Female Surgeons – Defiance in the Face of Adversity

From: comestepbackintime.wordpress.com

‘A few words upon a very important aspect of this question – the right of women to compete with men in any occupation by which they can earn a livelihood. A woman has to pay like a man, she has neither mercy nor favour shown her because she is a woman, therefore she should have the same chance as a man, and the same pay if she can render as good work.  Why should not women enter the legal and medical profession…..During a four years’ sojourn in America I had the pleasure of knowing Dr Mary Walker, Dr Elizabeth Blackwell and hundreds of others who are doing the noblest work that is being done in the United States at the present time. The medical profession is one particularly adapted to women.’
Ada Campbell, Liverpool, 21st September 1891

Ada Campbell wrote the above letter, on equal rights for women in the professions, 26 years after the end of The American Civil War (1861-1865).   Nearly 1,000 women disguised themselves as men and served as soldiers during the campaign, 3,000 white women became nurses and a handful of women served as physicians.

Dr Mary Edwards Walker, Dr Elizabeth Blackwell, Dr Esther Hill Hawks and Dr Sarah Ann Chadwick Clapp were among a pioneering group of medical professionals who broke with social conventions by offering their services for frontline duty. They received a hostile reception from their male counterparts, who firmly believed that field medicine was a male environment and no place for women. Undeterred, the feisty females continued to flout the accepted norm and all 4 demonstrated defiance in the face of adversity.

Dr Blackwell (1821-1920) was the first female MD in the US, graduating from Geneva Medical College in 1849. During the War she trained the nurses that were sent to the Union Army. Dr Clapp was appointed assistant surgeon of the 7th Illinois Volunteer Cavalry and served in post between 15th November 1861 and 25th August 1862. She also served as assistant surgeon/surgeon in general hospitals in Cairo, Illinois and aboard transport ships. However, the medical examining board refused to give her an examination and she never received a commission or pay for her War work.  Dr Hawks (1833-1906) graduated from the New England Female Medical College in 1857. At the start of the War she followed her husband, John Milton Hawks a regimental doctor with the U.S. Coloured Troops, to the South Carolina Sea Islands and Florida. She treated the wounded from the attack on Fort Wagner and the Battle of Olustee.

Dr Walker (1832-1919) graduated from Syracuse Medical College in 1855. At the outbreak of War she applied for a surgeon’s contract, a request which was flatly refused by the Medical Department. She did not give-up and remained in Washington serving as a nurse in a number of camps and hospitals for Indiana troops. Whilst working at the Indiana Hospital, Washington she met Dorothea Lynde Dix. Dix had been appointed on 10th June 1861 by the Secretary of War as Superintendent of Female Nurses. She was a formidable character and insisted that her nurses were over 30 and plain, lest they should incite sexual desire in the surgeons. Dix’s nurses wore brown/black dresses, no bows, no curls, no jewelry and no hooped skirts.

Mary made repeated attempts to secure the allusive surgeon’s contract and was abused for her demands. After proving her worth during the battles of Fredericksburg (1862) and Chickamauga (1863) where she worked, unpaid, as a field surgeon, General Ambrose Burnside declared his confidence in her medical skills and recommended her for a commission. In September 1863, Major General Thomas appointed her an assistant surgeon in the Army of the Cumberland and she was assigned to the 52nd Ohio Volunteer Infantry serving in Chattanooga. Finally, in October 1864, she was officially commissioned as a Contract Surgeon and received the rank of First Lieutenant.

Although a talented and competent surgeon, Dr Walker’s temperament was described by her fellow surgeons as being cantankerous, abrasive, harassing, a professional scold and some thought her insane. Always outspoken and never afraid to challenge her colleagues and their decisions. She was appalled that the battlefield surgeons were performing amputations with such regularity and in her view many were unnecessary. She would undermine her colleagues by conspiring with the wounded soldier to challenge the Surgeon’s decision to remove a damaged limb. She was equally horrified at the heavy doses of mercuric compounds that were being given to patients.

Dr Walker was a beautiful woman, with raven hair which she kept long and curled so that no one would think that she was a man. The reason that she may have been mistaken for a man, was due to her unusual attire, for which she was famed and criticised for throughout her life. Beginning at medical school she wore bloomers, much to the disgust of her lecturers. Bloomers were the outfit of choice for radical feminists of the day and were first invented by Amelia Jenks Bloomer (1818-1894), who spearheaded the movement. When Dr Walker began her medical career she abandoned the bloomers and wore instead a modified version of male dress, a calf-length skirt worn over trousers, teamed with an Army uniform jacket. Whilst on front-line duty she would always carry 2 pistols about her person.

