Surgical Pathology in the Era of the Civil War: The Remarkable Life and Accomplishments of Joseph Janvier Woodward, MD

Archives of Pathology & Laboratory Medicine, Oct 2005 by Rapkiewicz, Amy V, Hawk, Alan, Noe, Adrienne, Berman, David M

Joseph Janvier Woodward was an assistant surgeon in the US Army during the Civil War, coauthored the definitive works on the mortality and morbidity of that war, attended at the autopsy of President Lincoln, and attended President Garfield after he was shot. He revolutionized the field of photomicroscopy and was one of the first pathologists to use aniline dyes as tissue stains. Yet despite the occasional biographical sketch every few decades, he is largely unknown today. Herein, we review his contributions to surgical pathology and medicine and present modern-day photomicrographs of 140-year-old slides from Woodward's original collection.

(Arch Pathol Lab Med. 2005;129:1313-1316)

James Janvier Woodward (1833-1884) was born in Philadelphia, Pa, where he remained for medical school at the University of Pennsylvania (1853).

He was the published author of several papers related to microscopic studies and a founding member of the Pathological Society of Philadelphia in 1857. ' Following the outbreak of the Civil War, Woodward (Figure 1) volunteered for the US Army. Initially, he served as an assistant surgeon and brevet major, participating in several battles, including the first Battle at Bull Run.2 In June 1862, Woodward was assigned to the Office of the Surgeon General to prepare the medical section of the Medical and Surgical History of the War of the Rebellion (MSHWR). His duties included acquiring gross pathologic specimens to document medical conditions suffered by American soldiers along with the case history. Two years later, he was given control of the Medical and Microscopical sections of the Army Medical Museum (currently the Armed Forces Institute of Pathology) and the Office of the Surgeon General Records and Pension Division, where he remained for the rest of his career.1,3 In addition to collecting specimens for the museum's archive, he coauthored the definitive medical history of the Civil War in the 6-volume 1870 publication of the MSHWR.4 Woodward's technique using aniline dyes for staining thin sections of tissue, along with his pioneering work in photomicroscopy, helped prepare the groundwork for modern surgical pathology.3,5

THE MEDICAL AND SURGICAL HISTORY OF THE WAROFTHE REBELLION

More Americans (Confederate and Union) died in the Civil War than any other conflict in American history. Following the end of hostilities, Woodward was commissioned to coauthor the medical section of the MSHWR. This work is acknowledged to be the first major academic medical accomplishment in the United States.6 In the medical section of the MSHWR, Woodward's meticulous insight and attention to detail are evident in the description, organization, and tabulation of diseases found in soldiers of the Civil War.7 The monthly records of sickness and mortality submitted by more than 200 hospitals and the medical directors of 8 armies were painstakingly compiled, and the troops were stratified based on active versus volunteer, "colored" versus white, officers versus enlisted men, and American versus foreign born. The total number of Union deaths from the commencement to the close of the Civil War was tabulated at 304369, with 186216 deaths resulting from disease and the remainder from trauma and other causes.4

"Camp diarrhea," dysentery, and "camp fevers" are listed as the most frequent causes of nontraumatic death; they resulted from overcrowding, poor hygiene, and malnutrition. Woodward noted the severity in the MSHWR, commenting: "These disorders occurred with more frequency and produced more sickness and mortality than any other form of disease. .. . Soon no army could move without leaving behind it a host of victims." In fact, the adage that a soldier needed "guts" arose during this era.6-8 For example, in 1862, the "monthly mortality from diarrhea and dysentery among the white troops" reached its maximum of 128 per 1000 soldiers during July, which correlated with General George McClellan's disastrous Peninsula Campaign. By the end of the war, Woodward observed, 1 soldier died for every 30 cases of acute diarrhea or dysentery. In unusually clear and explicit writing for the era, Woodward details the effect of region and season on the cases of dysentery, microscopic analysis of the stools, postmortem gross and microscopic appearance of the bowel, treatment of the condition, and known associated complications. These gross and microscopic descriptions and pictures were intended to remove independentobserver variability and create images that could be reproduced and studied for future reference comparison and diagnostic purposes. It was hoped that the accurate descriptions would facilitate etiologic subclassification of the various types of gastrointestinal diseases and lead to a better understanding of prevention and treatment.

WOODWARD AND PHOTOMICROSCOPY

A major strength of the MSHWR is the inclusion of photomicrographs of histologie specimens. To accomplish this, Woodward needed to first develop new histologie and photomicroscopic techniques. In contrast to modernday pathologists, Woodward cut the tissue and mounted his own slides. Woodward and Dr Edward Curtis used a straight razor or small knife9 to manually cut histologie sections (Figure 2) from frozen tissue mounted on the microtome, which served as a guide to ensure thin sections. The tissue was then immobilized in either cork or wax and the tissue section mounted onto a glass slide using gum, glycerin, Venetian turpentine, and/or Canada balsam. The latter medium was preferred because it had a good refractive index (1.524) and adhesive qualities.