Armed Forces Institute of Pathology: Its First Century 1862-1962/Chapter V

by Robert S. Henry

CHAPTER V

An Ending and A Beginning

Shortly after the new building was occupied, in 1888, the sixth and final "part," comprising the two "volumes" of the monumental "Medical and Surgical History of the War of the Rebellion," was published. From its inception this project had been, in all but name, an integral part of the Museum operation. The first Curator of the Museum, Dr. John H. Brinton, had been the first editor of the Surgical volume, and he was succeeded in the editorship by Dr. George A. Otis, the second Curator, who brought out part I of that volume in 1870 and part II in 1876, leaving part III to be brought out by still another Curator, Dr. David L. Huntington, in 1883. The first and second parts of the Medical volume were edited by Dr. Joseph Janvier Woodward, coming out in 1870 and 1879, respectively, and the third and concluding part was edited by Dr. Charles Smart, the Army surgeon detailed to complete the History.

Each of the six "parts" is a massive volume in itself, averaging nearly 1,000 quarto pages of text, with an average of some 40 full-page plates, many in color, plus scores of black-and-white woodcuts. The volumes contain the reports of thousands of medical and surgical cases, usually in the words of the doctors who treated the wounds or diseases. In view of at least one unfriendly critic, indeed, the work was a "mere compilation of other people's writings," l but it is far more than that. The History contains an orderly arrangement and presentation of vital statistics, while the body of the text summarizes, analyzes, and comments on the specific cases in the light of the best medical literature and thought of the times in which it was published. Thus, Dr. Woodward's skepticism as to the bacterial origin of disease, expressed in the volume issued in 1879, was replaced with a more tolerant view by Dr. Smart in the 1888 volume. He was not yet ready to admit that the "causal relationship of a micro-organism to the disease" of typhoid fever had "been established" but he discussed at some length the researches supporting that view and concluded, "Although the typhoid germ

1 Sunday Herald, Washington, 1 April 1883. has not been recognized its existence is generally allowed, and many of the conditions needful to its development have been demonstrated." 2^[1]

All in all, the History merited the high praise which it received, even from such an outstanding and keenly critical authority as the great Rudolf Virchow, who wrote:

Whoever takes up and reads the extensive publications of the American medical staff will be constantly astonished at the wealth of experience therein found. The greatest exactness in detail, careful statistics even in the smallest matters, and a scholarly statement embracing all sides of medical experience are here united, in order to preserve and transmit to contemporaries and posterity in the greatest possible completeness, the knowledge purchased at so vast an expense. 3^[2]

The Museum and the Army Medical School

With the completion of the Medical and Surgical History (fig. 35), there ended the last major link tying the Museum to its Civil War origins. True, the majority of its specimens were the result of Civil War wounds and sickness, and the interest in Civil War specimens persisted, but there was the strong infusion of more recent and different pathological material and, more importantly, there was the new direction of thinking typified in the launching of the Army Medical School.

The idea of a medical school for Army personnel had been put forward as early as 1862, first informally by Brinton and his associates, and later by Surgeon General William A. Hammond in his report of 10 November to the Secretary of War, in which he recommended "an army medical school, in which medical cadets and others seeking admission into the corps, could receive such special instructions as would better fit them for commissions, and which they cannot obtain in the ordinary medical schools * * *". 4^[3]

Like so many other of the excellent recommendations in this report, nearly all of which were ultimately adopted, the idea was rejected at first, to remain dormant for over 30 years until, in 1893, President Grover Cleveland appointed Lt. Col. George Miller Sternberg (fig. 36) to succeed Charles Sutherland as

Figure 35.—A. Medical and Surgical History of the War of the Rebellion. B. A page from the History.

Figure 36.—Brig. Gen. George M. Sternberg, The Surgeon General of the Army for 9 years, 1893-1902, turned the thought of the Museum toward bacteriology.

