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Foreword to Photographic Atlas of Civil War Injuries
by Bradley P. Bengston & Julian E. Kuz (Grand Rapids: Medical Staff Press 1996), pps. iv-ix. by Michael G. Rhode

I was quite pleased to be asked to write the introduction to the first reprinting in this century of the photographs which have been known variously as Surgical Photographs, Photographs of Surgical Cases and Specimens, or Photographic Series. Some background information may help explain why these photographs were taken and distributed in the first place.

The attack on Fort Sumter on April 12, 1861, now appears to us to be an inevitable result of 85 years of disputes over slavery and states' rights. To the people living through the events though, the Civil War was by no means the definite result of those years. Accordingly, like much of the rest of the country, the Army Medical Department was unprepared when the war began. The Department had no ambulance corps. The Surgeon General actually had the rank of Colonel. Most doctors had little experience with gunshot wounds and almost none with the new Minie ball. To address some of the problems of military medicine, William Alexander Hammond and John Hill Brinton created the Army Medical Museum.

William Hammond, founder of the Army Medical Museum (now the National Museum of Health and Medicine), was 34 years old in 1862 when he was placed in charge of the Union Army's medical activities. Hammond had previously been in the Army and returned as Surgeon General shortly after the Civil War began. He established the Army Medical Museum in May 1862 to conduct scientific research on military medicine. The Museum was first mentioned on May 21, 1862, in Circular Letter No. 2, which ordered the collecting of reports and statistics on wounded soldiers. Hammond continued, "As it is proposed to establish in Washington, an Army Medical Museum, Medical officers are directed diligently to collect, and to forward to the office of the Surgeon General, all specimens of morbid anatomy, surgical or medical, which may be regarded as valuable; together with projectiles and foreign bodies removed, and such other matters as may prove of interest in the study of military medicine or surgery. These objects should be accompanied by short explanatory notes. Each specimen in the collection will have appended the name of the medical officer by whom it was prepared." Hammond followed this order with one on June 9th creating the Medical and Surgical History of the War of the Rebellion. This giant undertaking, which eventually took 21 years and over 6,000 pages to complete, was assigned to Surgeon John Hill Brinton and Assistant Surgeon J.J. Woodward. Brinton had the responsibility for the Surgical section and Woodward for the Medical section. The terms Surgical and Medical were used in a way that is archaic today: to put it simply, Surgical cases were the result of an injury while Medical cases were the result of a disease. Hammond appointed Brinton curator of the Museum and gave him the authority to begin organizing it.

Dr. John Brinton was 30 years old in 1862 when he was assigned the task of creating the Museum. Brinton began by writing to doctors at hospitals throughout the country asking them to send specimens to the new Museum. He also traveled to the eastern battlefields, meeting surgeons and collecting specimens. In his Autobiography, Brinton discussed his collecting technique, "Many and many a putrid heap [of amputated limbs] have I had dug out of trenches where they had been buried..." Revealing one of his techniques for getting contributions to the Museum, Brinton continued, "Very many specimens I had brought [to the Museum] from the battle-fields, collected by myself. These I put into the first catalogue, assigning them to such medical officers, as I could call to mind, and especially to those whom I knew to be lukewarm in Museum interests. The effect of the procedure was good." On one occasion, he convinced a dead soldier's comrades it would be patriotic to have his wounded leg in the Museum, so they went out and dug up his grave!

Brinton began the first catalogue of the collection and acquired "Mr. Corcoran's School House" on H Street to hold the new Museum. In the fall of 1863, the Museum moved to its new location and began exhibiting some of the 3,500 specimens collected. When Museum founder Surgeon General Hammond was court martialed on trumped-up political charges in 1864, Brinton convinced Hammond's successor, Joseph Barnes, to keep the Museum open. Later in 1864, Brinton was assigned to normal medical duties and returned to Philadelphia to practice medicine after the war ended. Brinton was succeeded as curator by his assistant Dr. George Alexander Otis.

