Preparation of Cases from Medical and Surgical History of the War of the Rebellion

Since late May of 2011, I have reviewed case reports found in The Medical and Surgical History of the War of the Rebellion (1861-65.) that involved care within the immediate DC area, including Washington, Georgetown, and Alexandria, Virginia, to further prepare them for presentation as text documents on Civil War Washington.  The Medical and Surgical History of the War of the Rebellion (MSHWR) is a multi-volume report and assessment of the medical and surgical care provided during the war to the Union army, as well as to a small number of Confederate soldiers.  The history was mandated by Congress and was prepared under the direction of Dr. Joseph K. Barnes, Surgeon General of the United States Army at the end of the war and in the post-war years.  Volumes were published between 1870 and 1879 by the Government Printing Office in Washington.  My review and preparation of the cases includes final corrections of any errors left from the OCR scanning process, completing all necessary XML tags, and determining and inserting the appropriate keywords for each case.      

So far, the reviewed cases have come from Part 1, Volume 2 (surgical-injury cases) and from Part 3, Volume 1 (cases of medical diseases) of the MSHWR.  The reported medical conditions, or “camp diseases,” are varied, of course, but there are a great number of cases of just a few diseases — typhoid fever (the most common of the “continued fevers”), tuberculosis (a.k.a. “consumption” or, even more commonly, “phthisis pulmonales”), malaria (“paroxysmal fever” or “remittent fever”), and “diarrhoea and dysentery,” the latter often concurrent with or complicating other conditions — plus presumed “rheumatic diseases” (actually rather ill-defined), a variety of heart conditions (both anatomic and functional), small-pox, measles, scarlet fever, and other infections of the lungs, soft tissues, and central nervous system.  Many case reports of patient deaths also include records of post-mortem examinations, some of the descriptions quite detailed and insightful (and comparable to autopsy reports today), while many others are more cursory (after all, there was a war on).

The surgical cases that have been reviewed so far involve wounds and injuries of the head, face, neck, chest, and spine. These include incised and punctured wounds by sabre, sword, or bayonet; railroad accidents; falls from trees and off of horses; kicks by horses and mules; and (naturally) gunshot wounds that fractured bones, penetrated organs, and created significant hemorrhage.  The cases describe surgical techniques for removing gunshot missiles and debriding bone fragments from the wounds, for relieving increased pressure within the cranium, for removing herniated soft tissues, and for arresting hemorrhage.  The most commonly reported complications of traumatic cranial injuries were infection of the wound, including gangrene or tetanus; meningitis or encephalitis; recurring hemorrhage; paraplegia or hemiplegia; and complete or partial loss of the special senses of sight, hearing, or smell.  The same complications occurred with facial injuries, but also particularly common was the destruction of one eye, soon followed by decompensation of the vision in the other eye.  Spinal injuries and fractures often produced quadriplegia, paraplegia, or hemiplegia.  Frequent chest wound complications were hemorrhage from the major blood vessels located there, pneumothorax (lungs perforated and deflated by the missile itself or by sharp fragments of fractured ribs), pneumonia, inflammation and scarring of pleural membranes, and pyemia.  In fact, all types of penetrating soft tissue injuries also were very prone to secondary pyemia (now known to be disseminated, usually blood-borne, bacterial infections).

The reviewing process continues now and will eventually include cases of injuries, surgical problems, and operations of all the other parts of the body.  The only remaining cases of medical disease to be reviewed are all found in Part 2, Volume 1 of MSHWR — the final volume published and dedicated entirely to cases, statistics, epidemiology, and therapeutics of acute and chronic “diarrhoea and dysentery,” also called “the Alvine Fluxes,” across the temporal length and geographic breadth of the Civil War.  “These disorders occurred with more frequency and produced more sickness and mortality than any other form of disease,” wrote Dr. Joseph J. Woodward, the editor of that volume.[1]

In the immediate future the additional surgical-injury cases will include abdominal injuries, injuries of the pelvic area, and all injuries of the four extremities.  The case reports of the latter injuries include many more reports of diverse types of surgical interventions than have been reported for the injuries reviewed previously.