The Surgeon General. The new Surgeon General was outstanding among American bacteriologists. Working independently, he had discovered the pneumococcus responsible for pneumonia in 1881, the same year in which, earlier, Louis Pasteur had described the same microorganism. In 1882, Sternberg had photographed for the first time the tubercle bacillus, discovered in the same year by Robert Koch. Ten years later, in 1892, he had published "A Manual of Bacteriology," the first American textbook on the subject. He came into the Office of the Surgeon General bearing the reputation of being the Army Medical Corps' first man in scientific attainment.

Within less than a month after taking office, the new Surgeon General secured authority of the War Department for the long-deferred Army Medical School set forth in General Orders No. 51, A.G.O., dated 24 June 1893. "By direction of the Secretary of War," the Orders read, "upon the recommendation of the Surgeon General of the Army, an Army Medical School will be established in the city of Washington for the purpose of instructing approved candi dates for admission to the Medical Corps of the Army in their duties as medical officers."

"The course of instruction will be for four months, and will be given annually at the Army Medical Museum, in Washington City, commencing on the 1st day of November."

As General Sternberg explained in his annual report for 1894, the new school, although affording "all the advantages that could be derived from one costing heavily for establishment and maintenance," would add nothing to the expense of the Army. Professors were selected from among the senior members of the corps stationed in or near the Capital, while the new Museum and Library building provided the necessary lecture rooms and "the accumulation of material for bacteriological and chemical study in the Army Medical Museum which furnished everything essential for laboratory work."

Walter Reed; Curator

The Museum, indeed, furnished more than laboratory facilities and class rooms, for one of the most useful members of the faculty of the school was the newly appointed Curator of the Museum, Capt. Walter Reed (fig. 37), soon to become Major Reed, who took over the office on 8 September. The appointment was, in a sense, symbolic of the lessening of emphasis on the Civil War as the dominant theme of the Museum's activities. Born in Virginia in 1851, of North Carolina lineage, he was the first Curator of the Museum who had not served in the Union Army during the Civil War, and the first officer of Confederate antecedents to become Curator, serving under Maj. John Shaw Billings who continued to hold the post of Director of both the Museum and the Library.

Both Major Billings and Captain Reed were members of the faculty of the Army Medical School at its first session — Major Billings as professor of military hygiene, including practical instruction in the examination of air, water, food, and clothing from a sanitary point of view, and Captain Reed as professor of clinical and sanitary microscopy and director of the pathological laboratory.

Other members of the faculty were: Col. Charles H. Alden, Deputy Surgeon General and president of the faculty, who lectured on the military duties of medical officers, including property responsibility, examination of recruits, certificates of disability, reports, rights and privileges, customs of the service, and like topics; Lt. Col. William H. Forwood, attending surgeon at the Soldiers' Home, who was professor of military surgery, including care and transportation of the wounded; and Capt. Julian M. Cabell, instructor in Hospital Corps drill.

In addition to the regular courses taught by the members of the faculty, there

Figure 37.—Maj. Walter Reed, fifth Curator of the Museum, 1893-1902.

were lectures on bacteriology by General Sternberg; on military law by Mai. G. B. Davis of the Judge Advocate's Office; on comparative anatomy by Capt. J. C. Merrill; on medical jurisprudence by Dr. Robert J. Fletcher of the Library; on parasites in man by Dr. C. W. Stiles of the Department of Agriculture; and on head surgery by Dr. W. W. Keen, professor of surgery at the Jefferson Medical College and one of the most active surgeons of the Union Army in the Civil War. 5^[4]

The first annual session of the school closed with appropriate exercises on 28 February 1894, attended by most of the officers of the War Department. The distinguished Prof. William Osier of the Johns Hopkins University addressed the graduating class of five assistant surgeons, as did Maj. Gen. John M. Schofield commanding the Army, briefly, and Colonel Alden more at length. The address of the President of the Faculty doubtless was directed more to the assembled spectators, which included ex-Surgeons General Hammond, Murray, and Sutherland, than it was to the graduating class. In his address, he outlined the many duties and responsibilities of the Army doctor which were outside the work of the physician and surgeon as ordinarily understood, and described the school's courses of study designed to fit the medical officer for these military duties. Referring to the work of the Department of Clinical and Sanitary Microscopy, the colonel said:

