7m		;v'.. r'
''!■ .C	> ■ ■ 't	V";	' •'"^.

ggf^:M5ir'i^^i^^ ^' :

'.v.T'v.'i

Digitized by the Internet Archive

in 2007 with funding from

IVIicrosoft Corporation

http://www.archive.org/details/contributionsrelOOflinuoft

SANITARY MEMOIRS

OF THE

WAR OF THE REBELLION.

COLLECTED AND PUBLISHED

BY THE

UNITED STATES SANITAEY COMMISSION.

^^lo\. 1-3

»t

C-*-*-

CONTRIBUTIONS-

RELATING TO THE

CAUSATION AND PEEVENTION OF DISEASE,

CAMP DISEASES;

TOGETHER WITH

A REPORT OF THE DISEASES, Etc., AMONG THE PRISONERS AT ANDERSONVILLE, GA.

EDITED BY

AUSTIN FLINT, M.D.

NEW YORK:

PUBLISHED FOR THE U. S. SANITARY COMMISSION,

BY KURD AND HOUGHTON,

459 Broome Street.

1867.

/««l

Entered according to Act of Congress, in the year 1867, by the

United States Sanitary Commission,

in the Clerk's Office of the District Court for the Southern District of New York.

RIVERSIDE, CAMBRIDGE:

STEREOTYPED AND PRINTED BT

H. O. HOUGHTON AND COMPANY.

PREFACE BY THE EDITOR.

After the tennination of the late war of the rebelhon, the United States Sanitary Commission resolved to publish a series of volumes, with a view to the diffiision and permanent availability of important infonnation, acquired during the war, relating to the grand object of the labors of the Commission, namely, to lessen the evils of warfare as far as possible by the systematic and efficient employment of sanitary measures. Much valuable material for the proposed volumes had already accumulated in the Historical Bureau, consisting of reports and various documents received from appointed inspectors and agents, as also from medical officers and otliers interested in the labors of the Commission. To this mate- rial has been added much obtained by means of a printed circular, inviting contributions from all who had had " opportunities for special studies in hospitals or in the field," or who had " made pro- fessional observations upon any subject connected with military- Hygiene, Camp Diseases, and Surgery." In addition, elaborate papers have been furnished, upon parsonal application, by members of the medical profession, distinguished for researches or large experience in the departments of inquiry to which their papers relate. These measures and all arrangements connected with the preparation of the volumes, have been under the immediate direc- tion of the Medical Committee of the Commission, the committee consisting of Professor Wm. H. Van Buren, M. D., Cornehus R. Agnew, M. D., Elisha Harris, M. D., Professor Wolcott Gibbs, M. D., and Professor J. S. Newberry, M. D. — the last-named member of the Commission having been recently added to the Committee.

This volume is devoted to topics pertaining to medicine, in a

vi PREFACE BY THE EDITOR.

restricted sense of the term ; that is, as distinguished from surgery. The larger portion is occupied by Camp Diseases. The Causation and the Prevention of Disease form a portion of the volume ; but Military Hygiene comprehensively considered, the Construction and the Administration of Hospitals, the Transportation of the Sick and Wounded, together with other kindred topics, and all those which belong to surgery, are assigned to other volumes.

As regards arrangement of topics, that which suggested itself as the most simple and natural, was a division corresponding to General and Special Pathology. In accordance with this arrange- ment, contributions relating to the Causation and Prevention of Disease are embraced in the first section of the volume, and those relating to Camp Diseases are embraced in the second section. A third and the last section consists of an elaborate Report on the Diseases, etc., prevailing among the prisoners confined at Ander- sonville, Ga. This Report could not well be divided into separate parts, and distributed in the foregoing sections, and it seemed to. require a distinct portion of the volume. The author, Professor Joseph Jones, was a Confederate medical officer, and the Report which is pubhshed in this volume, and which was placed by him at the disposal of the Sanitary Commission, is an ofiicial account of personal investigations made by authority of the Surgeon-General of the Confederate Army. The Report is published as- received from the author, no alterations having been made in any part, the title-page, the division into chapters, and the headings of the latter being included in this statement. Some portions, however, owing to the great length of the Report, have be6n omitted, but care has been taken that the omissions should not in any way alter its char- acter or impair its value.

It has been the duty of the editor to examine the mass of ma- terial relating to the topics belonging properly to this volume, and to select therefrom the contributions which form the contents of the volume. It is proper to state that in the performance of this duty, there have been no restrictions placed upon him by the Med- ical Committee of the Commission, and that he is therefore alone responsible for the manner in which the duty has been performed. It has also been his duty to arrange the matter for publication, and to supervise its passage through the press. To these editorial

PREFACE BY THE EDITOR.

vu

duties lie has confined himself, taking no part as a contributor ; and he may, therefore, without impropriety express the belief that the volume will be found to possess interest for all classes of readers, and to have much value as a repository of an important part of the sanitary experience of the war.

A. F.

New York, August, 1867.

1/

UNITED STATES SANITARY COMMISSION.

Rev. H. W. Bellows, D. D. . . Alexander Dallas Bache, LL. D. William H. Van Buren, M. D. .

WOLCOTT GiBBS, M. D. . . . .

* Robert C. Wood, M. D., U. S. A. f George W. Cullum, U. S. A. . X Alexander E. Shiras, U. S. A, Samuel G. Howe, M. D. ...