As I review the cases, I am also collecting on my own an already long list of medical and therapeutic terms that are much less familiar to health care providers today and easily could be unknown to those less experienced in reading about medicine in the 19^th century.  I hope to develop a glossary — and perhaps even a mid-19^th century pharmacopeia — for users of the web site.                                                                                                                                                                                                                                                                                                                                                             – Matthew M. Bosley

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[1] Joseph J. Woodward in The Medical and Surgical History of the War of the Rebellion (1861-65.), Part 2, Volume 1, prepared under direction of Joseph K. Barnes, Surgeon General, United States Army (Washington, D.C.: Government Printing Office, 1879), 1.

Coming in the Spring . . . .

As the fall semester winds down and we approach the winter break, we are looking ahead to what the spring semester holds in store for Civil War Washington. For the first time since being awarded our NEH Collaborative Research Grant in 2010, we will be making significant new content available on our project website, following on hundreds of hours of behind-the-scenes work. We are excited to make this new content available to the public, and users will also benefit from increased functionality of our site.

Screenshot of new project map (in progress), showing currently mapped point and line layers, as well as voting wards.

In the near future, we will launch an expanded and improved Map section. Featuring nearly twenty layers of mapped features and two historical base maps, the revamped project GIS will allow users to select layers, study changes over time, and locate addresses. In addition, the interface enables users to draw on the maps, measure distances, and print customized maps.

The Data section of Civil War Washington will soon look remarkably different as well. Users will have direct access to the newly designed project relational database, with more than 3,000 records of people and nearly 400 places, in addition to hundreds of records for events, organizations, and documents (see below for sample image). The database also documents relationships across the full range of categories, so that an object of one type can be linked to an object of any other type.

The public interface to the project database will look very similar to the private interface (shown here). Users will have the ability to search the database, trace relationships, and move between database records and other content on the site.

The first half of 2012 should also see hundreds of new texts added to the site, including encoded transcriptions of the petitions for compensated emancipation. We are also taking a different approach to presenting cases from the Medical and Surgical History of the War of the Rebellion, and we will begin presenting the cases in their new format soon. Each case will be presented individually, with easy access to other cases that treat the same kinds of diseases and wounds. Along with an HTML view of each case and petition rendered in the browser, we will make available the TEI-encoded XML for individual documents. In addition, users will be able to download corpus files that include the XML of all cases and all petitions. Indeed, throughout the site, users will have access to our presentation of the material and to the files from which our website is generated, including a complete dump of all data from our relational database and project GIS files made available as both shapefiles and KML.

Look for other changes and additions to the site in 2012 as well. If you have comments or suggestions for Civil War Washington, please send them to us.

~Elizabeth Lorang

A Landmark Event

The District Emancipation Act was a landmark event for many reasons, but it was never about equality for African Americans or even focused primarily on their freedom. Emancipation was meant to facilitate the “ultimate” destruction of slavery, but more immediately and importantly at the time the destruction of the South.[i] In the midst of the Civil War, either slavery or the nation would die, and the DC Act was a way to save the nation.[ii][iii] A compromise would not bring peace, and the government’s current policy of tolerating the continued existence of slavery was prolonging the war.[iv] The conditions embodied in the District Emancipation Act, Frederick Douglass argued, would also protract the war.[v]

Many Americans believed that emancipation would hurt blacks because they were not ready for, nor capable of, freedom. However, Chaplain C. W. Denison often wrote to The National Republican from various refugee camps about just how capable “contrabands” were proving to be. Whether at Fortress Monroe or in South Carolina or elsewhere, he saw contrabands eager to learn and improve their condition. They were more than willing to work hard in the fields to earn their living.[vi] Contrabands, especially adults, attended classes diligently to learn to read and write. The Chaplain wrote that rumors of contrabands being lazy and uneducated were only true when Union Generals would not employ them or only put them to work as servants.[vii] Denison argued that if fairly treated and paid, contrabands had a great advantage because they were willing to work hard to maintain their freedom, which many army officers would attest to.[viii] Denison also vehemently insisted that “negroes [could] do other things to promote the Constitution and liberty besides work,” although work was the most important.[ix] In the past, blacks had acted as citizens should. They took care of their sick, buried their dead, set up schools and improvement organizations for their own betterment, and more. African Americans would continue to act as citizens should to help their recently freed brethren upon passage of the District Emancipation Act.[x]