Perhaps it is proper to say here to our non-medical friends that the day when bacteria were a scientific curiosity and their study a pastime or fad has passed. The investigation of these microscopic organisms and their effects lies at the very foundation of modern medicine and surgery, and of advanced medical and surgical practice. In this direction lies today our strongest hope and brightest prospect of preventing and arresting disease.6^[5]

Thus there was launched, in quarters provided by the Army Medical Museum, and using facilities furnished by it, the school which was to grow and develop into the Medical Department Professional Service Schools in 1923 and, in 1947, into the Army Medical Department Research and Graduate School, with its own quarters and facilities in the Walter Reed Army Medical Center (fig. 38).

Problems With Space

Even before the inauguration of the School in the Museum quarters, and, in fact, within a year of the occupation of the new building, the old question of lack of space and overcrowding had already been raised. In his annual report for 1888-89, Surgeon General John Moore said :

The question of space for the better accommodation of the present holdings of the Museum and for the additions which experience shows are to be expected, is already ob

Figure 38.—Army Medical School laboratories, located in the Museum-Library building in the first decade of the 20th century. A. Bacteriological laboratory.

truding itself. Some special and valuable exhibits * * * already suffer from insufficient or unsuitable presentation * * *. In fact that is no avoiding the conclusion that the whole of the office rooms on the first floor * * * now occupied by the Record and Pension Division should pass into my control for the use of the growing Library and Museum for which the whole building was originally constructed * * *. I therefore earnestly recommend that provision be made elsewhere for the work of the Record and Pension Division of the War Department and that justice may be done to the intent for which this building was constructed.^[6]

In the report for the next fiscal year, 1889-90, the recommendation is repeated with equal earnestness, and a like lack of success in securing the use of the entire building for Library and Museum purposes. In support of his request, The Surgeon General said, erroneously, that the building had been erected at a cost of only one-half of the estimates, resulting in a reduction in its dimensions and facilities.

Figure 38.—Continued. B. Chemistry laboratory.

In the use of the building, unanticipated needs were encountered and had to be dealt with as part of the regular operation of the Museum. For example, on 28 August 1888, within a few months after occupation of the building, Dr. Billings found it necessary to ask for bids on the construction of a "cremating furnace," sufficiently powerful to consume the body of an animal of the size of a large Newfoundland dog without leaving obnoxious odors.^[7]

Another lack of the building was a dependable source of electricity for the light necessary to carry on continuously photomicrographic work without having to depend upon the vagaries of the weather, and also for lighting the Library hall on the "rare occasions when it is necessary to use this room at night." One such occasion was the anticipated opening of the Museum at night during the meeting of the American Medical Association, which was held in Washington in the first week of May 1891. In a letter of 14 April to The Surgeon General, Dr. Billings asked authority to purchase, for not more than $410, a dynamo to be driven by an 8-horsepower steam engine, already connected with the boilers, and urged action in time to have the lights working during the evenings when 1,500 members of the A.M.A. were expected to be in the city." 9^[8]

Special and specific authority had to be sought from the Office of the Surgeon General for items of far less consequence than the dynamo needed to replace one which had been borrowed from the National Museum and had been recalled by its owner. "I have the honor to state that the following articles are required for use at the Army Medical Museum and request authority to buy them as emergency purchases to be paid for from the Museum appropriation: 5 gallons of Benzine, Estimated cost, $.75" read a typical formal letter of the sort, duly signed by "Your obedient servant, John S. Billings, Major and Surgeon, U.S. Army, Curator Army Medical Museum." Other such letters request authority to purchase items as minute as 30 cents' worth of flour, 10 cents' worth of resin, and a half a dozen washers for a dime. 10^[9]

The degree of financial stringency involved in operating the Museum on an annual appropriation of $5,000— and that not always forthcoming without a struggle— is indicated by a letter of 30 December 1890 from Major Billings to M. Jules Talrich, Officier de l'lnstruction Publique in Paris, from whom Billings had purchased some anatomical models during a visit to Paris, and who had offered others for sale.

