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 19th century.  I hope to develop a glossary — and perhaps even a mid-19th century pharmacopeia — for users of the web site.                                                                                                                                                                                                                                                                                                                                                             – Matthew M. Bosley

[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.

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