Lessons Learned (Medical Department Column #3)

Below is the third installment of my "Medical Department" column from The Civil War News. Published in the November 2000 issue, it describes some specifics about medical case studies in the Civil War as seen through the eyes of artifacts and documentation at the Army Medical Museum (now the National Museum of Health and Medicine) - the brainchild of Surgeon General William A. Hammond which had the purpose of serving as a repository of medical and surgical specimens collected during the war to use for future study.

One thing the blog is allowing me to do is to add hyperlinks to items of special interest in the column...something I wasn't able to do easily in the printed version. Enjoy!

"Lessons Learned"

by Jim SchmidtFrom the November 2000 issue of The Civil War News

An army always tries to learn lessons from its last battlefield and apply them to the next. This is no less true for those responsible for treating the wounded on the field and fighting disease in hospitals. The Union’s Surgeon General William A. Hammond (1862-64) recognized the Civil War’s potential as a “natural laboratory” for aiding research in military medicine. To that end, he established the Army Medical Museum as a repository of medical and surgical specimens collected during the war to use for future study. To this day the collection remains a vital link to our past and an important tool for medical research. The museum is also the repository of several “celebrity” specimens, among them the leg that Union Major General Dan Sickles lost after it was crushed by an artillery round at Gettysburg.

The museum, its Civil War roots, and its evolving mission are the subject of an excellent article by Dr. Lenore Barbian and her colleagues at the Armed Forces Institute of Pathology (AFIP): “Case Studies in Pathology from the National Museum of Health and Medicine,” published in a recent issue of the Annals of Diagnostic Pathology (Vol. 4, No. 3, June 2000, pp. 170-173).
In May 1862, Hammond directed medical officers in the field to begin collecting medical and surgical samples, extracted projectiles, case reports, and photographs, and forward them to the museum. After the war, curators John Brinton and George Otis compiled the information from the thousands of specimens in their monumental work, The Medical and Surgical History of the War of the Rebellion, published between 1870 and 1883.

During the late 1800’s and early 1900’s, the museum staff were engaged in a variety of activities, including pioneering techniques in photomicography and conducting important research in infectious diseases. In 1946 the Army Medical Museum became a division of the new Army Institute of Pathology, which in turn became the AFIP in 1949. The museum became the Armed Forces Medical Museum in 1974 and the National Museum of Health and Medicine in 1989. The collection and museum remain in Washington, DC.

A most interesting aspect of the Annals article is the examination of the case study of Private J. Potter of the 12th Illinois cavalry, including his entire medical record as extracted from the Medical and Surgical History. In April 1864, Potter was wounded in a charge at Cane River, Louisiana, spending the rest of the year in a New Orleans hospital before being transferred to De Camp Hospital in New York. After the bullet was extracted, his right arm developed inflammation, swelling, and abscesses, resulting in intense pain for the horseman.

It took nearly another year of careful nursing before Potter had recovered enough to safely undergo an amputation. The surgeon was intrigued by Potter’s infected humerus for “the character of the injury, the extent of disease, the duration of the case, and the results,” and contributed the bone to Hammond’s museum (see figure). Indeed, Potter’s case is literally a textbook example of bone infection resulting from a soft tissue gunshot wound: photographs of his bone and descriptions of his case have been published in orthopaedic and pathology texts as recently as 1997! The authors promise to publish more case studies, including ones from the Civil War, in future issues of the Annals.

Lenore Barbian, Ph.D., Assistant Curator of the museum’s anatomical collections, was kind enough to share some additional insight into the museum’s history and mission with me. “Collecting by the military was not unknown in Hammond’s time,” she told me. “For example, the Smithsonian started as part of a Navy collecting program, and military personnel often forwarded medical specimens to the Institution. There was also a tradition of anatomical museums in Europe that began as early as the 1500’s. And in the early and mid-1800’s, it was a common practice for American doctors to collect interesting specimens over the course of their careers.” Although the idea of a military medical museum was not unique, without the forward thinking of medical researchers like Hammond the opportunity to learn from the war may have been lost.

Despite Hammond’s hope that the collection would become more than a “cabinet of curiosities,” the celebrity specimens continue to receive the most attention. “Hands down, we receive more questions, requests for photographs, and film crews interested in General Dan Sickles’ leg than any other object,” she said. Also receiving widespread interest are the fragments of Abraham Lincoln’s skull and the vertebrae of his assassin Booth.

The bulk of the museum’s Civil War collection, however, consists of thousands of specimens from average soldiers, such as the aforementioned Private Potter. Lenore told me she likes to think of the Army Medical Museum as an “equal opportunity” collector. “Whether you were a president, general, or private soldier, it seems that if a Union surgeon operated on you, you were likely to become part of the collection, she told me.” The museum also holds a number of specimens collected from Confederate soldiers that were treated by Union doctors.

The museum is on the Civil War Preservation Trust’s “Discovery Trail,” and the Civil War collection is featured in one of the permanent exhibits: “To Bind Up the Nation’s Wounds.” Through artifacts and selected specimens, including Potter’s amputated arm, the exhibit allows visitors to follow the medical progress of wounded Union and Confederate soldiers. Lenore is encouraged that the museum has witnessed a steady increase in visitation, with nearly 20,000 more people visiting in 1999 than in 1996.

The anatomical collections are open to the public for research purposes, and attract the interest of individuals interested in anthropology, pathology, skeletal biology and Civil War medicine. Some of the specialized collections require a research fee, so Dr. Barbian recommends that interested persons contact the museum to make an appointment.

Private Potter undoubtedly would have rather finished life with the use of the arm he lost in battle. Perhaps the Illinois cavalryman would appreciate that it is not really lost at all; it continues to serve as a reminder of his brave service, and as the subject of medical research it may have helped save the arm of a future horseman. Lesson learned.