On 10th April 1864, following a battle, Mary had stayed behind to tend Confederate wounded upon retirement of the Union Army. She had taken a wrong turn in the camp and was captured by Confederate troops and charged with being a spy. The Confederates believed that her male attire was a deliberate attempt to don a disguise and infiltrate the encampment. She spent 4 months in prison and continued to be abused for the manner in which she dressed. Eventually in August she was exchanged for a Confederate surgeon whom the Union Army had captured. She was proud of the fact that the price on her head was that equal to a male surgeon and often boasted about it throughout her life.

In 1866, she became President of the National Dress Reform Association which urged women to discard their corsets on health grounds and adopt dress reform. The Association sought to pioneer a movement which necessitated a change of style in the dress of American women. In July 1866 she was arrested in New York for the crime of impersonating a man. The Dundee Courier & Argus reported the incident:

‘Miss Dr Mary E. Walker who indulges in the Bloomer costume, appeared one day in Broadway with a very long train of boys. A policeman arrested her, and took her before the justice in question, on charge of being dressed in the attire of a man. It was alleged that the crowd which followed Dr Mary sufficiently proved that no deception was attempted with regard to her sex. A lawyer of the Police Court declared that “any man or woman who should dress in a way that would attract attention was violating the law.” To this it was replied triumphantly that the great majority of New Yorker’s dressed for the purpose of attracting attention. We say triumphantly, for the justice decided that no case was made out against the fair physician, who thereupon returned to Broadway, where she has since appeared in her “Bloomer” at her pleasure.’

Mary always wore male dress and even in her final years, she could be seen about town wearing a wing collar, bow tie, top hat and carrying a cane. She was awarded the Medal of Honor in November 1865 for her services at the First Battle of Bull Run (Manassas).

Image: Dr. Mary Walker

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Civil War Laxatives

By T.A. Wheat
Excerpted from: encyclopediavirginia.org

At the time of the Civil War, most medical treatment was not only unhelpful but could actually be harmful.

Harsh laxatives, sometimes called "drastics," were often used and included heavy-metal salts such as mercury chloride (calomel and "Blue Mass"). Ironically, an effective treatment for chronic diarrhea—consisting of a diet limited to clear liquids and the use of opiates to slow intestinal contractions—was available and sometimes used in conjunction with other, inappropriate measures. Some surgeons appear to have learned from personal experience and gradually shifted to regimens favoring the more appropriate treatments.

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Six Feet Under: Body Bags and Burial Cases

By James M. Schmidt, The Civil War News, July 2011

“In the present condition of the country, when the fatal calamities of war render it a duty incumbent on fathers, mothers, wives, sisters and brothers to seek their dead upon the battlefield and to bring home for burial the remains of their kindred, any invention which will tend to ameliorate these afflictions and assist in the performance of this sad duty is worthy of special notice.” – Scientific American, February 28, 1863

The Civil War proved to be a camp-to-grave proposition for more than 600,000 soldiers and sailors, North and South. Though the mission of military surgeons was to heal the living, they had an interest in corpses for a number of reasons, including: the postmortem examinations of dead soldiers – either from wounds or disease – allowed them to continue the study of anatomy first begun in medical school; the chemistry and biology of decomposition almost certainly appealed to their scientific minds; army regulations required a copious amount of paperwork on men who died in their care.

While innovations and inventions in the military arts have received significant attention in the Civil War literature, less attention has been paid to wartime improvements in the implements required for burial. In fact, inventors met that grim reality with dozens of improvements in coffins, caskets, biers, and embalming tools.

One of the more interesting inventions was designed for the battlefield: Dr. Thomas Holmes’ United States Patent No. 39, 291, “Improvement in Receptacles for Dead Bodies” (a rather fancy name for a “body bag,” and yet it was an invention ahead of its time). Holmes, of Washington, D.C., declared that his object was:

“…to facilitate the carrying of badly-wounded dead bodies hurriedly away that could not otherwise be quickly removed for the want of proper conveyances, or difficulty to procure boxes or coffins for removing the dead, as the boxes or coffins cannot be so easily transported or handled on the field of battle.”

The “receptacle” was made of india-rubber, oval-shaped, about six feet in length and about two and a half feet in width. The top was funnel-shaped, “so that a dead body may easily be thrust in at the top.” The bag had two handles, “so that the body can be immediately lifted up and carried off…to be transported safely to any desired place to be inclosed in a box or coffin.” A tube was attached near to the center of the bag receptacle to accommodate deodorants or preservatives, “until received by its friends to be...prepared for interment,” or embalmed.