Elisha Harris, M. D

Cornelius R. Agnew, M. D. . . George T. Strong, Esq. . . . John S. Newberry, M. D. . . . Frederick Law Olmsted, Esq. Rt. Rev. Thomas M. Clark . . Horace Binney, Jr., Esq. § Hon. R. W. Burnett . Hon. Mark Skinner . . § Hon. Joseph Holt . . Rev. James H. Heywood II Fairman Rogers, Esq. J. Huntington Wolcott, Charles J. Stille;, Esq. Ezra B. McCagg, Esq. .

N6w York . . Washington, D. C. New York . . Cambrido;e, Mass.

DATE OP APPOINTMBNT.

June 9, 1861.

Esq.

Boston, Mass. . New York . . New York . New York . . Cleveland, O. . New York . Providence, R. I. Philadelphia, Pa. Cincinnati, O. . Chicago, III. Washington, D. C Louis '/ille, Ky. . Philadelphia, Pa. Boston, Mass. . Philadelphia, Pa. Chicajro, 111.

June 12, 18G1.

June 13, 1861. June 14, 1861. June 20, 1861. July 30, 1861. July 30, 1861. Dec. 5, 1861. Dec. 7, 1861. Jan. 23, 1863. Jan. 23, 1863. Feb. 6, 1863. June 13, 1863. Jan. 15, 1864.

* Resigned, December, 1864. t Resigned, February, 18S4.

t Resigned, December 17th, 1864. § These gentlemen never took their seats. Resigned, 1864.

FAMES OF THE AUTHORS OF CONTRIBUTIONS TO THIS V0LUME.1

Abbott, Samuel W., Surgeon 1st Massachusetts Cavalry. Adams, Samuel L., Assistant Surgeon, U. S. A. Anderson, H. P., Surgeon 60th Ohio Infantry. Andrew, G. L., Inspector U. S. Sanitary Commission.

Bartholow, Roberts, Assistant Surgeon U. S. A., in charge of the

McDougal General Hospital. Batwell, E., Surgeon 14th Regiment Michigan Infantry. Bid WELL, Edwin C, Surgeon 31st Regiment Massachusetts Infantry. Bailhache, J. H., Surgeon 14th Regiment Illinois Cavalry. Brock, Jesse W., Surgeon 66th Regiment Ohio Infantry. Benedict, M. D., Surgeon 7oth Regiment New York Infantry.

Clark, A. M., Surgeon U. S. Volunteers, and Medical Inspector of

Prisons. Clark, H. W., Surgeon 15th Regiment Ohio Infantry. Coe, Agemon S., Surgeon 147th Regiment New York Infantry. Cook, T. M., Surgeon 15th Regiment Ohio Infantry. Crawford, S. P., Surgeon Confederate Army.

Denig, C. E., Surgeon 28th Regiment Ohio Infantry. DwYER, R. A., Surgeon 175th Regiment Ohio Infantry. Dibble, Frederick L., Surgeon 6th Regiment Connecticut Infantry. DuNSTER, Edward S., Assistant Surgeon U. S. A., and Medical Di- rector of Hospital Transportation. Da Costa, J. M., Assistant Surgeon, U. S. A.

Everts, Orpheus, Surgeon 20th Regiment Indiana Infantry, and

Medical Inspector Second Corps d'Armee. Eve, Paul F., Surgeon Confederate Army. EwiNG, George C, Surgeon 115th Regiment Pennsylvania Infantry.

Flagg, Samuel, Assistant Surgeon 25th Regiment Massachusetts In- fantry.

1 To the names in this list are attached titles denoting official positions held dunng the war. Most of the contributors have retired from the service since the termination of the war. Other titles, denoting positions held before and since the war, are not here intro- duced.

(ix)

X NAMES OF CONTRIBUTORS.

Galloupe, I. F., Surgeon 17tli Regiment Massachusetts Infantry. Green, Samuel A., Surgeon 24th Regiment Massachusetts Infantry.

Gennet, , Surgeon 17th Regiment Ohio Infantry.

Gay, Norman, Surgeon U. S. Volunteers.

Gill, H. Z., Surgeon 95th Regiment Ohio Infantry.

Heise, a. W., Surgeon 100th Regiment Illinois Infantry.

Hand, A., Surgeon 8th Regiment Illinois Cavalry.

Houston, Wm. M., Surgeon 122d Regiment Ohio Infantry.

Habersham; S. E., Surgeon Confederate Army.

Hunt, Sanford B., Surgeon U. S. Volunteers.

Harvey, Wm. A., Surgeon IT. S. Volunteers, in charge Sickles U. S. A.

General Hospital, Alexandria, Va. Hamilton, Frank H., Medical Inspector, U. S. A. Howard, B., Assistant Surgeon, U. S. A. Harris, Elisha, M. D., Member U. S. Sanitary Commission.

Jewett, Chas. C, Surgeon 16th Regiment Massachusetts Infantry. Jones, Amos S., Surgeon 40th Regiment Wisconsin Infantry. Jones, Joseph, Surgeon Confederate Army.

Lidell, John A., Surgeon U. S. Volunteers, and Inspector Medical

Department Army of the Potomac. Long, Owen M., Surgeon 11th Regiment Illinois Infantry. Leavitt, D. F., Surgeon 3d Regiment Massachusetts Cavalry. Lee, Chas. A., Medical Inspector U. S. Sanitary Commission.

Mitchell, S. Weir, Acting Assistant Surgeon, U. S. A. Manfred, Henry, Surgeon 22d Regiment Kentucky Infantry. Miller, George D., Surgeon 5th Regiment Wisconsin Infantry. McDonald, Alex., Inspector U. S. Sanitary Commission.

New, George W., Surgeon 7th Regiment Indiana Infantry.