I greatly appreciate your kind offer to let me have the two figures: "Une premiere attaque d'hysterie chez une jeune femme de la race caucasique" and "une jeunne fille de Zouzouland," for the sum of $4,000.00 but the means at my disposal will not allow me to purchase them. The yearly appropriation made by Congress for this Museum is very small, and after reserving the amount absolutely necessary for the current expenses of this Institution, there remains less than a thousand dollars available for the acquisition of new preparations and specimens. 11^[10]

The Prime Source of Specimens

How nearly complete was the reliance placed on contributions for specimens is shown by the pamphlet catalog of the Museum's portion of the Army Medical Department's exhibit at the World's Columbian Exposition in Chicago in 1892-93. 12^[11] In its "Description of Selected Specimens," the pamphlet lists 82 medical and surgical specimens, contributed by 60 physicians and surgeons, with only three specimens identified as having been purchased.

In a foreword to the pamphlet, Dr. Billings described the purposes and collections of the Museum. Its primary object was, he said, to illustrate wounds and diseases of armies as a "step in the study of the best means of diminishing disease and mortality among soldiers," but it had soon been found necessary to extend the scope of the collection to include all forms of injuries and diseases, and also to form collections of means of transportation of the sick and wounded, of surgical instruments, and of instruments for diagnosis and research, including microscopes.

The Museum had, in 1892, a total of 29,486 specimens, including 3,439 of normal anatomy, 1,717 of comparative anatomy, 10,746 in the pathological section, 12,270 in the microscopical section, and 1,584 instruments and pieces of apparatus.

"Large as these numbers may appear," he said, "there yet remain many gaps in each series * * *." And since Congressional appropriations left little margin for the acquisition of additional specimens, The Surgeon General appealed to all medical men to "aid, by contribution of specimens, an institution which is already of great value and interest, having an enviable reputation both in Europe and in this country, and which, it is believed, is destined to be of great importance in the advancement of medical science." Increasingly, he added, contributions were being received from practitioners in civil life, as the "facilities afforded by the Museum for the permanent preservation of pathological specimens, and of the records connected with them, are more and more appreciated" — a trend which Billings sought to strengthen by his earnest appeals for cooperation from all medical men, civilian as well as military.

The appeal for civilian cooperation was not a one-sided seeking of help without corresponding mutual benefits, for it had long been the settled policy and practice to open the facilities and collections of the Museum to qualified investigators and students — a policy which was made explicit by the passage of a joint resolution of the Congress, approved 12 April 1892, declaring it to be the policy of the Government to make available to students the facilities of the Army Medical Museum and other scientific and literary institutions in the Nation's Capital, as a measure for the promotion of research and the diffusion of knowledge. 13^[12] While this action was in the nature of a ratification of existing policies and practices, it constituted congressional recognition of the scientific character of the Museum. Recognition of the character of the institution by others was abundantly forthcoming. Thus, Dr. Henry W. Bettmann, Curator of the Cincinnati Hospital, wrote the Curator of the Army Medical Museum on 13 July 1895, seeking information as to the literature dealing with the best methods of preserving and mounting anatomical and pathological material, or a detailed account of the "methods employed in your own famous collections." Dr. Billings, who replied on 20 July, observed that the literature on the subject was "very limited, consisting principally of isolated hints scattered in various medical publications," but gave, in a nine-page memorandum, a "general summary" of the methods employed at the Museum which "after many futile experiments, have to some extent proved successful." 14^[13]

The memorandum describes the steps in the process of cleaning, degreasing, and mounting bones showing disease or injury, and in even greater detail the processes of preparing wet specimens, preserved in ethyl alcohol or formalin. Special precautions were taken with specimens intended for microscopic or bacteriological work. For the latter, tissues were kept apart, handled as little as possible and with every care to prevent access of foreign bacteria.