Indeed, the very same Dr. Thomas Holmes - an 1845 graduate of the “College of Physicians and Surgeons at Columbia University,” in New York - is considered the “Father of American Embalming” for his experiments in improving the preservation of cadavers used for anatomical studies and in preparing bodies for burial. He was the premiere embalming surgeon of the Civil War era, reportedly preparing more than 4000 soldiers for burial, including the first prominent Union casualty of the war, Col. Elmer Ellsworth.

Still, not everyone could afford embalming. As Valentine Mott - one of the foremost surgeons of the era – declared:

“…in times like the present, when so many are bereft of one or more members of their family by the calamities of a horrid war . . . .the rich and the titled can afford to be embalmed, but the commoner must be pitched into the pit unheeded and unknown.”

For that reason, Mott praised the “rare inventive skill” manifested in Dr. G. W. Scollay’s “Air-Tight Deodorizing Burial Case” (U. S. Patent No. 34,700). Scollay, of St. Louis, held several patents related to undertaking. Scientific American magazine featured the case in one of its wartime issues. The long article outlined — rather graphically — the chemical and biological processes of decomposition, described the invention, and featured an engraving of the case with a fallen soldier as its occupant.

The mechanics of the innovative burial case received the approbation of the Western Sanitary Commission (which performed numerous and diligent experiments to test its utility) which appreciated the “safer, cheaper, and better method of preserving the remains of deceased persons without burial, for transportation to friends at a distance an object greatly desired by those having relations killed in battle, or dying in the military hospitals.”

The editors of Scientific American agreed, and declared, “Especially at the present time is its introduction to be desired, when desolation and grief exist in almost every home in the land.”

From: civilwarmed.blogspot.com

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Huge Pewter Irrigator Syringe

From: joshuasattic.com

This is an extremely large irrigator made out of pewter and marked on the rim "HD/US" meaning "Hospital Department/ United States." Internal leather plungers seal off the inner cavity so that liquids and gels could be forced out tip by ramming down on the wooden plunger.

This was used for larger body cavities and could even have been employed in the Veterinary Care of the Cavalry's horses (hopefully not on two species in the same day!)... Without an effective use of electricity yet during the American Civil War, equipment was literally hand-driven with elbow-grease. Thus, both suction effects and washing procedures were done with such pieces of equipment. Imagine a wounded or sick soldier's dread when seeing the physician carrying such a big metal human plunger toward you! Some might claim that staying sick was the better option!

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Osteomyelitis (Bone Infection)

by Janet King, RN, BSN, CCRN

This acute inflammation and infection of a bone or bones was usually the result of some type of surgical procedure. Without aseptic and sterile techniques, cutting into the bone almost assured such a disease. In some cases this infection would become chronic with the wound "spitting out" bits of diseased bone for decades, causing much pain and suffering for the soldier - long after the war ended.

At first, the wounded soldier would complain of chills, high fever and severe pain, tenderness, swelling and redness of the skin over the affected bone(s). Eventually the condition would progress and if the patient survived he might be left with an extremely stiff joint or non-functional limb.

1860's Treatments: Quinine; liquor of potassium iodide; morphine; opium and some use of mercurial compounds. "Local treatments" such as rest of the infected part; application of cold compresses; cupping and leeches were also tried. Sometimes operations were performed to cut out the infected areas.

Modern Knowledge: Common bacteria found in cases of osteomyelitis are: streptococci and staphylococci. Today Orthopedic and Infectious Disease doctors would be very aggressive in treating such an infection. Great care is taken not to have this infection occur, as it tends to become chronic and can cause many problems and great destruction of the bone. The surgeon would first attempt to drain or "clean out" the infected area and then place the patient on long term antibiotic therapy (months to year) via the intravenous route. Careful monitoring for reoccurrence and progression of the disease would be done. Modern surgical techniques and the initial treatment of victims of trauma - i.e. gunshot wound victims - have prevented many cases of this disease.

From: vermontcivilwar.org

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Ivory and Brass Civil War Period Stomach/Cavity Pump

From: joshuasattic.com

A very interesting set of old Medical equipment, contemporary to the Civil War. A brass hand-pump, connected by a weaved tubing to various custom-made ivory tips. Physicians would use this apparatus to pump out various body cavities. I suppose that most soldiers would rather face deadly double-cannister on the battlefield than to take on one of these nasty babies!!!

