Recording Anatomical Practice During the American Civil War
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Editor's Note: PBS has partnered with Mercy Street's historical consultants to bring fans the Mercy Street Revealed blog. Shauna Devine, Ph.D., is an assistant professor at the Schulich School of Medicine and the Department of History at Western University.
In this blog post, Devine explains how photography and medical sketches evolved our knowledge of disease, injury and the toll of combat during the Civil War era.
Recording Anatomical Practice During the American Civil War
Episode 203 of Mercy Street introduces viewers to a new character, an anatomical artist from Paris, named Lisette. How was anatomical practice and medicine recorded during the war?
Historians examine the Civil War clinical photographs and artist renderings particularly for their importance in illustrating the medical and surgical history of the war, but also for the role these visuals took in establishing professional authority among orthodox practitioners. However, there has been less emphasis on the development of medical photography within evolving understandings of disease causation. During wartime, this information was developed through the new Army Medical Museum and though the sharing of the knowledge both nationally and internationally, but perhaps most significantly, these materials and resources were made available to the larger body of American physicians, which created a foundation to debate and develop them into new research tools.
The Civil War was the first war to be thoroughly documented using photography. The daguerreotype—an image made on silver plated copper—had been introduced in 1839. The technique required a long exposure time and was used largely to produce portraits in studios. In the late 1850s, the wet-plate process reduced exposure time and allowed multiple prints to be made from a single glass negative. These were individually sensitized with collodion, dried in the dark, and then exposed and developed. Photographers generally used either the large single plate camera (which handled 8/10 inch glass negatives) or a stereo camera (which produced a double image on a smaller glass negative). Photographers needed natural lighting—photographs were generally made in the bright light of the day and any motion could cause a blur. Thus, battles were hard to capture. Posed portraits in a hospital setting, however, were quite manageable.
The Civil War was the first war to be thoroughly documented using photography.
Wartime photographs augmented medical records to help determine postwar pension payments, but importantly, they also historically document the complexities revealed by disease, and disease processes, for physicians. Picturing disease was not new and had been employed for centuries through drawings. However, medical photography was a new tool, its proponents argued an “objective” tool, one that might reveal the “true” condition to an audience of observers.
In December 1864, for example, Reverend H.J. Morton, associate member of the United States Sanitary Condition and a photographer himself noted, “The operator desires to have a record of skill and pictures of the former and latter state of patients are produced. Is it human nature not to exaggerate the original deformity, and increase after loveliness? Photography will not do this. It gives the first and last state of the patient and refuses to flatter.”
Donated photographs were numbered and labeled at the Army Medical Museum. Many were used in the decade after the war to demonstrate unique medical cases or difficult surgical procedures. The photographic record provides visual documentation of the severity of wounds caused by the minié ball or the pathological manifestation of camp and hospital diseases. What mattered most to doctors was creating a larger picture of disease, a visual dialogue about the impact of disease — what parts of the body would be damaged by specific diseases? Or rather, what were the common features represented by specific diseases?
Each photograph is accompanied by a case history detailing where the patient was wounded, the course of treatment, result of the case and the doctor’s name. The patient/subject was less a medical curiosity but rather representative of changing medical perceptions: the emphasis was on experimental and clinical pathology, anatomy and physiology. These were not portraits—nothing was staged to dress up the photo—the object was the disease. The photographs taken together represent changing ideas of sickness and health — what condition was most important to document when trying to understand gangrene, erysipelas or dysentery. The bland drawing, it was suggested, could not compete with the photograph.
When the public visited the medical museum they saw six departments: surgical, medical, anatomy, comparative or animal anatomy, microscopy and miscellaneous articles and they saw photographs of unique cases, and photomicrographs prepared by American physicians. This was a national collection filled with the preparations obtained from military bodies, which had been diagnosed, prepared and dissected by American physicians. Framing the specimens as important contributions for the advancement of medical science, not trophies, was a theme that resonated powerfully with the public who flocked to the museum.
The bland drawing, it was suggested, could not compete with the photograph.
Curator George Otis remarked shortly after the war “visitors to the museum are so numerous” that he was compelled to extend the hours of opening. Indeed, by the end of 1867 more than 6000 people visited the museum and four years later that number had tripled again. John Brinton similarly noted, “The public came to see the bones, attracted by a new sensation.”
In 1864 George Otis wrote Professor Flowers, curator of the Museum of the Royal College of Surgeons in London, in reference to an exchange between the two repositories. He assumed a new professional authority grounded in his wartime acquisition of anatomical specimens: “At present our collection includes thirty five hundred specimens in the surgical series, five hundred in the medical series, one hundred and fifty plaster casts and models, one hundred drawings and paintings and eleven hundred microscopial preparations ... Duplicates of many of these specimens have been prepared, and we are now engaged in photographing the choicest of them.”
These clinical photographs, however, did not explain how to treat, manage or even understand the nature of disease.
In the hopes of better understanding disease processes, but also creating a means in which the wartime program of microscopic research would be available as a resource to the larger body of American physicians, Joseph Woodward, and his associate Assistant Surgeon Edward Curtis, pioneered through experimentation, new methods to photograph microscopic images. Photomicrography, or photomicroscopy, is a process in which the most “delicate microscopial preparations can be successfully photographed with any power under which they are distinctly visible.”