Powers, Cyrus, Acting Assistant Surgeon Stanton Hospital.

Phelps, A. J., Surgeon U. S. Volunteers.

Page, J. W., Inspector U. S. Sanitary Commission.

Ramsay, A. W., Surgeon Confederate Army. Russell, Ira, Surgeon U. S. Volunteers.

Stevenson, B. F., Surgeon 22d Regiment Kentucky Infantry. Southwell, Charles, Surgeon 18th Regiment Michigan Infantry. Sanborn, J. E., Surgeon 27th Reginjent Iowa Infantry.

yifl

NAMES OF CONTRIBUTORS. xi

Teal, Norman, Surgeon 88th Regiment Indiana Infantry. Thrall, S. B., Assistant Surgeon 13th Regiment Iowa Infantry.

Upham J. Baxter, Surgeon U. S. Volunteers, in charge Stanley U. S. A. General Hospital, Beaufort, N. C.

Varian, William, Surgeon U. S. Volunteers.

Woodward, Benj., Surgeon 22d Regiment Illinois Infantry. Whitaker, John, Assistant Surgeon 81st Regiment Ohio Infantry. Wright, John, Surgeon I07th Regiment Illinois Infantry. Willis, Wm. S., Surgeon 1st Regiment New Jersey Cavalry. Williams, J. H., Surgeon 123d Regiment Ohio Infantry. White, A. A., Surgeon Massachusetts Cavalry. Windsor, I. W., Surgeon 49th Regiment Massachusetts Infantry. Walton, C. J., Surgeon 21st Regiment Kentucky Infantry. Wilbur, George D., Surgeon oth Wisconsin. Wragg, W. T., M. D., of Charleston, S. C.

X

CCNTBl^TS.

SECTION FIRST.

CHAPTER FIRST.

THE VARIOUS INFLUENCES AFFECTING THE PHYSICAL ENDURANCE, THE POWER OF RESISTING DISEASE, ETC., OF THE MEN COMPOSING THE VOLUNTEER ARMIES OF THE UNITED STATES.

Influences previous to Enlistment. — Qualifications for Military Service, relating to Race, Temperament, Occupation, Age, etc. — Causes affecting Physical Stamina sub- sequent to Enlistment, relating to Exposure, Diet, Overcrowding, and the Lack of Cleanliness. — The Mental and Moral Effects of Association. — Liability to specific Febrile Affections. — Causes affecting the Physical Stamina in Active Service, Cli- matic, Dietetic, Accidental, Specific, Moral, and Compound. — Moral Causes affecting the Physical Stamina of the Soldier, relating to Cowardice, Weakness of Will, and Nostalgia. — Malingering, its Causes and Degree of Prevalence. — The Forms of Disability feigned, namely : Affections of the Cerebro-Spinal System, of the Thoracic Organs, of the Digestive System, of the Genito-Urinary Apparatus, of the Extremi- ties, and Constitutional or General Affections. — Detection and Treatment of the va- rious Forms of feigned Disability. — Discharges on Surgeon's Certificate . . . 3

CHAPTER SECOND.

REMARKS ON VARIOUS CIRCUMSTANCES RELATING TO TFIE CAUSATION OF DISEASE, ESPECIALLY AMONG VOLUNTEER TKOOP3, BASED ON PERSONAL OBSERVATIONS IN THE FIELD, DURING THE YEARS 1861-65.

The Aptitude of the American Mind. — The newly -appointed Medical Officer, his Early Embarrassments, and the little Instruction that he derives from those regularly in the Service. — The First Duty of the Medical Officer. — Bad Effects of the Volunteer Plan for Recruiting an Army.' — Sketch of the Earl}' History of an Ohio Regiment, as representing tlie History of New Regiments generally. — First Organization of Buell's Army, or " The Army of the Ohio," and Appointment of Division and Brig- ade Surgeons. — Increase of Sickness. — The Superiority of Tent Hospitals. — The Effect of Marching Orders upon the Health of the Troops. — The Size of Men best suited for Soldiers. — Line of March of Troops from Nashville. — Battle of Pittsburg Landing. — The Want of Coiiperation between Commanding- Officers and their Sur- geons. — Account of the First General Hospital of this Army. — The Severe Services and Bad Nourishment of the Army before Corinth. — The Type of Disease that pre- vailed in the Army before Corinth. — The March of the Army of the Ohio, after its

Evacuation of Corinth, and its improved Hygienic Condition The Reenforcement

of the Army from the Calls of 1802; the Error of the Government; no Improvement in the Personnel over the Troops of 1861. — First Attempt at an Organization of the Medical Department, for the Field of Battle, in Wood's Division. — The Long Rest of the Army; the Time is spent in Recuperating, Organizing, and Reenforcing. — The March of the Army to Chattanooga. — Battle of Chickamauga. — Retreat to Chattanooga. — Siege of Chattanoog;a. — The Battles of Mission Ridge and Lookout Mountain. — The March to the Rel'ief of Knoxville ; remarkable Health coexisting with Destitution of all Kind of Supplies. — Still further Improvement in the Medical Department 42

CONTENTS.

CHAPTER THIRD.

ARMY ALIMENTATION IN RELATION TO THE CAUSATION AND PREVENTION OF

DISEASE.