Contrary to our impressions, doctors were quite well-trained and sophisticated in the 1860's, going to formal Medical Schools in the east to study anatomy, physiology, pharmaceuticals, and natural curatives. They were at a crossroads between the old and new worlds of scientific knowledge. Sadly, modern doctors know nothing of herbalism or the great homeopathic philosophies.

Civil War physicians did not simply cut off legs and watch people die. They were excellent hands-on diagnosticians who cared greatly, applied dressings, did minor surgery, made their own medications. They could all set a bone, drain a boil, compose a hysteric and even deliver a baby on a buckboard if need be!

This pump-set is an uncommon accessory in its original walnut box. (No, I have NOT tested it!!!)

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Andersonville Prison, Andersonville, Georgia

Andersonville, or Camp Sumter as it was known officially, held more prisoners at any given time than any of the other Confederate military prisons. It was built in early 1864 after Confederate officials decided to move the large number of Federal prisoners in and around Richmond to a place of greater security and more abundant food. During the 14 months it existed, more than 45,000 Union soldiers were confined here. Of these, almost 13,000 died from disease, poor sanitation, malnutrition, overcrowding, or exposure to the elements.

The prison pen was surrounded by a stockade of hewed pine logs that varied in height from 15 to 17 feet. The pen was enlarged in late June 1864 to enclose 261/2 acres. Sentry boxes—called “pigeon roosts” by the prisoners—stood at 90-foot intervals along the top of the stockade and there were two entrances on the west side. Inside, about 19 feet from the wall, was the “deadline,” which prisoners were forbidden to cross. The “deadline” was intended to prevent prisoners from climbing over the stockade or from tunneling under it. It was marked by a simple post and rail fence and guards had orders to shoot any prisoner who crossed the fence, or even reached over it. A branch of Sweetwater Creek, called Stockade Branch, flowed through the prison yard and was the only source of water for most of the prison.

In an emergency, eight small earthen forts around the outside of the prison could hold artillery to put down disturbances within the compound and to defend against Union cavalry attacks.
The first prisoners were brought to Andersonville in late February 1864. During the next few months, approximately 400 more arrived each day. By the end of June, 26,000 men were penned in an area originally meant for only 10,000 prisoners. The largest number held at any one time was more than 33,000 in August 1864. The Confederate government could not provide adequate housing, food, clothing or medical care to their Federal captives because of deteriorating economic conditions in the South, a poor transportation system, and the desperate need of the Confederate army for food and supplies.

These conditions, along with a breakdown of the prisoner exchange system between the North and the South, created much suffering and a high mortality rate. “There is so much filth about the camp that it is terrible trying to live here,” one prisoner, Michigan cavalryman John Ransom, confided to his diary. “With sunken eyes, blackened countenances from pitch pine smoke, rags, and disease, the men look sickening. The air reeks with nastiness.” Still another recalled, “Since the day I was born, I never saw such misery.”

When General William T. Sherman’s Union forces occupied Atlanta, Georgia on September 2, 1864, bringing Federal cavalry columns within easy striking distance of Andersonville, Confederate authorities moved most of the prisoners to other camps in South Carolina and coastal Georgia. From then until April 1865, Andersonville was operated in a smaller capacity. When the War ended, Captain Henry Wirz, the prison’s commandant, was arrested and charged with conspiring with high Confederate officials to “impair and injure the health and destroy the lives…of Federal prisoners” and “murder in violation of the laws of war.” Such a conspiracy never existed, but public anger and indignation throughout the North over the conditions at Andersonville demanded appeasement. Tried and found guilty by a military tribunal, Wirz was hanged in Washington, D.C., on November 10, 1865. Wirz was the only person executed for war crimes during the Civil War.

Andersonville prison ceased to exist when the War ended in April 1865. Some former prisoners remained in Federal service, but most returned to the civilian occupations they had before the War. During July and August 1865, Clara Barton, along with a detachment of laborers and soldiers, and former prisoner Dorence Atwater, came to Andersonville cemetery to identify and mark the graves of the Union dead. As a prisoner at Andersonville, Atwater had been assigned to record the names of deceased Union soldiers for Confederate prison officials. Fearing loss of the death records at war's end, Atwater made his own copy of the register in hopes of notifying the relatives of the more than 12,000 dead interred at Andersonville. Thanks to Atwater’s list and the Confederate death records captured at the end of the War, only 460 of the Andersonville graves had to be marked “Unknown U.S. soldier.”
—Adapted from National Park Service brochure "Andersonville"