Bacteriology and Roentgen Rays at the Museum

With George Sternberg as Surgeon General and Walter Reed as Curator, bacteriology was bound to expand in importance in the world of the Museum, but the main emphasis of the laboratory work, if we may judge by the correspondence files of the period, continued to lie in the pathological examination of specimens sent in from Army posts and Indian agencies. Indeed, when the Health Officer of the District of Columbia asked Major Reed if he could conveniently make bacteriological examinations of specimens of water from public wells of which the health officer was suspicious, Major Reed was compelled to reply that "with every desire to assist" it would be impossible to "give you at present any material assistance," his own time and that of his assistants being "so completely taken up with the routine Museum work." 15^[14]

Routine work of the Museum did not, however, keep Major Reed from taking a keen interest in medical developments. For instance, Wilhelm Roentgen's discovery of X-rays was announced to the world on 6 January 1896. Within 3 months, Reed had applied to The Surgeon General for authority to obtain apparatus for the purpose of experimenting with the new rays, and had been turned down on the ground that it was "not probable that any experiments you would find time to make would add anything of importance to our knowledge of these rays and their practical application in medicine * * *. Later, when the exact practical value of photography by these rays has been determined, we may want the necessary apparatus in order to assist in the diagnosis of cases occurring in the District, to which the new method may be applicable." 16^[15]

That the Museum got its apparatus within 3 months after being turned down, is indicated by a letter of Dr. Joseph S. Wall of Washington, in which he describes an early clinical use of the X-ray. On 10 June 1896, as Dr. Wall recalls, and as the admission records of the Garfield Hospital showed, "a girl of seventeen was admitted to the hospital because of a .22 calibre penetrating gunshot wound of the hip, accidentally inflicted by her brother." It became the duty of Dr. Wall, as a young "externe" of the hospital, "to accompany the patient in a horse-drawn ambulance to the Army Medical Museum to obtain the services of Dr. William Gray," who had been engaged in microscopic and bacteriologic work for the Museum since 1884, and who, Dr. Wall said, had the only Roentgen tube in Washington at that early date (fig. 39). "After the orderly-driver and myself had struggled up four flights of stairs to Dr. Gray's laboratory," he continued, "carrying a rather plump young lady on the stretcher, she was exposed to the X-ray for a period of one hour in order to secure a picture showing the location of the bullet." A satisfactory plate was secured, "even though the tube was activated by a kind of static grindstone," the girl was taken back to the hospital, and the bullet was successfully extracted. 17^[16]

Services of Dr. Billings

Midway in the closing decade of the 19th century, in 1895, Dr. John Shaw Billings retired from the Army, after 34 years of service, of which 30 years had been spent in building up the Library, with 12 years of concurrent service to the Museum. Dr. Billings, a mighty man of medicine, went on to a postretirement career of rare distinction. From the University of Pennsylvania, where he occupied a chair in the medical school for a year after retirement from the

Figure 39.—Early X-ray apparatus at the Medical Museum. A. Roentgen ray tube. B. Static electric apparatus.

Army, he was called to New York where he worked out the consolidation of the Astor, the Lenox, and the Tilden Libraries to form the great New York Public Library, of which he became the first director, heading not only the main library, housed in a building erected in accordance with his ideas, but also the whole library system with some 80 branches in Greater New York. 18^[17]

Among Dr. Billings' last official services to the Museum was his initiation of a movement to have the dental profession adopt the Museum as a repository for study materials in the field of dentistry (fig. 40), "just as other sections of the Museum and Library are considered to be their national collections by the physicians, surgeons, and specialists of the country," as Dr. Billings wrote Dr. Williams Donnally, D.D.S., of Washington, on 10 December 1894. The suggestion bore fruit when, in 1895, the American Dental Association accepted the suggestion when offered by Dr. Donnally. This action, the first such formal acceptance of the Museum as a national repository, may be regarded as a step toward the system of national registries of pathological materials and case histories of the various specialized medical groups which is such an important factor of today's Armed Forces Institute of Pathology. 19^[18]

Animal Experimentation at the Museum

Upon the retirement of Lieutenant Colonel Billings, Col. David L. Huntington, Deputy Surgeon General, was placed in charge of the Museum and Library Division, with Major Reed continuing as Curator of the Museum. As Curator, he was called upon to deal with charges of unnecessary cruelty to animals, said to have taken place in the Museum some years earlier. These charges were contained in a letter from Dr. L. E. Rauterberg to the Senate Committee on the District of Columbia, in connection with an investigation of the practice of vivisection in the District. Dr. Rauterberg wrote :