Public Opinion respecting? the Wants of the Army prior to the Rebellion. — Experience of the British and French Armies in the Crimea. — Defects in the United States Army as regards the Equalization of the different Nutriments, and their Lack of Adaptability to the Vicissitudes of Climate and the Accidents of Campaigns. — Work of the Sanitary Commission. — Standard of Alimentation. — Classification of Foods into Nitrogenetic and Calorifacient. — Analysis of Blood. — Army Rations of differ- ent Nations. — Rations of the United States Army compared with those of the French, Russian, Turkish, East Indian, and British Armies. — Nutritive Value of Rations. — Nitrogenous Foods. — Experience of British Statisticians. — Experience at the Con- valescent Camp in Virginia, and in the Military Prisons of the United States. — The Confederate Army Ration. — Experience of the 16th Army Corps in 1864-65; of the Frontier Head-quarters at Fort Smith, Arkansas, and at the Confederate Prison at Andersonville — Conclusions respecting Nitrogenous Diet. — Carbonaceous Foods. — Fresh Vegetables and Salt. — Notes on the Special Components of the Ration. — Beef, fresh or salt; Pork or Bacon; Bread, hard or soft; Pease and Beans; CotFee, Tea and Whisky. — Summary. — Professor Horsford's Plans to diminish the Weight and Bulk of the Army Ration 64

CHAPTER FOURTH.

Testimony of Medical Officers respecting the Relations of Physical Endurance and the Power of resisting Disease to Age, Period of Service, Season, Climate, and Locality; Residence in City or Country prior to Enlistment; and the Influence of previous Habits of Life. — Remarks on the Physical Characteristics of Different Classes of Re- cruits and the Influence of Previous Habits, by Dr. S. B. Hunt — Remarks by Dr. Hunt on the Effects of Altitude. — Opinions and Facts Pertaining to Alimentation, the use of Tea and Coffee, and the Whisky Ration 95

CHAPTER FIFTH.

EFFECTS OF A MALARIOUS ATMOSPHERE AS REGARDS PHYSICAL ENDURANCE. — AGENCY OF MALARIAL POISONING UPON DISEASES AND THE RESULTS OF SUR- GERY.— RELATION OF MALARIA TO THE DIARRHCEAL AND PULMONARY MALADIES OF THE CAMP AND TO SUCCESS IN THE CONSERVATIVE TREATMENT OF WOUNDS.

Slow and Insidious Absorption of Malaria as contrasted with Sudden Poisoning. — Two Forms of Poison. — Gradual Absorption of Malaria, without Febrile Phenomena, due to the Poison not being Intense, to the Organism not being Susceptible, and to Hygienic Circumstances being unfavorable to its Speedy Absorption. — Effects of Malaria on Ph^'sical Endurance, without inducing Fever, shown by Lesions of As- similation and by Lesions of Innervation. — Morbid Anatomy of Chronic Malarial Poisoning. — Symptoms denoting the Influence of a Malarious Atmosphere upon the Functions and Physical Endurance. — Danger from Intercurrent Diseases. — Ten- dency to Pneumonia, Diarrhoea, Phthisis, and General Dropsy. — Effects of Malaria manifested in Febrile Diseases, in Inflammations, in Intestinal Diseases, in Dis- eases of the Nervous System, and in Constitutional Affections other than Fevers. — Malarial Typhoid Fever. — Typhoid Pneumonia. — Development of Phthisis. — Re- lation of Malarial Poisoning to the Diarrhoeal ^laladies of the Camp. — Affections of the Nervous System connected with Malarial Poisoning. — Influence of Malaria on the Results of Surgery, as manifested in the Repair of Fractures and other Injuries; in Predisposing to Pyaemia, Hospital Gangrene, and Secondary Hemorrhage, and inducing a State confounded with Pysemia (Pseudo-Pyaemia). — Case illustrative of Interference with Repair. — Case illustrative of Agency of Malaria in predisposing to * Pyaemia. — Conclusions. — Prophylactic Emploj'ment of Quinia. — Essay by Prof. Van Buren. — Testimony of Medical Officers 118

yVi/

CONTENTS. xi

CHAPTER SIXTH.

VACCINATION IN THE ARMY. — OBSERVATIONS ON THE NORMAL AND MORBID RE- SULTS OF VACCINATION AND REVACCINATION DURING THE WAR, AND ON SPU- RIOUS VACCINATION.

Vaccination of Volunteers delayed or neglected. — Revaccination generally neglected in Civil Life. — Much of the Vaccination in Civil Life not Effectual. — The Army Regulation. — Aid in Vaccinating the State Volunteers before they left for the Field. — Self- Vaccinations, Consequences of Marching, etc. — Efforts by Purveyors and the Medical Institutions in New York. — Amount of Small-Pox in the first Year of the War. — Results of Official Inquiry concerning Vaccination in New York, by Sur- geon-General Vanderpoel. — Fifty Thousand Charges of fresh Virus supplied gratu- itously by the New York Eastern Dispensary. — Analysis of Surgeon-General Vanderpoel's Returns. — Statistics of Vaccination ; Ratio of the Protected to the Un- protected.— Experience in the Prussian Army; Benefits of Revaccination. — Impor- tance of Genuine and thoroughly Protective Vaccination. — The Sanitary Commission urged and aided timely Vaccination, and insisted upon proper Precautionary Meas- ures. — Amount of Virus supplied by the Sanitary Commission. — Spurious Vacci- nation. — Official Orders for Vaccination of the Troops of both Armies. — Early Appearance of Morbid Results of Vaccination. — Small-Pox and the Bad Results of Vaccination in St. Louis and the Mississippi Valley. — Scorbutic and Unhealthy Conditions. — Surgeon Ira Russell's Account of Cases at St. Louis. — Surgeon White's Cases and Conclusions. — Wide-spread DiflFusion of the Inoculations. — Inquiry and Personal Inspection by a Committee of the Surgeons of St. Louis. — Prevalence of the Morbid Effects of Vaccination and of Spurious Vaccination. — Professor Ham- ilton's Observations after the Battle of MurfVeesboro. — Testimony of Surgeons Hunt, Dwyer, Cook, Batman, Stevenson, Houston, Galloupe, Williams, and Grove. — Self- Vaccination of Soldiers from Foul Sores. — Experience among Prisoners at the North. — Experience in the Confederate Army. — Dr. Habersham's Report. — Dr. Ramsay's Report. — Dr. Crawford's Testimony. — Pathological History of Spurious and Impure Vaccination. — Jenner's Views ; his Evidence before Parliament, and his experimentum crucis. — Sources of Impaired or Spurious Virus ; Scurvy, Sero-Puru- lent Matter, Inoculation by Specific Infections, Deterioration of the Genuine Virus, and Destruction of the Virus by Heat. — Conclusions. — Vaccination to be proved by Revaccination at Enlistment. — Virus from Men in Camp and Hospitals not to be used. — The Results of Spurious Vaccination the same now as in Former Time. — Virus from Unhealthy Persons not to be used. — The Diseases which may be Inocu- lated. — The Syphilitic Poison may be Inoculated. — Vaccination to be performed when the Person to be vaccinated is Healthy. — History of Vaccination in our Armies confirms Jenner's Doctrines 137