IMAGE: The deadline that kept prisoners back from the walls of the stockade was marked by a simple fence. Prisoners who crossed the line were shot by sentries who sat in “pigeon roosts” located every 90 feet along the wall. The man in this image was shot reaching under the fence as he tried to obtain fresher water than was available downstream. (Andersonville National Historic Site)

FROM: civilwar.org

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Organization of the Hospitals in the Department of Washington

Excerpted from: civilwardc.org
By Susan C. Lawrence

"At the outbreak of the civil war," the author of the chapter on general hospitals in "The Medical and Surgical History of the War of the Rebellion" wrote, "this country knew nothing practically of large military hospitals; indeed, most of our volunteer medical officers knew nothing of military hospitals, small or large."

In fact, most of the volunteer medical officers would have known nothing of hospitals at all unless they had practiced in a city large enough to have had one or more charity hospitals, such as New York, Boston, Philadelphia or Washington, DC. Both volunteer and newly recruited medical officers must have quickly discovered that they needed to learn something about the military as well as something about hospitals in order to work in some of the ad hoc, transitory establishments that housed the sick and wounded at the start of the war. It was the military, after all, that requisitioned space, built new hospitals, provided supplies, and needed regular, complete reports of the numbers of sick and wounded. The military imposed order (or at least tried to) on the proliferation of hospital sites, working along both military and medical chains of command.

In theory, every regiment had a hospital (a regiment was 10 companies of 100 men each). For armies on the march, these were field hospitals, with supplies carried along in wagons and set up in whatever quarters could be found or organized around ranks of tents.

For armies encamped, there were post hospitals created out of tents or wooden barracks; these were organized at the regimental or brigade (3 to 6 regiments) level. The District of Columbia hosted huge camps for mustering the troops moving through the city to form the armies operating to the south and southwest, and so had flexible camp hospitals.

As the army constructed fortifications around the District, it also established post hospitals to serve those who garrisoned the forts. Field and post hospitals served only the companies and regiments assigned to them, and were under the authority of the highest ranking military officer in the specific command. Given the number of troops needed to garrison the posts and batteries, and to be held in reserve in case of attack, these post and camp hospitals provided care for tens of thousands of soldiers. They held those too sick or injured to remain in their camp or post quarters, but not sick or injured enough to be transferred to one of the general hospitals in Alexandria, Washington or Georgetown.

General hospitals, in contrast, primarily took care of the sick and wounded left behind as troops moved out and, more importantly, to deal with the influx of sick and wounded transported in from field hospitals for longer term care than could be managed near battlefields or by soldiers on the march. General hospitals took in soldiers from any company, and so had a place outside of direct military authority. The surgeon in charge of a general hospital held an officer's rank and reported to the Medical Director of the relevant Department. Medical Directors, in turn, reported to the Surgeon General. From the very beginning of the war, however, tensions flared between the surgeons-in-charge and local officers of higher rank over who had the authority to manage the general hospitals' organization and administration. The War Department had to send out several reminders that the surgeons in charge of general hospitals followed the orders of the Surgeon General, not the orders of higher ranking military officers around them, and that they were totally in charge of all medical decisions within their institutions.

The Defenses of Washington: Organization of the Post Hospitals
The defense of the capital preoccupied Washingtonians throughout the war. How many troops and resources were needed to march against the South and how many were required to protect Washington became significant bones of contention within the army and among politicians.

General Mansfield, placed in charge of the Department of Washington at the start of the war, began construction of new defensive forts in May, 1861. In late July, the task of defending the District fell to Major General George B. McClellan. Under McClellan's authority, construction began on the series of forts, redoubts, and batteries that would eventually encircle Washington and Alexandria with sixty-eight forts and one-hundred batteries by the spring of 1864. Brigadier General James S. Wadsworth organized all of the post hospitals in March of 1862. Then, on February 2, 1863, the defenses were formally divided into two divisions of the 22nd Army Corps, one for those forts north of the Potomac (Washington) and one for those south of the river (Alexandria). Forts were manned by specific volunteer regiments, organized into three to four brigades. Clusters of forts (and redoubts and batteries) shared one or more post hospitals, with a hospital usually (but not always) found at the fort serving as brigade headquarters. In July of 1864, the brigades north of the Potomac were again reorganized, with the 1st Brigade becoming the 2nd Brigade and vice versa; the 3rd Brigade remained the 3rd Brigade.