When asked what would happen to the contrabands if emancipated, Frederick Douglass advocated leaving the them to themselves. These freed persons would not be violent nor would they incite violence from pro-slavery fanatics and start a race war (ending in the genocide of all blacks). They would not overrun jails or cheapen labor. They would work just as they had before and would learn just as he had.[xi] He recommended that white citizens leave them alone to make their own decisions because it was their “doing with them [that was blacks'] greatest misfortune.”[xii] “As colored men … [they] only ask to be allowed to do with [them]selves,” a sentiment that resonated with all black Washingtonians.[xiii]

However capable African Americans seemed to be or believed they could be, many emancipationists did not foresee any major changes within society as a result of emancipation. They considered black inferiority a law of nature that could not be altered by the laws of men. Each race would remain separate – in schools, churches, and neighborhoods.  New freedmen would remain in the same second class station that free blacks in DC already inhabited. Emancipation was purposely seen and presented to the community as a change in legal status. The only difference would be that these freed persons were no longer in bondage and were entitled to equality under the law. African Americans received legal rights – liberty, property, assembly.  Legal equality did not confer social equality. The District Emancipation Act did not entitle African Americans to be treated differently by society. And because of that, many DC residents supported it.

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[i] “Abolition of Slavery,” Douglass’s Monthly, March 1862, 619.

[ii] “A Way to Save the Country,” Douglass’s Monthly, April 1862, 632.

[iii] “Abolition of Slavery,” Douglass’s Monthly, March 1862, 619.

[iv] “The Policy of the Administration,” Douglass’s Monthly, August 1862, 638-639.

[v] Ibid.

[vi] “How the Freed Slaves Behave,” The National Republican, January 11, 1862.

[vii] “Marshal Lamon,” The Evening Star, January 16, 1862.

[viii] “Will the Contrabands Work,” The National Republican, January 13, 1862.

[ix] Ibid.

[x] “Emancipation; as Regarded by the Colored People,” The National Republican, April 28, 1862.

[xi] “What Shall be done with the Slaves if Emancipated,” Douglass’s Monthly, January 1862, 573.

[xii] “What Shall be done with the Slaves if Emancipated,”Douglass’s Monthly,  January 1862, 573.

[xiii] Ibid.

The Supplemental Act

When I began working on the CWW project I thought there was only one set of petitions relating to the District’s Emancipation Act.  However, after scanning the microfilm of the 966 petitions, we noticed in addition a Supplemental Act (mentioned in my last post). The Supplemental Act was a continuation of the first act. While the District Act expired after three months (in July), the Supplemental Act not only extended it for another three months, but also had new terms to help African Americans achieve emancipation.

The District Emancipation Act freed all slaves, but not all slave holders filed for compensation – subsequently not all freed their slaves – and, even worse, some stole their slaves out of the district to avoid emancipating them. Accounts of this slave smuggling are present in many of DC’s newspapers. Even after its passage people tried smuggling their slaves out of the District. Reports surfaced of owners fraudulently imprisoning people, effectively keeping them in servitude.

To offset the aforementioned problems this second bill was drafted and passed in Congress on July 12, 1862. This allowed slaves to file petitions for themselves if they had been covered under the original Act. The same committee met over three months to decide upon the validity of each petition, and granted certificates of freedom accordingly. A part of the Supplemental Act allowed slaves from other states who had been employed in the District to be emancipated, as well. This was conditional, because owners technically had to give consent for a slave to receive their certificate of freedom under this bill. Owners testified that the slave had been employed/ in the District on or after April 16, 1862.  Only 22 of these 161 petitions were rejected.[i]

Often contradictions appear in the testimony included in these petitions. The Supplemental Act equally weighed black testimony with that of whites when conflicts arose.[ii] Charlotte Beckett is an example of this sort. She was owned by Mary Bibb and granted a certificate of freedom on October 1, 1862, for herself and children (George, Zara, Mary Ann, and Bohemia). Of Beckett’s 18 witnesses most affirmed her testimony about working in the District upon the bill’s passage. One witness, H. Key Hunter testified that she’d known Charlotte for 12 years and she definitely had been working in Georgetown before April 16. Witnesses also testified to the fact her owner’s husband took the Becketts out of the DC when the District Emancipation Act first passed.  Owners were supposed to give consent, yet Mary Bibb claimed she’d had no knowledge of Charlotte’s intent to petition and that all of her slaves were fugitives as the Fugitive Slave Law was still enforced in DC at this time. The commissioners still issued certificates for Charlotte and her children.[iii]

