The Government Hospital for the Insane (St. Elizabeths) had been in operation about a decade when the Civil War began. Wounded soldiers were treated there, and in January, 1863, the surgeon-general of the U.S. army requested that a separate room be set aside “for the convenience of one of the manufacturers of artificial legs.” A soldier who had lost a limb through amputation could then be easily and conveniently fitted for an artificial limb. Soldiers from close-by hospitals could request a transfer to St. Elizabeths when their wounds healed, for an artificial limb-fitting.
The government hospital expanded greatly over the next two decades, and was a leader in the scientific treatment of its patients. Dr. I.W. Blackburn, its first special pathologist, was one of the first in the country assigned to a hospital. St. Elizabeths was also one of the first hospitals to use hydrotherapy to treat the insane. Dr. G.W. Foster began using this therapy around 1893, mainly in the form of cold packs to the head. The hospital purchased a complete hydrotherapeutic outfit in fiscal year 1897-1898.
A school of nursing instruction began in 1894, and became more formalized around 1899, when it was reorganized and expanded. The school began giving certificates after a two-year course, along with a promotion and raise in pay for graduates.