The location of post hospitals moved according to the distribution of regiments among the various forts, as well, with more or less consistent attempts to keep them equally accessible to all of the positions they covered.

Given the capital's location, it became a major point of care for Union soldiers. Indeed, by December, 1864, the Department of Washington (twenty-four of the twenty-five general hospitals in the Department of Washington were in the District of Columbia) had more beds (21,426) in its general hospitals than any other department in the war.

The organization of the general hospitals in the District fell to the Medical Director of the region, Robert O. Abbott. At the start of the war, the military simply requisitioned the civilian city hospital (the E Street Infirmary) and the Union Hotel to serve as general hospitals when needed for the first casualties, who arrived in May of 1861.

Other sites were soon located, such as rooms in the Patent Office, but the big push to claim sites for general hospitals started in March of 1862. The general hospitals in Washington and Georgetown were loosely organized throughout the war, with no clear hierarchical structure.

In contrast, nearly all of the general hospitals located in Alexandria were grouped into three divisions on September 20, 1862. The surgeon placed in charge of all of the division hospitals supervised the surgeons responsible for each of the divisional hospitals' branches. (It must be emphasized that the divisional structure of the hospitals in Alexandria had no relation to military divisions within the army, but only represents an unfortunate use of parallel terminology.)

The Union Hotel was only the first of the buildings that the military took over to use as a hospital. Churches, schools, homes, and warehouses had crews come in to fill them with beds and to organize rooms for managing hospital functions: kitchens, stores, laundries, surgeons' rooms and, of considerable concern, water closets. Next in use were the wooden barracks abandoned by troops moving out on campaign. Commentators, both during and after the war, complained bitterly about how inappropriate such makeshift accommodations were for hospitals.

Ventilation and sanitation were the watchwords of up-to-date hospital construction in the early 1860s. By the end of the war, however, the military had constructed relatively few buildings designed from the start to be hospitals. None were built in Alexandria, for instance. Indeed, only five institutions were erected specifically as hospitals in Washington itself: Judiciary Square (built on the site of the burnt-down City Infirmary), Harewood, Armory Square, Mount Pleasant, and Lincoln general hospitals. Yet even the latter three incorporated some existing barracks buildings or tents into their plans.

All five of these general hospitals were constructed in 1862, with Judiciary Square and Mount Pleasant opening in April of 1862, Armory Square in August, Harewood in September and Lincoln in December. Their plans followed contemporary wisdom: wards, with fourteen foot ceilings, a window between each bed, and floors raised off the ground, contained 60-63 beds each. They were built as separate buildings linked by open-sided covered walkways, all in order to maximize the circulation of fresh air. In overall design intention, if not in precise detail, these hospitals presaged the requirements for purpose-built, pavilion style hospitals laid out in a War Department Circular printed on July 20, 1864, and were sent to all departments to direct the future construction of general hospitals.

As the census figures for December 17, 1864 show, 7,783 (39%) of the hospital beds in the District of Columbia were in "proper" hospitals over two and a half years into the war. These numbers do not include the number of beds found in the District's post hospitals, moreover, so there was an even lower percentage of beds in facilities designed with medical goals in mind within the District and its circle of fortifications. Most sick and wounded soldiers, in short, spent their days in makeshift accommodations, from well-appointed houses to tents in muddy fields.

The Hospitals in Space and Time
The locations of all of the District's hospitals, including all of those established as part of the defenses of Washington, even if slightly outside the District's boundaries, are displayed on our maps, in the context of the District's fortifications, churches, bawdy houses and other institutions vital to the life of a city at war. The time slider allows the user to examine the chronological arc of the hospitals' presence, and reveals how these institutions were one of the dominant features of Washington's and Alexandria's landscapes during the intense years of 1862 to early 1865. A closer examination of the hospitals that appear and disappear from May 1861, to early 1863, documents the initial use of temporary housing, particularly of churches and government buildings (the Capitol and the Patent Office), and then the shift to the large hospitals positioned in barracks or purpose-built on empty sites. When the fiercest fighting of the war moved away from Washington, some of the post hospitals and smaller general hospitals began to close. At the end of the war, hospitals closed more rapidly, with only three remaining to serve regular army needs after September of 1866. Churches and chapels all returned to being churches and chapels, re-purposed barracks hospitals were torn down, and the purpose-built hospitals, for all their up-to-date design, ceased to exist. From constant reminders of the war's presence, and its human costs, to empty spaces in the District's terrain, hospitals were, ironically, one of the most transitory of features in the District's infrastructure.

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