in Louisiana.
- March 18: The United States Sanitary Commission holds a Sanitary Fair in Washington, D.C.
- April 9: A medical purveying depot is established in Alexandria, Virginia, by Medical Purveyor Thomas G. McKenzie of the Army of the Potomac.
- April 12: General George Meade issues Special Orders No. 197, placing the medical department of the Army of the Potomac on the same level as other staff corps.
- May 4: The 1864 campaign of the Army of the Potomac begins.
- May 5-6: In the Battle of the Wilderness, VA, 21,463 Union troops are wounded. The newly organized ambulance system is able to remove all of the wounded by 9pm on May 6th.
- May 7: Union General W.T. Sherman begins his Atlanta campaign against Confederate General Joseph Johnston.
- May 8-12: Battle of Spotsylvania Court House, Virginia.
- May 12: Confederates evacuate Dalton, Georgia in the Atlanta campaign.
- May 14-15: Battle of Resaca, Georgia of the Atlanta campaign.
- May 15: Battle of New Market, Virginia.
- May 15: Federal orders are given to establish a prison camp at Elmira, New York. In all, 12,123 Confederate prisoners were sent to Elmira. Of those, 2,963 died there.
- May 16: Battle of Dewry’s Bluff, Virginia.
- May 18-19: Spotsylvania Court House, Virginia experiences more fighting.
- May 23-26: Battle of North Anna River, Virginia.
- May 31-June 3: Battle of Cold Harbor, Virginia.
- May 31: The Ambulance Corps of the Army of the Potomac consists of 620 ambulances, 40 medicine wagons, 174 army wagons, 15 forges, 1,882 horses, 870 mules, 767 stretchers, 57 officers and 2,092 enlisted men.
- June: The U.S. Army adopts the “Autenrieth Wagon” for the transport of drugs, surgical tools and supplies. The Autenrieth Wagon was displayed in Paris, France, at the 1867 World’s Fair.
- The Union Naval blockade creates severe medical supply shortages for the South. Jefferson Davis has the Confederate Congress pass a law requiring that blockade runners’ cargoes consist of at least 50% government supplies.
- June 3: By orders of Acting Surgeon General Joseph K. Barnes, Lincoln General Hospital in Washington, D.C. is designated for the care of wounded Confederate soldiers.
- June 14: In a U.S. Sanitary Commission sponsored-lecture at the Smithsonian Institution, Parisian physician Dr. Charles Edouard Brown-Sequard introduced his experience with the revolutionary technique of blood transfusion.
- June 14: Battle of Pine Mountain, Georgia. The Army of the Potomac crosses the James River.
- June 16-18: Siege of Petersburg, Virginia begins.
- June 23: Siege of Petersburg: Engagement at Weldon Railroad.
- June 27: Battle of Kennesaw Mountain, Georgia in the Atlanta campaign.
- July 9: Battle of Monocacy, Maryland.
- July 11: Confederate General Jubal Early is stopped at Fort Stevens in the Washington suburbs.
- July 13: Confederate agents torch Barnum American Museum and Astor House in an unsuccessful attempt to burn New York City.
- July 14: Battle of Tupelo (Harrisburg), Mississippi.
- July 17: General John Bell Hood replaces General Joseph E. Johnston as commander of the Confederate Army in Tennessee
- July 20: Atlanta campaign: Battle of Peachtree Creek, Georgia.
- July 22: Atlanta campaign: Battle of Atlanta, Georgia.
- July 28: Atlanta campaign: Battle of Ezra Church, Georgia.
- July 30: Siege of Pettersburg: Battle of the Crater (mine explosion).
- August 18: William A. Hammond is convicted in a court-martial and removed as Federal surgeon-general.
- August 18-19: Siege of Petersburg: Battle of Weldon Railroad, Virginia.
- August 22: Dr. Joseph K. Barnes is officially appointed Surgeon General, U.S. Army, with the rank of Brigadier General.
- August 22: In Geneva, Switzerland, the representatives of 12 nations agreed to sign the First Geneva Contention “for the Amelioration of the Condition of the Wounded in Armies in the Field”. Twenty countries had signed by 1866.
- August 23: Desmarres Hospital, the Federal specialty Eye and Ear Hospital is moved from Washington, D.C. to Chicago, Illinois. It had 150 beds.
- August 25: Siege of Petersburg: Battle of Reams Station, Virginia.
- August 30: William A. Hammond, M.D., Surgeon General, is dismissed from the U.S. Army.
- August 30: George A. Otis, M.D. is appointed Surgeon of Volunteers, U.S.A.
- August 31: Atlanta campaign: Battle of Jonesboro, Georgia.
- September: Yellow fever epidemic in New Bern, North Carolina.
- September 1: Confederates evacuate Atlanta, Union forces occupy the city.
- September 19: Third Battle of Winchester (Opequon Creek), Virginia.
- September 23: Battle of Fisher’s Hill, Virginia.
- September 29-October 2: Battle of Peeble’s Farm and Chaffin’s Bluff (Fort Harrison), Virginia.
- October 5: Engagement at Altoona, Georgia.
- October 9: Engagement at Tom’s Brook, Virginia.
- October 19: Battle of Cedar Creek, Virginia; Confederate raid on St. Albans, Vermont.
- October 23: Battle of Westport, Missouri.
- October 27: Engagement at Burgess Mill (Boydton Plank Road), Virginia.
