When the Brecksville-Broadview Heights High School gymnastics team competes in the Ohio High School Athletic Association state gymnastics meet, they’re expected to win. That’s because they’ve won each year—since 2004. And as the streak builds, there’s more pressure each year on the public school’s team to continue that tradition. No year was more tense than the year that they were hoping to take home their 20th straight title.

The Civil War was a watershed in public awareness of the many health-related issues soldiers faced while living in camps. Sanitarians among civilians and regular army officers attempted to meet those challenges by addressing a range of topics associated with preventive healthcare in the volunteer army. The US Sanitary Commission, a nongovernmental agency sanctioned by the Federal government, created a massive campaign to study conditions in semipermanent camps and advise unit commanders how to avoid unnecessary illness and curb soldier deaths by disease. Commission inspectors, mostly civilian physicians, examined camps from 1861 to early 1864 and filed more than 1,400 reports of their findings.