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.

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

~Susan C. Lawrence

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One Response to Cases in the Classroom

  1. Pingback: Updates on our Work | Dispatches from Civil War Washington

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