SECTION SECOND. CHAPTER FIRST.

THE COMPARATIVE MORTALITY IN ARMIES FROM WOUNDS AND DISEASE.

Error of Popular Opinion. — Purpose of the Writer. — Casualties of the English Forces in the Crimean War. — Mortality in the Crimea. — Eflfect of Sanitary Measures. — Comparative Mortality from Wounds and Disease. — Consolidated Table of the Losses of the English Army in the Crimean War. — Comparative Mortality among Enlisted Men and Officers. — Comparison of Enlisted Men and OflScers as regards Casualties. — Mortality from Disease in the different Arms of the Service. — French Quota of the Allied Army. — Total Mortality during the War. — Comparative Mortality from Wounds and Disease. — Statistics of Scrive and Chenu. — Comparative Mortality among Enlisted Men and Officers. — Casualties of the United States Army in the War with, Mexico. — Strength of the United States Army. — Total Mortality during

xu CONTENTS.

the War. — Consolidated Table of the Losses of the United States Army in the War with Mexico. — Comparative Mortality from Disease and Wounds. — Comparative Mortality among Enlisted Men and Officers. — Comparative Mortality in Different Branches of the Service. — Mortality in the Recent Rebellion. — Statement of the Casualties in the Armies of the United States, from the Commencement of the Re- bellion to August, 1865. — Recapitulation of the losses from Woynds and Disease in the Regular and Volunteer Armies and among Colored Troops. — Comparative Mor- talitj' from Disease and Wounds. — Comparative Mortality among Enlisted Men and Officers. — Large Excess of Deaths from Disease among Colored Troops. — Mortality in the different Arms of the Service. — The Proportion per One Thousand of Mor- tality from Disease and Wounds. — Comparative Mortality among Troops from dif- ferent States. — Proportional Analysis of the Table of Casualties by States. — Mor- tality in Kansas. — Comparison of Mortality among Regular, Volunteer, and Colored Troops. — Comparison of Losses from Wounds and Disease among Troops from dif- ferent States. — Casualties among Medical Officers. — Casualties in the Rebel Army. — Losses in other Notable Campaigns; in the Sardinian Army in the Crimean War; in the French Army in Africa; in the English Army in Spain; in the Expedition to Walcheren. — Losses in the English Navy. — Losses in the Russian Army in Tur- key. — Conclusions 169

CHAPTER SECOND.

CAMP FEVERS. — REMITTENT, TYPHOID, TYPHO-MALARIAL OR MALARIAL TYPHOID, COMMON CONTINUED, AND MOUNTAIN FEVER. REPLIES OF MEDICAL OFFICERS TO QUESTIONS CONCERNING CAMP FEVERS, — REMITTENT AND INTERMITTENT, TYPHOID, AND TYPHO-MALARIAL.

Conditions modifying the Sj'mptomatology and Morbid Anatomy of the Fevers of the Army. — Remittent and Typhoid. — Dr. Woodward's Theory of Typho-Malarial Fe- ver. — Classification of the Fevers of the Army into Periodical and Continued. — Subdivision of Periodical Fevers into Intermittent, Remittent, and Typho-Mala- rial (?). — Subdivision of Continued Fevers into Simple Continued, Typhoid, Mala- rial Typhoid, and Typhus. — Error of considering all these as Modifications of one Disease. — The Scorbutic Element in Camp Fevers. — Existence of Typho-Malarial Fever considered. — Comparison of Army Tj'phoid and Army Remittent Fever. — Alterations characteristic of Chronic Malarial Poisoning. — Etiology of T3'-phoid Fe- ver. — Emanations from Excreta the chief determining Cause. — Facts showing Contagiousness of Typhoid Fever. — Simple Continued Fever. — Number of Cases in the First Year of the War. — Occurrence among Recruits and Young Soldiers. — Mountain Fevor. — Dr. Ewing's and Dr. Logan's Account. — Malarial Origin of this Variety of Fever. — Remittent and Typhoid Forms of Mountain Fever. — Sources of the Malarial and Typhoid Poison. — Typhus Fever. — Conclusions.