It was my lot for a number of years to be engaged in the Microscopical Division of the Army Medical Museum, and I saw practiced the most inhuman and barbarous mutilations of the dumb animal, under the supervision and with the sanction of the United States officers in charge. A desired part or section of the animal would be removed, not under anesthesia, and the poor beast would be then placed back in its cage or vessel until it suited

the convenience of the operator to help himself to another portion, so long as the animal

Figure 40.—Changes in the concepts of dentistry since the time when this type of equipment was familiar have been quite as profound as the change in the equipment and instruments used.

would survive these tortures. I have thus seen animals with eyes, section of brain and other parts removed, and kept in reserve for future experiments for a number of days, and all for the verification and repetition of results obtained and published years ago.

Since the practices alleged were ascribed to a time before he became Curator, Dr. Reed asked Dr. J. C. McConnell, who had been connected with the Museum from about 1870 to the end of 1895, about the truth of the charges. Dr. McConnell replied on 8 June 1896, "That a very wonderfully distorted, inaccurate and false description has been given of work conducted at the Army Medical Museum some twenty years ago." He continued :

Those who were practically engaged in the Microscopical Division should know better than anyone else the character of the work that was performed, and that all animals experimented upon were under the influence of an anesthetic. One who was not in any manner connected with the Microscopical Division of the Museum, as was the case with Dr. L. E. Rauterberg, could draw upon his imagination very satisfactorily, and write a vivid description of what might have been done with animals, the remains of which he saw under alcohol in specimen jars. I, however, testify that at no time during my connection with the Army Medical Museum, from about 1870 to the end of the year 1895, have any experiments been performed upon animals in which an anesthetic was not used, unless some of the ordinary inoculation experiments, which are practically painless, nor were animals kept in a mutilated condition. 20^[19]

Dr. Reed did not appear before the Senate Committee, that function being performed for the Army by General Sternberg, who vigorously opposed passage of the bill which, in the opinion of most doctors, would have so restricted animal experimentation as to have the practical effect of prohibiting the use of this avenue to increased medical knowledge. Dr. Reed did, however, appear in opposition to the bill at a preliminary hearing before the commissioners of the District of Columbia, as is mentioned in an account in die Washington Post of 10 February, and reproduced in the transcript of the Senate Committee hearings.

The Spanish- American War

The major military event of the nineties, the war with Spain, seemed at first to have passed the Museum by. Col. Dallas Bache, who had been appointed Director of the Museum and Library Division on 31 January 1898, as the war clouds were thickening, made a report to Surgeon General Sternberg on 17 October, after the brief war had been fought and won, in which he said:

The contributions to this Museum from the active theatre of the recent war with Spain and from the extensive field of subsidiary operations, have been so few and unimportant that it seems desirable to renew the attention of Medical Officers to this important subject. The hurry and peculiar military conditions of the Santiago campaign, and the amount of work imposed upon Medical Officers in our large camps of instruction would naturally obscure the more remote interests of the Museum; but from our large General Hospitals and Hospital Ships, and the more deliberate methods of our forces of occupation may well be demanded a return to the systematic collection of specimens illustrating the bone and tissue injuries produced by modern firearms and explosives, and a careful preservation of such illustrations of disease as may be obtained upon cadaveric examination.

Colonel Bache's observations, with accompanying renewed directions as to methods of preparation and preservation of specimens and their delivery to the Museum, were published to the Medical Corps in the Surgeon General's Circular No. 10, 20 October 1898; 21^[20] with what response does not appear. But the Spanish-American War, with its record of nearly seven times as many deaths from disease as from enemy bullets, with more than half the deaths from disease from one cause, typhoid fever, and with the specter of yellow fever lurking in the background, sounded a challenge to the best brains and the most devoted dedication to medical advancement.

