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The number of soldiers who died from sickness, disease and infection was higher than the number of battlefield deaths in the Civil War (1861-1865). A doctor who lived to see the medical changes of the 20th century remembered the primitive state of army medicine in the 1860s. "We operated in old blood-stained and often pus-stained coats...we used undisinfected instruments...we knew nothing about antiseptics and therefore used none." The courage and strength of Union and Confederate soldiers began on the battlefield and continued in the hospitals. Menander Patrick of Massachusetts brought this medicine cup home from the South, a reminder perhaps of friends who never returned.