Replies of Medical Officers. — Statistics of Fevers during the First Two Years of the Rebellion. — Replies relating to Intermittent and Remittent Fever. — Statistics of Periodical Fevers. — Extract from Communication by Surgeon H. W. Clark. — Com- munication from Surgeon Liddell. — Statements by Surgeons Miller, Jones, Windsor, Flagg, and Assistant-Surgeons Gennet and Abbott. — Extract from Letter by Sur- geon Dibble. — Infrequency of Typhus Fever. — Frequency of Typhoid Fever. — Two " Walking Cases" of Typhoid Fever. — Proper Use of the Term Typho-Mala- rial Fever. — Surgeon Evert's Opinion. — Communication by Surgeon Harvey. — Cases reported by Medical Inspector F. H. Hamilton 193

CHAPTER THIRD.

CAMP MEASLES. TESTIMONY OF MEDICAL OFFICERS RESPECTING THE PREVALENCE, FATALITY, ETC., OF CAMP MEASLES.

Prevalence of Measles, and its Fatality. — Liability of Recruits to the Disease. — Dr. Salisbury's Theory of Fungi. — Observations of the Writer with respect to this The- ory— Circumstances rendering Recruits especially liable to the Disease. — The

Xi>^:

CONTENTS.

xm

Eruption in One Hundred Cases. — Desquamation in Camp Measles. — Defirium in Fatal Cases. — Symptoms and AfFections pertaining to the Respiratory System. — Symptoms referable to the Heart. — Symptoms referable to the Mouth, Fauces, etc. — Symptoms referable to the Kidneys. — Sequelae of Camp Measles, Typhoid State, Bronchitis, and Pneumonia. — Chronic Pneumonia and Diarrhoea. — Two Methods of Treatment. — A rational Method of Treatment proposed. — Testimony of Medical Officers. — Means of ftotection against Losses by Death and Discharge from this Disease. — Testimony to Prevalence, Fatality, etc., from Surgeons Long, Gill, An- derson, Sanborn, Jones, Norton, Phillips, Leavitt, Wilbur, New, Windsor, Seal, Flagg, Whittaker, Bailhache, and Prof. Eve. — Communication by Surgeon Benja- min Woodward. — Communication by Surgeon Samuel L. Adams .... 218

CHAPTER FOURTH.

TELLOW FEVER ON THE ATLANTIC COAST AND AT THE SOUTH DURING THE WAR.

Predictions concerning Yellow Fever. — Assurances of Hygienic Protection. — The Cap- ture of New Orleans did not open a Highway for Yellow Fever. — Sanitary Police in New Orleans. — The Troops in a Condition to take Yellow Fever. — Constant Expos- ure of New Orleans. — Quarantine. — Yellow Fever at Wilmington, N. C. — Com- mencement of the Epidemic. — Statistics of the Epidemic. — Arrival of the Kate. — Infected at Nassau, N. P. — Dr. Wragg's Report. — The Hygienic Condition of the City. — Facts relating to Origin. — Sporadic Cases. — Importation. — Remarkable Fatality. — Yellow Fever at Key West and the Dry Tortugas. — The Gunboat Ta- homa, 1864. — Outbreak on the Tortugas. — Localizing and Personal Causes. — Key West and Nassau as points d'appui of Fever Infection. — The Epidemic at Hilton Head, S. C, in the Autumn of 1862. — The Ship Delaware as the Carrier. — The Manner of communicating the Infection. — A Series of Cases in Hospital. — Decline of the Disease. — Origin and Localizing Causes. — Two Distinct Outbreaks of the Epidemic. — Epidemic Causes. — General Mitchell and his Staff. — Fever at Beaufort traced to Hilton Head. — Diagram and Medical Topography of the Infected District at Hilton Head, 1862. — Yellow Fever at Newbem, N. C. — Number of Fatal Cases.

— Heroism of the Physicians. — Beaufort and Morehead City. — The " Roll of Honor." — Was the Newbern Epidemic of Exotic Origin? — Conclusions.

Yellow Fever in the Gulf Ports. — Rigid Quarantine at New Orleans. — Liability to Exotic Infection Excluded. — The Question of Domestic Origin for the First Time susceptible of Solution. — One Class of River Craft prepared to generate Yellow Fever; but the City secure. — All the Gulf Ports and some Texian Towns Inland infected. — The Galveston Epidemic. — A District of the City escapes Yellow Fever by Exclusion from Intercourse with the Epidemic Quarter. — The Fever was conveyed Inland. — Experience in New Orleans in 1862-65. — New Orleans as Liable as any Gulf Port. — The Fever widely Epidemic in the Gulf Ports. — Exotic Germs and Localizing Causes of Past Epidemics. — The Exotic and the Domestic Factors con- trolled by Sanitary Measures. — River " Rams," etc., furnished the Artificial Causes,

— Internal Sanitary Police of the City. — The Chances of Exotic Infection excluded.

— Medical Topography of the Delta. — Temperature and Humidity, Cryptogamic and Infusorial Life and Decay. — Persistent Scourging by Yellow Fever before the War. — The City full of Uncreolized and most Susceptible Men. — Low Death-rate in 1864-65. — Death-rates and Epidemic Causes. — Sanitary Government of the City. — Yellow Fever in Iron Boats in 1863 ; not of Imported Origin. — New Orleans Quaran- tme Record of 1863-64. — Locality of Naval Hospital. — Record of the Naval Epi- demic.— Foul Vessels long at Anchor; Twenty-five Boats become Infected. — The Boat-landing becomes Infected. — Hygienic Truths taught by this Record. — Con- clusions.

