The Medal of Honor is the highest decoration for gallantry in the United States and the oldest official American medal that is still awarded. Instituted in 1861-1862, the Medal of Honor was first awarded in March 1863 at the height of the Civil War. Second in distinction are the Distinguished Service Cross of the U.S. Army, the Navy Cross, and the Air Cross. Gallantry awards also include the Purple Heart, first instituted by George Washington in 1782 and re-instituted by Congress in 1932, the Silver and Bronze Stars, and the Distinguished Service Medal. The United States issues "ribbon bars," which bear the same pattern as the ribbons worn with campaign medals and other decorations. Actual medals are worn only on extraordinary state occasions.