The history of the Spanish-American War was, in a way, a repetition of that of the Civil War, in that a Medical Department, barely adequate for peacetime and actually forbidden by law to store up reserve supplies, was suddenly called upon to care for a tenfold increase in army numbers. Moreover, General Sternberg had been denied his request for allotment of a reasonable share of the emergency funds voted for defense purposes before the start of actual hostilities, and so was not permitted to anticipate his increased needs before the flood of raw volunteer troops fell upon his slender medical resources.

Typhoid soon became epidemic in nearly nine out of ten of the new regiments, and about one soldier in five contracted the disease. The reasons asscribed for these epidemics were numerous but, in the language of Col. P. M. Ashburn, "fundamentally they are one, ignorance." 22^[21] To the task of dispelling the prevailing ignorance of the transmission of typhoid, and the equally unknown method of transmission of yellow fever, and so to make a beginning in the control of two of the major diseases of man, the Army Medical Museum was called.

1. 2 Medical and Surgical History of the War of the Rebellion. Medical History. Washington: Government Printing Office, 1888, pt. III, vol. I, pp. 492, 493.
2. 3 Hume, Edgar Erskine: Victories of Army Medicine: Scientific Accomplishments of the Medical Department of the United States Army. Philadelphia: J. B. Lippincott Co., 1943, pp. 152, 154, quoting, Morgan, William Gerry: Contributions of the Medical Department of the United States Army to the Advancement of Knowledge (With Particular Reference to Fields Not Directly Connected with the Practice of Military Medicine). The Military Surgeon 66: 779-790, June 1930.
3. 4 Annual Report of the Surgeon General, U.S. Army, 10 November 1862.
4. 5 Ashburn, P. M.: A History of the Medical Department of the United States Army, Boston: Houghton Mifflin Co., 1929, pp. 149, 150.
5. 6 (1) Army Medical School: Closing Exercises of the First Session. Journal of the American Medical Association 22: 352-354, 10 March 1894. (2) Ashburn, op. cit., pp. 149, 150.
6. Lamb, Dr. D. S.: A History of the Army Medical Museum, 1862-1917, compiled from the Official Records. Mimeographed copy in historical records of AFIP, pp. 103, 104.
7. Circular Letter, J. S. Billings. On file in historical records of AFIP.
8. 9 Letter Book, J. S. Billings, October 1890 to June 1891, pp. 360, 361. On file in historical records of AFIP.
9. 10 Ibid., pp. 33, 200.
10. 11 Ibid., p. 70.
11. 12 Pamphlet catalog, World's Columbian Exposition, Chicago, 1892-93. On file in historical records AFIP.
12. 13 27 U.S. Statutes 395.
13. 14 In correspondence files, AFIP.
14. 15 In correspondence files, AFIP, 30 January and 1 February 1895.
15. 16 (1) Castiglioni, Arturo: A History of Medicine. Translated from the Italian and edited by E. B. Krumbhaar, 2d ed. New York: Alfred A. Knopf, Inc., 1947, p. 1065. (2) Letter, George Sternberg to Walter Reed, 6 March 1896.
16. 17 Letter, Dr. Joseph S. Wall to R. A. Sloan, Army Medical Museum, 13 January 1950. From a story in the Washington Times Herald, 6 October 1954, it appears that there was an earlier use of the X-ray, in the District of Columbia, to locate a bullet accidentally fired into the hand of Carl A. Loeffler, as reported in the Washington Post, 24 April 1896.
17. 18 Who Was Who in America, 1943 edition, "Billings, John Shaw."
18. 19 Lamb, op. cit., pp. 109-111. The invitation extended by Dr. Billings through Dr. Donnally was published in Dental Cosmos, June 1895, p. 519- Dr. Donnally's eloquent and persuasive presentation of the reasons for acceptance of the invitation appears in the Transactions of the American Dental Association, 1895, pp. 134-I49.
19. 20 Senate Report 1049, to accompany S. 1552, 54th Congress. 1st session, 26 May 1896.
20. 21 (1) Lamb, op. cit., pp. 112, 113. (2) Lamb, D. S.: Army Medical Museum, Washington, D.C. The Military Surgeon 53: 131, 132, August 1923.
21. 22 (1) War Department Records, Office of the Surgeon General. On file in National Archives. (2) Ashburn, op. cit., p. 169.