Thin sections of tissues were cut by hand with razors from frozen tissue mounted on the microtome; they were then mounted on glass slides using an adhesive such as Canada balsam. The soft tissues were mounted in “such a way as to retain their most minute details and secure their indefinite preservation.” The idea was to display, photograph, and subsequently study, the stained histologic specimens then representing the various stages of the wartime camp diseases.
At first, Woodward employed artists (much like Lisette) to draw the specimens—the most noted of whom was Hermann Faber. As Woodward noted, "The arrival or recent specimens at the Museum has afforded good opportunities for making drawings representing the appearance of the preparations immediately after their removal from the body." These drawings, however, were criticized by some physicians for being subjective: they showed not the true nature of disease but rather the disease as the artist saw it.
Woodward explained that "such drawings have attached to them more or less suspicion of being at least in part ideal and for this reason numerous attempts have already been made both in Europe and America, to photograph objects as seen with the microscope." Indeed, beginning in the 1850s numerous professional medical journals reported the varied efforts of the medical community in photographing specimens and organs in the hopes of better understanding histopathology.
The problem was that the representations were initially very poor. Thus, physicians continued to use engraving and lithography; however, some physicians of the era believed that photographing disease opened new possibilities for medicine—but again this was not without technical and conceptual debates.
Woodward and Curtis thus spent an enormous amount of time experimenting with different sources of illumination (first the sun and, by 1869, electric lights and magnesium lamps), along with various techniques for photographing histological specimens, including staining different sizes of soft tissues with different color aniline to see what photographed best. They photographed normal anatomical preparations and thin sections of diseased tissues, and even the most "delicate microscopial preparations," showing the "most subtle markings," were displayed. Woodward explained that "reproducing microscopial objects can be employed with ease ... a degree of success that had not previously been obtained." And again, he invited other researchers to tour the museum and learn these methods.
In 1865 a small catalogue of the Army Medical Museum photographic series was published with 109 photographs. These photographs were also bound into volumes of 50 to make an eight-volume set entitled "Photographs of Surgical Cases of Specimens," which was distributed to medical societies, schools and individual physicians. In 1867, numerous photographs were sent to the Universal Exposition in Paris. By 1869 the museum had just under a thousand pathological, clinical, and photomicrographic photos (of both test objects and histology), which were used to make engravings for the Medical and Surgical History of the Rebellion, Circular No. 6 and the Army Medical Museum Catalogue, where Woodward observed that it was his intention to use these photographs to educate physicians on the disease conditions among the soldiers but also on photographic technique.
In 1876 the United States celebrated its centennial with a huge exposition in Philadelphia, and numerous Civil War medical photographs were displayed in a volume entitled Photographs of Cases of Consolidated Gunshot Fractures of the Femur, along with a collection of photomicrographs. This exhibit brought the wartime medical work to the attention of the public along with medical and scientific audiences.
More than one 150 years later the photographs are still disquieting.
The wartime medical photographs reveal the diligent attempt by wartime physicians to understand, learn from the body and disease, to document war wounds and develop American medicine. George Otis discussed the “choicest” photographs or rather the interesting cases, which were taught, studied, debated and analyzed.
More than one 150 years later the photographs are still disquieting. It is difficult to see the youth of the men, the severity of the wounds, the ravages of disease and their anxiety, sadness and humility as they posed and were posed. But physicians made powerful statements through these photographs that seemed to strike a cord with Americans: they were representative of a thoroughly tested nation and medical community. They were also a part of America’s national identity.
The museum resonated powerfully with the public but there was a more important message: it was an institution in which new frontiers were developed, signaling promising new directions and possibilities for American medicine. Most importantly, the museum highlighted the new interpretations and standards for photomicroscopy, and emphasized the practical applications for these standards. The museum proudly displayed and advertised the large body of material, an epistemically well-grounded record of experience, in which physicians could see, judge, dispute, share and develop medical knowledge.
— Shauna Devine, PhD
- Shauna Devine, "Learning from the Wounded: The Civil War and the Rise of American Medical Science" (University of North Carolina Press, 2014): chapter 2;
- J.T.H. Connor and Michael Rhode, “Shooting Soldiers: Civil War Medical Images, Memory, and Identity in America”
- Robert I. Goler and Michael Rhode, "From Individual Trauma to National Policy: Tracking the Uses of Civil War Veteran Medical Records"
- Stanley Burns, "Early Medical Photography in America," 1839-1993 (New York: The Burns Archive, 1983);
- Janet Golden and Charles Rosenburg, "Pictures of Health Care in Philadelphia" (Philadelphia: University of Pennsylvania Press, 1991)
- Stanley Burns, "Shooting Soldiers: Civil War Medical Photography by R.B. Bontecou," (New York: The Burns Archive Press, 2011)
- Lorraine Datson and Peter Galison, "Objectivity" (New York: Zone Books, 2010
Shauna Devine, Ph.D., is an historian of Civil War and American medicine. She has a Ph.D. in medical history and currently holds a joint appointment as an assistant professor at the Schulich School of Medicine and in the Department of History at Western University. She also sits on the Board of Directors for the National Museum of Civil War Medicine. Read Bio | Read All Posts