The biggest difference between the Supplemental Act and the earlier compensated emancipation act was that the final result often ended up being the issuing of a certificate of freedom to former slaves instead of compensation to former slave owners. In the Supplemental Act slave owners were longer entitled to compensation.  Another difference was the petitions themselves. These petitions were just testimonials. Petitioner had to bring at least two witnesses to testify on their behalf but there were no formal petition template.  Also, it was geographically expanded to cover the surrounding counties in Maryland and Virginia. When the Supplemental Act was first implemented slaves still had to have been in the District on or before April 16, 1862. Later it became that if their owner was a DC resident they qualified. The committee otherwise went through the same process of evaluating these petitions.

~Brittany Jones

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[i] Kurtz, Michael J., “Emancipation in the Federal City,” in Civil War History: A Journal of the Middle Period, ed. Hubbell, John T. (The Kent State University Press, 1978, vol. XXIV) 264-266.

[ii] Kurtz, Michael J., “Emancipation in the Federal City,” 264.

[iii] R. G. 217: Records of the U.S. General Accounting Office: Records of the Board of Commissioners for the Emancipation of Slaves in the District of Columbia, 1862-1863. Microfilm Publication M520, rolls 6 frames 830-836.

Origins of the District Emancipation Act

President Lincoln strove to preserve the Union, and late in 1861 he realized that emancipation was one way to achieve that goal. Lincoln first introduced his version of emancipation to the Delaware state legislature. There were three main features of Lincoln’s version: gradual emancipation, compensation for loyal slaveholders, and the voluntary colonization of African Americans overseas. Lincoln believed he could easily persuade citizens of Delaware to pass his bill because of their relatively low slave population — 2% (1,800). Delaware’s emancipation of the state’s slaves was to be the first step in Lincoln’s Border State plan.

Lincoln believed slavery would eventually die out if not allowed to expand. As such, when the Civil War began he did not feel that emancipation was a necessity at the time nor that he had a right to personally alter slavery. However, Delaware’s state legislature failed to pass Lincoln’s emancipation bill. The Union was fighting over slavery, whether or not its citizens acknowledged that fact. Lincoln came to see the exigency of emancipation, even if only as a means to save the Union, and he thus decided to take emancipation to the nation’s capital.

One could argue the District Emancipation Act (passed April 16, 1862) resulted from years of past emancipation legislation, yet the American Civil War provided the catalyst necessary to transform the ideals of emancipation into a legal document. In 1805 the first bill advocating the emancipation of slaves in the District of Columbia was proposed and defeated in Congress. Congress rejected a dozen more emancipation bills over the next half century. On December 16, 1861, Congress heard the most anticipated bill of the century: Senator Henry Wilson of Massachusetts proposed “An Act for the Release of Certain Persons held to Service or Labor in the District of Columbia by Reason of African Descent.” Wilson’s act was debated by Congressmen and DC residents alike. After many modifications, Wilson’s proposal passed as the District Emancipation Act on April 16, 1862.

Lincoln’s support was crucial to passage of the bill. Wilson’s bill had two of Lincoln’s fundamental features, colonization and compensation. Wilson, however, did not believe emancipation could ever be gradual. Both sides were reflected in the city’s newspaper editorials, and the public was split on all three aspects of the District Emancipation Act. Gradual emancipation was essential for some citizens and abominable for others. Colonization was a must for many DC residents, while others saw it as an injustice to those who considered America their home. Compensation proved to be the most disputed feature of the bill. Slaveholders argued that the compensation that was offered—initially set at a maximum of $300 per slave—was insufficient, while abolitionists argued it was more than enough. After four months of debates in Congress and in editorials, a compromise was reached in which Lincoln gave up the gradual and voluntary features of his bill, while Congress kept the colonization and compensation measures intact. The resulting Act instituted immediate emancipation, voluntary colonization, and compensation. The original Act was  to be in effect for 90 days, in which slaveholders had the option of filing a petition for compensation for their slaves. A committee of three men was appointed by Lincoln to assess the petitions.