- October 26-29: The Convention for the Amelioration of the Condition of the Wounded Soldiers of Armies in the Field, commonly known as The Geneva Convention, in Switzerland, establishes the neutrality of battlefield medical facilities.
- November 8: Abraham Lincoln is re-elected President of the United States. Soldiers in the Army gave him 70 percent of their vote.
- November 16: Union General William Tecumseh Sherman begins his “March to the Sea”.
- November 21: General John Bell Hood’s Army of Tennessee begins a march north to Tennessee.
- November 30: General Hood attacks General George Henry Thomas in the Battle of Franklin, Tennessee.
- December 13: Sherman’s forces capture Fort McAllister, near Savannah, Georgia.
- December 15-16: General Hood attacks General Thomas in Battle of Nashville, Tennessee.
- December 20: Sherman captures Savannah, Georgia.
- December 24-25: Federal attacks on Fort Fisher, near Wilmington, North Carolina.
- Near the end of the war, the Confederate Army establishes a hospital for the treatment of eye injuries at Athens, Georgia, under the command of Surgeon Bolling A. Pope.

1865
- Joseph Lister of Scotland initiates antiseptic surgery by using carbolic acid on a compound wound and introduces phenol as a disinfectant in surgery, reducing the surgical death rate from 45 to 15 percent
- Austrian Gregor Mendel publishes his first experiments in genetics.
- January 13-15: Union troops capture Fort Fisher, North Carolina.
- January 19: General Sherman begins a march north into the Carolinas.
- January 24: Prisoner exchanges between the two armies resume.
- February 3: Clara Barton wrote a letter to President Lincoln requesting the authority and endorsement for her to act as temporary general correspondent for letters to and from recently exchanged prisoners of war.
- February 5-7: Siege of Petersburg: Battle of Hatcher’s Run, Virginia
- February 6: Confederate President Jefferson Davis appoints General Robert E. Lee General-in-Chief of Confederate Army.
- February 17: General Sherman’s forces capture and burn Columbia, South Carolina, Confederate forces evacuate Charleston.
- February 17: The Confederate submarine H.L. Hunley makes a daring and successful night attack on the USS Housatonic. The Hunley survived the attack, although she foundered and sank on the return from the mission.
- February 18: The mayor of Charleston, South Carolina surrenders the city to Union general Alexander Schimmelfennig. Union troops retake control of the United States Arsenal.
- March 3: An Act of Congress creates the National Asylum.
- March 4: President Lincoln delivers his second inaugural address at his second inauguration.
- March 11: President Lincoln appoints Clara Barton to the post she had requested: of temporary general correspondent for letters to and from recently exchanged prisoners of war.
- April 2: Extensive Confederate medical records gathered during the war are destroyed in the Richmond, Virginia fire that destroyed many government offices.
- Siege of Petersburg ends as General Lee removes troops; Richmond is evacuated.
- April 3: Fire begins in Richmond around 3a.m.; Federal troops enter the city later in the day.
- April 3: Richmond, VA surrenders to General Grant.
- April 5: President Lincoln’s Secretary of State, William H. Seward sustained multiple injuries in a carriage accident. One of his most serious injuries was a broken jaw. Unsuccessful attempts to hold the jaw together were made by the attending surgeons.
- April 9: Confederate States of America formally surrender. General Robert E. Lee surrenders the Army of Northern Virginia to General Ulysses S. Grant at Appomattox Court House.
- April 12: Surrender of Mobile, Alabama.
- April 14: President Abraham Lincoln is shot in the head at close range by John Wilkes Booth in Ford’s Theater, Washington, D.C.
- April 15: President Lincoln dies at 7:22 a.m. He is succeeded as president by Andrew Johnson.
- April 26: The Army of Tennessee surrenders to General Sherman near Durham, North Carolina.
- April 29: Secretary of State William Seward’s broken jaw is attended by dentist Dr. Thomas Bryan Gunning. Gunning’s innovative interdental splint was used to treat the injury. Ann almost identical vulcanite splint was developed at the same time by another dentist, Confederate Dr. James Baxter Bean.
- May 4: General Richard Taylor’s forces surrender at Citronelle, Alabama.
- May 10: Confederate President Jefferson Davis is captured at Irwinsville, Georgia, by the Fourth Michigan cavalry and imprisoned.
- May 12: Engagement near Palmito Ranch, Brownsville, Texas
- May 23-24: Grand Review of the Army of the Potomac and Sherman’s army, Washington, D.C.
- May 23: Volunteer Mary Ann (“Mother”) Bickerdyke, was famous during the war for her work procuring equipment and supplies, and the establishment of camp and hospital kitchens and laundries. Her beloved troops insisted that she accompany them during the Army’s Grand Review, and she rode in the parade in an ambulance wagon.
- May 26: U.S. Civil War ends with the surrender of the last Confederate Army, the Army of Trans-Mississippi at Shrevesport, Louisiana.
- July 5: Elmira Prison in New York was closed. It was demolished in August.
- September 27: The last patient left Elmira Prison hospital and the facility closed.
- December 18: The 13th Amendment to the Constitution is officially ratified, abolishing slavery.
- December 24: The Ku Klux Klan is founded in Pulaski, Tennessee.
- Elizabeth Garrett Anderson began her practice as Britain’s first female doctor. She was refused admittance to medical schools and qualified via the Society of Apothecaries.

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