Pathological Inquiries. — Therapeutical Experience 1

XIV CONTENTS.

CHAPTER FIFTH.

THE ACUTE RHEUMATISM OF THE TROOPS IN NEW 3IEXICO. NOTE RESPECTING THE PREVALENCE OF RHEUMATISM.

Strength of Garrison at Fort Union, New Mexico. — Statistics. — Number of Cases of Rheumatism. — Relation of Climate to the Production of Acute Rheumatism. — Cli- mate of Fort Union. — Humidity not a Cause of Acute Rheumatism. — Electrical Phenomena in New Mexico. — Agency of the so-called Rheumatic Diathesis, Heredi- tary and Acquired. — Acute Rheumatism a Substitution for Epidemic Erysipelas. — Special Characters of Rheumatic Disease of New Mexico. — The Cases characterized by Severity and the Number of Parts affected. — Bronchitis and Pneumonia occur- ring as Complications. — Mortality. — Post-mortem Examinations. — Points of Simi- larity between Erysipelas and Acute Rheumatism. — Conclusions. — Note respecting the Prevalence of Rheumatism

CHAPTER SIXTH.

SCURVY IN ITS MEDICAL ASPECT.

First Appearance of the Disease during the War. — Prevalence during the War. — Scurvy Incident to the present Army Ration. — Causation of Scurvy. — Scurvy in the Army attributable to Diet. — Dietetic Origin shown by History. — Discrepancies as regards Theories of Causation. — Scurvy dependent on Lack of Albuminoids and Salts. — Fresh Animal Blood in Scurvy. — Healthy Blood the Typical Food. — The Salts derived from Vegetable Food. — Causes of Prison-Scurvy. — Relative Value of Albuminoids and Salts. — Acids in Scurvj-. — Symptoms and Pathology of Scur- vy.— Essential Pathology. — General Debility the First Manifestation. — Symptoms in Advanced Cases. — Symptoms those of Exhaustion. — Ecchymotic CEdema. — Destructiveness of Tissue the Characteristic of Scurvy. — Morbid Characters of Scurvy in Pus. — Diarrhoea. — Characters of Inflammation. — The Pathological Conditions dependent on Depravation of the Blood. — Treatment to be based on the Pathology and Causation. — Total and Partial Starvation. — Saline Remedies. — Phosphate of Lime. — Remedies for Diarrhoea. — Object of Treatment to repair the Starvation. — A Complete Diet the most Reliable. — Reports by Drs. Charles A. Lee, Andrews, Frank H. Hamilton, Varian, Woodward, and McDonald 276

CHAPTER SEVENTH.

CAMP DIARRHCEA AND DYSENTERY. EXTRACTS FROM COJIMUNICATIONS BY MEDI- CAL OFFICERS, RESPECTING CAMP DIARRHCEA AND DYSENTERY.

Frequency and Importance of these Diseases. — Their Prevalence in the United States Army. — Prevalence in the Confederate Prisons. — Symptomatology. — Pathology. — Anatomical Characters, and Intercurrent Affections. — Medical Geography in Relation to their Prevalence. — Forry's Geographical Divisions and Statistics. — Woodward's Statistics. — Comparison of Latter with Forry's Statistics. — Forry's Statistics, showing Relations to Intermittent Fever. — Woodward's Ditto. — Mortality in Dif- ferent Regions. — Conclusion respecting the Agency of the Causes of Intermittent Fever. — Woodward on Effect of Latitude in General Hospitals. — Causes Independ- ent of Latitude. — Altitude. — Prevalence in Low and Humid Localities. — Expe- rience of British Army in the Establishment of Hill Stations in India. — New Eng- land Hospitals. — Special Causes. — Dietetic Causes. — Agency of Scurvy. — The Bivouac a Special Cause. — Predisposition from Previous Attacks. — Crowd-Poison, etc. — Causes at the Andersonville Prison. — Treatment. — Use of Purgatives and Opium. — Removal to the North. — Value of Drugs. — Dietetic Management. — Ex- perience in Selma, Alabama. — Importance of Hygienic Measures. — Extracts from Communications by Medical Officers. — Intermittent Type of Diarrhoea. — Extracts from Communications by Dr. B. Howard, Surgeon B. Woodward, Surgeon Batwell, and Surgeon Ewing. — Conclusions respecting Malarial Influences. — Report by Dr.

n\

CONTENTS. XV

Salisbnn^. — Surgeon B. Woodward's Report on Agency of Cryptogamia. — defect- ive Police of Camps. — Suggestions bj' Surgeon Gay. — Remarks by Surgeon B. Wood- ward.— Surgeon Benedict's Account of Diarrhoea at Fort Pickens. — Surgeon Bat- well on Relations of Diarrhoea to the Nervous System. — Remarks by Surgeons Bail- hache and Jewett. — Surgeon Dwyer on Agency of Hard Bread. — Diarrhoea caused by Fresh Mutton. — Report of Surgeon Stevenson. — Explanation of Apparent Dis- crepancies of Opinion 291

CHAPTER EIGHTH.

PNEUMONIA AS IT APPEARED AMONG THE COLORED TROOPS AT BENTON BAR- RACKS, MO., DURING THE WINTER OF 1864. NOTE RESPECTING THE PREVALENCE AND FATALITY OF PNEUMONIA AND OTHER INFLAMMATORY AFFECTIONS OF THE RESPIRATORY SYSTEM AMONG THE UNITED STATES TROOPS DURING THE WAR.

