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| National Museum of Health and Medicine Photo: Ileana Johnson, June 2014 |
The National
Museum of Health and Medicine is housed in its new facility in Silver Springs,
Maryland. Originally located in the former Walter Reed Medical Center in
Washington, D.C., the museum focused on army medicine and artifacts from the
Civil War and subsequent world wars, including the wars in Vietnam and Korea.
I visited
the museum a few years ago in its former location and was struck about the
lugubrious atmosphere, the smell of decay, mold, and formaldehyde. The museum
today is modern and antiseptic, “dedicated to preserving, collecting, and
interpreting the artifacts, specimens, photographs and documents that chronicle
the history and practice of medicine over the centuries.
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| Specimen storage area Photo: Ileana Johnson, June 2014 |
The National
Museum of Health and Medicine’s collection contains more than 25 million
specimens, slides, photographs, artifacts, artworks, and documents that
accumulated since 1862 after the “Army Medical Department ordered that ‘all
specimens of morbid anatomy’ be gathered from Civil War battlefields.” Many
specimens are kept in temperature-controlled storage in the wall to wall
sliding bins and can be observed behind a huge glass enclosure. A forensic teaching
laboratory, visible through large windows, contained skeletal remains and the
tools necessary for identification.
Instruments
such as chisels, ossicle hooks, rotary burs, cerebral exploratory cannula,
mastoid gouge, Volkmann’s spoon, periosteal elevator, searcher and scoop,
retractors were Macewen’s instruments used in 1894 for brain operations.
A few tools
used by Surgeon General William A. Hammond (circa 1860) were displayed. During
the Civil War era surgeons performed cranial trephination, a procedure which
involved drilling a circular hole into the skull to relieve intracranial
pressure after head wounds. Of the 220 operations performed by Union surgeons,
50 percent were successful.
Today
surgeons have an array of tools, equipment, and materials at their disposal to
detect brain injury, including the life-saving titanium mesh which allows for
bone-regrowth and does not interfere with MRIs (magnetic resonance imaging).
Cross-sections
of the brain on display revealed subarachnoid hematomas (bleeding of smaller
vessels) and subdural hematomas (bleeding of larger vessels). Such injuries can
occur from a single blow to the head or from an explosion.
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| Photo: Ileana Johnson 2014 |
One
fascinating specimen floating in a vertical cylinder was a brain connected to
the spinal cord, dating back to 1935. It showed the complexity of the bundles
of axons (nerve fibers) that supply information from the brain to torso, arms,
and legs.
Biomedical
engineers developed devices and processes such as artificial kidneys used in dialysis,
prosthetic limbs, and tissue engineering of the skin. On display was a Drake artificial
leg dating back to 1866 and a Kolff-Brigham artificial kidney. Manufactured by
Edward Olson of Massachusetts, this artificial kidney could cleanse the blood of
one or two patients daily, passing arterial blood through cellophane tubing
wrapped around a drum, which rotated through a 100-liter chemical bath.
More than
45,000 Civil War soldiers from both sides survived amputations and were fitted
with prosthetics. Many soldiers did not survive their bullet and shrapnel
wounds unless their limbs were amputated.
The
bloodiest year of the Civil War was 1864. Ninety percent of the more than
200,000 soldiers who died during the Civil War were victims of small arms fire.
The museum’s collection documents the devastating injuries of almost 500
soldiers with shattered bones, holes in the skull, and horrible wounds. William
Tod Helmuth said in 1873, “The effects are truly terrible; bones are ground
almost to powder, muscles, ligaments, and tendons torn away… loss of life,
certainly of limb, is almost an inevitable consequence.”
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| Bones with osteomyelitis Photo: Ileana Johnson, June 2014 |
At that
time, surgeons were provided by the U.S. military with “more than 100 different
instruments used in complicated procedures ranging from bullet extraction to
reconstructive surgery. Standard medical supplies included 97 different drugs
produced by nearly two dozen manufacturers under government contract.”
“More than
400,000 soldiers from both sides died from disease during the war, almost twice
as many as were killed in action. Open latrines, unclean water, stifling tents
and rotting foods turned crowded camps into breeding grounds for sickness.”
Dysentery and childhood diseases such as chickenpox, measles, and mumps were
deadly in those unsanitary conditions. Osteomyelitis (bone infections) and
gangrene spread easily through hospitals.
The Army
Medical Museum had preserved by the end of the Civil War more than 4,000
skeletal specimens with various gunshot, blunt force, and sharp force injuries.
Wet tissue specimens were also preserved in alcohol. Medical records with
treatment and surgical procedures were also carefully catalogued, including
drawings, photographs, letters, reports, and diaries of nurses. The data was
compiled into a six-volume Medical and
Surgical History of the War of the Rebellion. The archives and the
specimens are still used in scientific studies today.
The museum
holds the largest collection of pathological gross tissue in the world and some
samples are quite rare. Microscopic sections of tissue, cells, or blood
identify abnormalities, disease, and deformities.
Among various
microscopes dating from 1853 and 1881, the Zeiss microscope used by Walter Reed
in 1898-1899 and the 1665 London microscope used by Robert Hooke of the Royal
Society stand out. Robert Hooke wrote Micrographia
and was the first person to use the word “cell” in microscopic structures.
U.S. Army
Major Water Reed (1851-1902) has saved countless lives through his research
into the causes of typhoid and yellow fever and the discovery that yellow fever
is transmitted by mosquitoes. Maj. Reed was the curator of the Army National
Museum and professor of clinical microscopy at the Army Medical School (now the
Walter Reed Institute of Research).