Dr. George Otis must be regarded as one of the mainstays of the Museum. He served for 17 years until his early death at 50 in 1881. Under his direction, the second, much larger Catalogue of the Army Medical Museum and the Medical and Surgical History of the War of the Rebellion were published, as well as many shorter monographs. Over 100 years after his death, Otis has become something of a cipher. His personal life is hard to trace. He married Pauline Baury in 1850. They had three children, Agnes Pauline, Anna Maria, and Alfred Louis, but only the girls seem to have survived to adulthood. His wife apparently died as well, since in 1869 he married Genevieve Poe and later disinherited her for abandonment. Thousands of pages of his official correspondence exist, but the formal style of the nineteenth century gives little feeling for the man. We can turn instead to his friends. Otis is described by his colleague J.J. Woodward as, "Hesitating, often embarrassed in his manner in ordinary conversation, especially with strangers, he became eloquent when warmed by the discussion of any topic in which he took interest." Otis was born in Boston on November 12, 1830. His father died before his first birthday and his mother returned with her son to her native Virginia. Otis had an undistinguished career at Princeton, preferring to read French literature instead of the assigned material. He returned to Virginia and privately studied in Richmond. He received his medical degree from the University of Pennsylvania in April, 1851. He spent the rest of that year and the next studying in Paris. A coup d'etat gave him the opportunity to begin a first-hand study of military medicine. He returned to Virginia in spring 1852 and the next year began the Virginia Medical and Surgical Journal. The Journal, in competition with the Stethoscope, was not a financial success. Otis sold a partial interest to Dr. James McCaw and moved to Springfield, Massachusetts but maintained his connection as corresponding editor. McCaw later became known for his organization of Chimbarozo Hospital in Richmond for the Confederacy. Otis enlisted as a surgeon in the 27th Massachusetts Volunteers to particpate in the war. He moved over to the regular army as the war continued and joined the Museum staff in 1864. Otis stayed with the Museum through a stroke in 1877 until his death in 1881. He continued working on Museum projects even after the stroke made him an invalid.

Otis supervised or created four photographic collections, the Surgical, Medical, Microscopical and Anatomical, which loosely paralleled the arrangement of the Museum. The Medical Series photographs, a very small run, consists of now little-used pictures of colons made by Woodward, who during the war was looking for physical clues to the cause of disease, especially the "alvine fluxes" or dysentery and diarrhea. Woodward also took thousands of Microscopical Series photographs in which he experimented with photomicrographs using artificial lights and specialized stains. Otis's Anatomical Series photographs compared skulls of aboriginal people throughout the world. This work stemmed from an arrangement with Secretary Joseph Henry of the Smithsonian Institution, under which the Army Medical Museum became the government's home for human anthropological remains while the Smithsonian handled cultural remains. Otis had plans for a larger publication (probably like the Surgical Photographs) and began compiling a checklist of the specimens which was published for the 1876 Centennial. The Army was not interested in funding this project though, and most of the photographs and remains were returned to the Smithsonian some years after Otis's death. The photographs that command people's attention at the present day, however, are the Surgical Photographs.

There are 400 Surgical Photographs. They are also known as the Photographic Series, especially in contemporary Museum correspondence, but as more series were created this term proved inadequate. Most of these photographs were taken at the Army Medical Museum in the 1860s and 1870s to illustrate interesting surgical operations or difficulties. The photographs usually show either a damaged bone or a soldier showing his wound. Many bones were collected and studied during the war; lacking radiology, Army doctors hoped that fracture patterns due to gunshot wounds would be consistent. They hoped to examine enough bones to discover a pattern to the fractures; unfortunately, this proved to be an unworkable hypothesis. As the war receded into the past, the pictures began including civilians and women. The very last pictures are long-term follow-ups of two soldiers eighteen and twelve years after they were wounded during the war. Following a patient over the course of years is common now, but was probably rarely done before the Civil War. The continuing publication of the pictures sixteen years after the war ended shows that they were still useful. Similar photographs from the Vietnam War were recently uncovered in the Otis Archives and are now 22 years later being used to illustrate the Army's Textbook of Military Medicine series.