Ultimately the President supported the bill, and DC citizens also supported the bill. As written in many newspapers of the time, residents of DC saw the inevitability of emancipation in DC. They might not have agreed wholeheartedly on the District Emancipation Act and its implications, but they trusted the President and saw the immorality of slavery, especially regarding its degradation of the nation. Many saw the present rebellion as a consequence of the nation not definitively addressing the slavery question and not conclusively affirming the supremacy of the national government. The city rejoiced when the District Emancipation Act was signed into law. This Act provided a remedy of sorts to the moral degradation of slavery and finally put the nation’s capital in harmony with its declaration as a free nation for all. In this regard DC was an example for the nation. DC embraced emancipation, if not social change, and stood behind Lincoln and the nation.

Components of the District Emancipation Act can be found in the Emancipation Proclamation. For example, although the District Emancipation Act was not gradual, Lincoln and many citizens intended it to be. The Act initially only pertained to slaves working or living in DC at the time of its passage. On July 12, 1862, the Act was extended to include any slaves owned by DC residents and slaves from nearby Virginia and Maryland counties. Slaves in DC whose owners had neither filed for compensation nor emancipated them could also file for certificates of freedom.

The Emancipation Proclamation only applied to slaves in states in rebellion who were freed by the Union Army, which was gradual, as Lincoln had planned. President Lincoln also wanted the Proclamation to include compensation on a national scale, but freeing some 3 million slaves was not financially feasible. Lastly, just as slaves under the District Act had the option of immigrating to parts of South America and Africa, that also was the case for former slaves following the Proclamation. Although not an exact replica of the District Emancipation Act, the Emancipation Proclamation was essentially the Act on a national scale.

~Brittany Jones

Updates on our Work

It’s been a few months since our last blog post, but now that the academic year is in full swing, we have a new goal of posting to the blog at least once every two weeks. There should be plenty to share and discuss: This year is shaping up to be an exciting one for Civil War Washington, as we start to see some of the behind-the-scenes projects we’ve been working on for the past twelve months or more come to fruition.

Since May, project directors and staff have been working on infrastructure and content for the site, and we’ve also talked about Civil War Washington in a range of venues, sharing about our project and soliciting feedback. A few highlights:

• In May, Ken Price presented his paper “The Work of Recovery: Civil War Poetry in Washington, DC’s Armory Square Hospital Gazette,” at the annual meeting of the American Literature Association.
• In June, I participated in the week-long seminar “Geographical Information Systems in the Digital Humanities,” led by Ian Gregory at the Digital Humanities Summer Institute in Victoria, BC.
• At the annual meeting of the Alliance of Digital Humanities Organizations, held at Stanford University in June, Price,  Brett Barney, and I presented our paper, “Civil War Washington: An Experiment in Freedom, Integration, and Constraint.”
• August saw the launch of version 2.0 of our project relational database. Currently, the database is internal only, but we anticipate making a public version of the database available by late 2011 or early 2012.
• Courtney Geerhart joined the staff of Civil War Washington for several months this summer as an Institute of Museum and Library Services intern. She worked on transcribing and encoding compensated emancipation petitions, scanning primary documents, and researching information for the project database.
• Also this summer, Matt Bosley, an undergraduate student in human nutrition, joined the staff of Civil War Washington, after taking Susan Lawrence’s history of medicine course last spring. He was so taken by the work Lawrence describes in her “Cases in the Classroom” post, that he sought out additional work on our project. To date, he’s worked his way through more than 1,100 medical cases from DC hospitals, checking the transcription and encoding and adding essential metadata.
• With the start of the academic year, we welcomed three additional staff members, Janel Cayer, graduate research assistant in the Department of English; AJ Howell, who comes to Civil War Washington through the Undergraduate Creative Activities and Research Experiences (UCARE) program; and Rob Shepard, a graduate student in the Geography Department and a graduate research assistant in the Center for Digital Research in the Humanities.

We’ll be writing more about many of these topics in the coming months. In particular, look for more posts on compensated emancipation petitions, the project database, wounds and injuries from DC hospitals, and the project GIS.