The first
physician to be inducted in the Hall of Fame for Great Americans at New York
University in 1963, Dr. Walter Reed left an indelible mark in the U.S. history
of medicine. In 1936 The Walter Reed Medal was established in his honor, to be
awarded annually for “meritorious achievement in tropical medicine research.”
Walter Reed
General Hospital was founded in 1909 and remained the Army’s premier treatment center
for more than a century until it was merged in 2011 with the National Naval
Medical Center in Bethesda, Maryland. The merger formed Walter Reed National
Military Medical Center. On my last
museum visit at the Washington, D.C. location, I spoke with a couple of
soldiers injured in Iraq who were recuperating and were taking a stroll on the
grounds.
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| Amputated Elephantiasis leg Photo: Ileana Johnson, June 2014 |
The most
gruesome non-military specimen was the amputated leg of a 27-year old in 1894
who had Elephantiasis and lived with this leg for 12 years. In response to a
parasite, the leg became inflamed and scar tissue formed which accumulated over
time. Elephantiasis is still prevalent in some tropical areas today.
One
interesting display contained two bits of blackened cloth expectorated by a
colonel 18 weeks after he had been shot in the chest when fragments of his
uniform were lodged within his body.
The bullet
fragment extracted from Abraham Lincoln’s head post-mortem is barely visible
under a tiny round glass container.
Capt. Henry
Wirz was arrested at the end of the war for crimes committed while commanding
the Confederate prison at Camp Sumter in Andersonville, Georgia. During his
watch, 13,000 of the 45,000 Union soldiers died in captivity from brutality.
Wirz denied the charges by claiming a debilitating injury to his right
arm. After his execution on November 10,
1865, an autopsy discovered that he had full use of his right arm.
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| Museum working lab Photo: Ileana Johnson, June 2014 |
A hydrocephalic baby, conjoined twins, fetal
skeletons, a cross-section of a black lung, a liver with cirrhosis, diseased
kidneys, a kidney with scarlet fever, carcinomas in the kidney, spina bifida, a
human hairball from the stomach, and a scrotum with Elephantiasis are some of
the non-war medical specimens on display.
A portion of
the museum is dedicated to identifying human remains both military and civil
through:
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DNA
evidence (after 1994 the military collects blood samples from service members
and archives them in a repository; mitochondrial DNA can be extracted 125 years
after death)
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Anthropological
evidence (analyzing skeletal remains, fingerprinting, dental records, and
nuclear DNA)
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Age-at-death-estimation
(based on age-related microscopic changes of bone)
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Dental
evidence (based on existing dental records)
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Virtual
autopsy (3-D images provide a detailed map of injuries and foreign objects in
the body)
After
September 11, 2001, 38 pouches and 13 boxes of human remains were flown to
Dover Air Force Base for examination by the Office of the Armed Forces Medical
Examiner. By November 16, 2001, “all but five of the 189 deceased had been
scientifically identified.”
Trauma Bay
II in Balad, Iraq, located on a scarred concrete slab, had saved more lives
between 2003-2007 than any other war theater hospital, with a survival rate of
98 percent, and served as a testing ground for innovative technologies that
relieved pain and suffering for patients who were evacuated when stabilized. This
floor is now preserved in the museum.
Lt. Col.
Chester Buckenmaier III pioneered the use of a peripheral nerve block while
deployed at the Balad hospital. While the patient remained conscious, his goal
was to manage pain, keeping a patient alert during a 5-hour flight. From
September 2001 through September 2007, more than 44,000 severely wounded patients
were flown from Balad to Landstuhl Regional Medical Center near Ramstein,
Germany, within 24-72 hours after arriving at Balad.
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| Arm and foot prosthetics |
Instruments
on display show the progression from wood and ivory to steel, the choice metal
in the age of sterilization, and the sophistication of tools that developed to
enable surgeons to perform more complex surgeries.
Military
medicine protected combatants against enemy weapons, infectious diseases (vaccinations
against tropical diseases, drugs to fight malaria, typhoid, and dengue fever,
starting with the Continental Army), psychological stresses, and environmental
forces such as high altitudes and extreme hot and cold temperatures (preventing
dehydration, altitude sickness). From the early strips of linen cloth or lint
packing and protecting wounds, modern bandages are hemostatic, helping wounds to
clot while protecting against infection.
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| Civil War Prosthesis Photo: Ileana Johnson, June 2014 |
After WWI,
rehab became part of military medicine. The primitive prostheses of mid-1800s were
replaced by bionic limbs that replicate the functioning of the lost limbs. Thirty
facial and skull reconstructions were documented during the Civil War such as
suturing the soft tissues of eyelids, nose, and mouth. Private Carleton Burgan
had his entire face reconstructed by Dr. Gurdon Buck in 1863 during a seven
month period at New York City’s Hospital. A gangrenous ulcer on his tongue
destroyed his upper mouth, palate, right check, and right eye.
Doctors
today at the 3-D Medical Applications Center at Walter Reed National Military
Medical Center in Bethesda, Maryland, create 250-400 3-D anatomical models and
custom implants annually.
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| WWII hygiene poster Photo: Ileana Johnson, June 2014 |
On a quick
trip to the bathroom before departure, I discovered four WWII posters produced
by the Army Medical Museum during its campaign to educate service members about
personal hygiene, STDs, and infectious diseases.
I left with
a sense of disappointment that had nothing to do with the museum. Although I
saw ample evidence of how well our servicemen are cared for on the battle field
and immediately afterwards in surgery and rehab, I know how inadequately
veterans are treated medically once they come home and retire, how rationed and
often substandard their care is.
Author’s Note: The data, photographs, and quotes used
in this article can be found in the National Museum of Health and Medicine in
Silver Springs, Maryland.
© Dr. Ileana
Johnson Paugh
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