The Museum had moved to Ford's Theater after Lincoln's assassination when Ford could no longer attract an audience. Ford's Theater also housed the Surgeon General's Library, which is now the National Library of Medicine, and the Bureau of Pensions, now the Department of Veterans Affairs. The pension records were used by Otis and his staff to compile the Medical and Surgical History, and sharing the same building meant other opportunities as well. Ex-soldiers requesting pensions came to the building where Museum doctors asked them to have their photograph taken. Much of the Army Medical Museum's early photographic work was done by William Bell in his nearby studio. As a result, the Surgical Photographs frequently look more like Matthew Brady's portraiture than Alexander Gardner's battlefield scenes, even as the patient displays his horrific wound. An example of the portrait style can be seen in Major General Barnum's pose (SP 93). Unfortunately, the conventions of the time can occasionally be disturbing now; an example of this is Jesse Smith (SP 185). Smith, a 16-year old cattle drover, was photographed with the removed skull fragment (as a mounted Museum specimen) balanced on his head. This contrasts strongly with Julius Fabry's dignified pose (SP 276) with his removed femur resting on a table alongside his chair. Fabry's reamputation at the hip was a difficult operation and one that Otis appeared proud of accomplishing successfully. Other photographs were donated to the Museum and rephotographed to be included in the Surgical Photograph series. Roland Ward's plastic surgery after the destruction of his lower jaw (SP 167-170, 186) is an example. Other good examples are Columbus Rush, a young Confederate from Georgia, demonstrating his artificial legs, and the Austrian Feldjager, Private John Schranz (SP 247). Schranz's case demonstrates Otis's contact with doctors throughout the world.

Some of the photographs were engraved to illustrate cases in the Medical and Surgical History. Some were distributed individually when requested. A small catalogue, Army Medical Museum Photographic Series, listing 109 photographs, was published in 1865. The photographs were also bound in volumes of 50 to make an eight volume set titled Photographs of Surgical Cases and Specimens. The first volume of 50 photographs was printed in an edition of 40 sets which were distributed to Medical Directors in the Union Army. By January 1869, the next three volumes containing photographs 51 through 200, along with the first volume, were being made available to interested parties, including the College of Physicians of Philadelphia and the Royal College of Surgeons in Dublin, Ireland.

In 1871, the first five volumes were formally published as Photographs of Surgical Cases and Specimens taken at the Army Medical Museum. The final three volumes had apparently been published by late 1881 to complete the set. At the end of the series, five photographs (SP 385-389) of President Garfield's spine are included. Garfield had been shot by Charles Guiteau, a disgruntled office-seeker, on July 2, 1881. Guiteau's shot wounded Garfield in the spine and the President lingered in pain until September 19th. Garfield was never properly treated for his wound because his doctors, lacking x-ray technology, could not find the bullet. Only a short time after the President died, the Museum published photographs of his vertebrae showing the bullet's actual location which probably helped to settle some of the controversy surrounding Garfield's treatment. One also wonders if the Museum included five prints, more than almost any other case, due to the celebrity of the patient and the notoriety of the assassination. One can perhaps see foreshadowing of this century's morbid preoccupation with President Kennedy's assassination in these photographs. Guiteau's skeleton joined the President's vertebrae at the Museum after his hanging.

Garfield was not the Museum's first celebrity Surgical Photograph. That honor belongs to General Daniel Sickles's shattered tibia and fibula (SP 43). Sickles, either a hero or fool at Gettysburg, had presented his amputated leg to the Museum and frequently brought visitors to see it. With the publication of the photograph in 1864, Sickles could have had a wider audience for his heroism, much to his satisfaction, one would suppose.