~Elizabeth Lorang

Cases in the Classroom

For the past three years, I have involved the students in my upper division History of American Medicine course at the University of Nebraska–Lincoln with Civil War Washington. We have already extracted all of the cases from the volumes that have any mention of one of the hospitals in Washington for Civil War Washington. I give the students, who work in pairs, a basic text file containing uncorrected OCR text from scans of the Medical and Surgical History of the War of Rebellion (MSHWR). I ask them to examine the pdf images of the MSHWR that correspond to their uncorrected text and to correct the text in their files.  The students produce nice, clean, corrected cases of Union soldiers who were sick and wounded and treated in Washington, DC during the Civil War for our site.

An extract of Case 805 from the MSHWR, as it appears in the print volume.

While the work that the students do has provided the site with some corrected OCR texts and, this year, corrected OCR and marked-up text, the primary purpose of engaging the students with a small amount of editing work is to ensure that they read the cases very carefully. To edit their cases, students must go through them word by word. Skimming doesn’t work, and not reading the cases at all makes that student’s editing partner annoyed and frustrated.

Depending on the complexity of the cases—some are very short, while others are quite lengthy—the student pairs have from three to two dozen cases in their samples. This year, we focused on wounds to the abdomen, pelvis and upper extremity (MSHWR, Part II, Volume II). In my class of 38, I had 19 pairs, with 6 pairs with abdominal wounds, 3 with pelvic wounds and 10 with wounds to the upper extremities. Each pair had to write a summary report of their cases (total number, ages, type of injury, use—or not—of anesthesia during any surgical procedure, and outcome) to post to their shared web space. Students could then use each other’s summary data to compile larger numbers, and could read each other’s corrected texts, if they chose to do so. I also provided them with some supplementary information from the MSHWR, including the circular letters sent to all military surgeons by the Surgeon General about submitting case reports, and links to major primary sources, such as Samuel Gross’s A Manual of Military Surgery: or Hints on the Emergencies of Field, Camp, and Hospital Practice (1862).

Uncorrected OCR text of Case 805; Case 805 after the text has been corrected and metadata added.

We spent class time working on the cases and discussing their historical context. What sort of education had the surgeons in the Washington hospitals likely had? What was the background for the development of surgical anesthesia, and why could the students not simply assume that it was always used in operations? How did soldiers get from the battlefields to the Washington hospitals? Why were the surgeons so concerned about identifying weapons used for various wounds? In addition, I constantly asked the students what they thought they needed to know in order to understand the cases that they were poring over.

The final part of the assignment was a four to five page paper, in which each student developed a theme about the ways in which their cases helped them to understand Civil War medicine. I gave them some suggestions, too. One possibility asked them to compare the practices that surgeons actually employed in the cases they studied compared with what Samuel Gross recommended in his Manual. Another suggested that they examine the cases’ language for evidence of whether the surgeons related to their patients as individuals or as simply problems to solve. I encouraged them to find their own insights, and to write about what the cases actually taught them instead of what they thought the cases should say because—as they too often still wrote—the surgeons “back then” didn’t know about germs and didn’t have modern technology.

Among the most common discoveries that my students make are the ones that go against the grain of what they think that they already know about the Civil War. They have discovered, to their surprise, that men with significant wounds actually lived and healed without all of the trappings of twenty-first-century hospitals. They have wondered at the fact that not all amputations ended in infection and death, and that men whose limbs were rendered useless by wound damage still preferred to keep their arms or legs, if they could. Most students, moreover, express an awareness that the cases that they edited were about real people, with real names, not simply vague figures of history. One of my students put it very well when she wrote:

Carefully structured and archived case summaries help scholars of today make sense of the aftermath of Civil War battles, and get a detailed view of the suffering of the men who fought them. The men in the cases I examined ranged in age from 22 to 38, and suffered their gunshot wounds at five different places throughout the war-torn nation. Altogether, they spent nearly 1,300 days in hospitals, but only three got to leave. Two of those men left with only one arm left, and endured pain and infections while still in the hospital. Reading the gruesome details of all of these injuries has breathed new life into the statistics about the war and its casualties that students have heard—but may not have fully comprehended—before.^*

Using the cases of soldiers who ended up in Washington hospitals as primary sources for courses in the history of medicine, the history of the Civil War, or even American history in general, offers students not only a large enough sample that they can grasp the toll the war took on American society, but also the individual stories that can spur their empathy with those who suffered.

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^*Quoted with the permission of Minda Haas, a student in my History of American Medicine course in Spring 2011.

~Susan C. Lawrence