The uniqueness is partly a function of the historical conditions of women’s military service: women were excluded from combat roles through most of American military history, and the Medal of Honor has primarily been awarded for combat valor since the 1917 standards revision. A woman could not perform the acts for which the medal was most commonly awarded because women were not allowed to be in the situations where those acts occurred.
Walker’s award predated those restrictions. It was given in 1865 under standards that recognized sustained service and endurance as well as battlefield valor, to a woman who had served as a physician in the Army of the Cumberland during some of the bloodiest campaigns of the war. The fact that the award was later rescinded and later restored, and that the restored award remains the only one in the category, is part of the specific history of how the medal’s standards evolved and who was excluded from military service and therefore from military recognition.
## The Syracuse Medical College and the Question of “First”
Walker is sometimes described as the first female surgeon in the U.S. Army, which requires some precision.
Elizabeth Blackwell was the first woman to receive a medical degree from an American institution, in 1849. Walker graduated from Syracuse Medical College in 1855. Walker’s appointment as a “Contract Acting Assistant Surgeon (civilian)” in September 1863 gave her a formal contract for military medical service — making her, in that specific sense, the first woman to hold a formal Army medical contract.