Selections of Surgical Photographs were also bound as Photographs of Cases of Consolidated Gunshot Fractures of the Femur by George Otis. This printing was done for the 1876 Centennial Exhibition and includes a listing of the 59 photographs in a table of contents. All of the cases were successful cases of excision or resection surgery as opposed to amputation. Only two copies of this reside at the Museum, and since it is not mentioned in Woodward's list of Otis's publications, it must have had a very small circulation. The plates included are SP 45, 46, 47, 48, 49, 50, 55, 64, 67, 68, 69, 71, 72, 73, 76, 83, 84, 85, 89, 90, 91, 92, 106, 107, 111, 114, 115, 116, 117, 118, 119, 128, 129, 130, 131, 139, 140, 141, 142, 151, 152, 153, 156, 157, 158, 161, 178, 179, 187, 194, 235, 236, 246, 265, 266, 273, 296, 302, 308. SP 64 is bound out of order behind SP 76.

The photographs were printed at different times from wet collodion glass plate negatives and show a variety of poses and retouchings. Several of the negative plates are still maintained by the Museum. The negatives were extremely heavy, being made with 1/4" thick glass. These had to be individually sensitized with collodion, dried in the dark, and then exposed and developed. Many of them have clear areas in the corners where the photographer held the plate while spreading the developing solution. Glass negatives are of course fragile and in some photographs with the same number, the pose is varied or completely different, presumably printed from a different negative when the first glass plate was broken. Similarly, on some soldiers, fig leaves have been discreetly placed on some of the copies. This seems to have been done for the Centennial Exhibition when the pictures would be available to anyone at the fair to examine. One soldier, Jonathan Wallace (SP 92) is actually wearing a real leaf in his picture; most appear resigned to their nudity. The mounts also point to the time of printing and were changed to reflect the Centennial Exhibition of 1876.

Some earlier users of these photographs have been confused by the fact that individual photographs were distributed and frequently bound in albums with other photographs or in the wrong order. It is worth noting that the collection does consist of a fixed number of 400 photographs. The photographs run consecutively and are always of the same individual, although the pose or view might vary if a negative was broken and replaced by a new one.

Otis wrote 375 of the 400 labels used in the Surgical Photographs. Otis's labels on the reverse of the photographs are packed with information. The number of the photograph is usually on both the mount and the label. Early printings can list the number as Photographic Series, but as has been noted, this is the same as Surgical Photograph. Each picture has been given a title that concisely sums up the information to follow. These titles were frequently printed in order and bound in the front of the volume to aid the user in finding cases of interest such as amputations. After the title, the patient was identified, usually by name, rank, company, regiment and state. Modern notions of privacy due in clinical situations had not yet become established, although some soldiers were only identified by initials. The particulars of the case are given in a succinct manner with proper credit to the doctors concerned in the case. The battle in which the soldier was wounded is identified. A specimen number is mentioned if a specimen from the case was accessioned in the Army Medical Museum. This numbering system is defunct, but it can still be used. Also, a Medical and Surgical History citation is given if it is available.

Soon after Otis's death, the Museum was merged with the Surgeon General's Library to create the Army Medical Museum & Library. This arrangement lasted into the twentieth century, but the Museum's staff gradually shifted its concentration to pathology. After the Museum's service in World War II, the reality of its pathology expertise was recognized when it was reorganized into the Army Institute of Pathology. With the creation of the Department of Defense, it became the Armed Forces Institute of Pathology. The Museum became a division of the Institute with many of its holdings dispersed throughout the Institute. The Museum was renamed first the Medical Museum of the Armed Forces Institute of Pathology and later the Armed Forces Medical Museum. In 1989, a reinvigorated National Museum of Health and Medicine was unveiled, along with a campaign to return to its former site on the National Mall near the Smithsonian Institution complex. During the 1980s, many of the Museum's collections were returned, and it became possible to view a complete set of the Surgical Photographs in the Museum's Otis Historical Archives. Named after George Otis, the Archives were created when the Museum moved to the Walter Reed Army Medical Center in the early 1970s. A computerized inventory of the photographs is available in the Museum. For those who cannot visit the Museum or would like to examine the photographs at their leisure, this volume should be an excellent resource.

The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the US Department of Defense. This introduction is a US government work and, as such, is in the public domain in the United States of America.