Number of Cases and of Deaths. — Division of the Disease into the Congestive Form, the Typhoid Form, and Pleuro-Pneumonia. — Congestive Variety most prevalent in January. — Severity of the Winter. — Congestive Form ; its Symptoms and Physical Signs. — Chlorides in the Urine. — Typhoid Pneumonia; its Symptoms and Physical Signs. — Pleuro-Pneumonia; its Symptoms and Physical Signs. — The Disease at- tributable to Over-crowding and to Measles. — Number of Cases after Measles. — Differences found after Death in Cases following Measles. — Table 1, showing Number of Days in Hospital ; the Affection of one or both Lungs ; Stage of Disease at Time of Death ; and Weight of Lungs in One Hundred Fatal Cases. — Table 2, showing the Dates of Deaths in One Hundred Cases. — Table 3, showing Duration of the Dis- ease, Amount of Effusion, etc., in Fifty Fatal Cases of Pleuro-Pneumonia. — Table 4, showing Duration in Fifty Fatal Cases of Pneumonia, and Thirty-eight Cases of Measles. — Table 5, showing the Order in which the Lungs and General Lobes were attacked; the Stage of the Disease in each Lobe at the Time of Death; and the Weight of each Lung in Fifty Cases among Colored Troops at Wilson Hospital, Tennessee.

— Table 6, showing Days in Hospital in Cases of Measles, and of Pneumonia ending in Recovery. — Treatment of Pneumonia. — Agents generally used. — Liability to Sudden Prostration. — Importance of the Carbonate of Ammonia. — Quinia as a Pro- phylactic. — Classes of Patients at Benton Barracks. — Liability of the Negro to Pul- monary Disease. — Efficacy of Treatment in Cases among Negroes. — Pleuritic Adhe- sions, found after Death, more frequent in Negroes. — Weight of Lung less in Negroes.

— Note respecting the Prevalence and Fatality of Pneumonia, and other Inflamma- tory Affections of the Respiratory System 319

CHAPTER NINTH.

ON THE PREVALENCE AND FATALITY OF PNEUMONIA AND OF TYPHOID FEVER IN THE CONFEDERATE ARMY DURING THE AVAR OF 1861-1865.

Importance of Pneumonia in view of its Prevalence and Fatality. — Table giving Mean Strength, the Total of Sick and Wounded, the Cases of Pneumonia, and the Percent- age of Pneumonia in Mean Strength, etc., in the Confederate Army during Nineteen Months, 1862-63. — Analysis of this Table. — Cases most Numerous in the Winter and Spring Months. — Table illustrating the Prevalence of Pneumonia in the Armies serving in Different Sections of the Confederate States. — Cases in Virginia; in the Army of the West, etc. — Cases of, and Deaths from. Pneumonia, Typhoid Fever, and other Diseases in the General Hospitals of the Army of the Potomac, Northern Virginia, and other Hospitals, during Fifteen Months, in 1862-63. — Common Con- tinued and Typhoid Fever identical. — Percentage of Deaths from Pneumonia. — Fatalitj' from Pneumonia and Typhoid Fever — Fatality from other Diseases. — Cases of, and Deaths from. Typhoid Fever, Pneumonia, and some other Diseases in the General Hospitals in and around Richmond during Seven Months in 1862-63. — Cases of, and Deaths from. Pneumonia, Typhoid Fever, and several other Diseases, in the General Hospitals in Virginia. — Cases of, and Deaths from. Pneumonia, and some other Diseases, in the General Hospital at Charlottesville, Va., during Twenty-

XVI CONTENTS.

six Months, from July, 1861, to August, 1863. — Fatalit}' in Hospitals at Savannah, of Pneumonia and Typhoid Fever.— Table showing the Numerical Relations of, Cases of, and Deaths from, Typhoid Fever and Pneumonia in the General Hospitals in Vir- ginia and Georgia. — Progressive Diminution of the Prevalence of Typhoid Fever during the War. — Table illustrating the Numerical Relations of Pneumonia and Typhoid Fever in the Confederate Armies during Nineteen Months, 1862-63. — Cases and Deaths from all Causes, and Cases of, and Deaths from. Pneumonia and Tj'phoid Fever in the General Hospitals of Charlottesville and Staunton, Va 335

CHAPTER TENTH.

OBSERVATION ON THE DISEASES OF THE HEART NOTICED AMONG SOLDIERS, PAR- TICULARLY THE ORGANIC DISEASES.

The Clinical Material for this Chapter. — Valvular Diseases. — Table of Valvular Dis- eases. — Cases of Valvular Disease following Rheumatism. — Cases of Valvular Dis- eases not preceded by Rheumatism. — Absence of Bright's Disease or any Diathetic Affection. — Cases of Valvular Disease attributed to Protracted and Violent Exer- tion. — Case of Insufficiency of the Pulmonary Valves. — Cases in which Valvular Disease did not prevent the Performance of Militarj' Duty. — Infrequency of Diseases of the Pericardium. — Enlargement of the Heart independent of Endocarditis or Per- icarditis. — Hypertrophy of Heart from persistent Functional Disorder and after Fevers. — Enlargement due to a Rheumatic Diathesis, or existing prior to Enlistment. — Cases of Hypertrophy without Valvular Lesions amenable to Treatment. — Treat- ment employed in these Cases. — Cases of Enlargement with Predominant Dilatation infrequent. — Of Irritable Heart. — Conclusions 360

CHAPTER ELEVENTH.

ON CEREBRO-SPINAL MENINGITIS.

Historical and Geographical Sketch. — Prevalence in America and during the War. — The Disease favored by Cold and Overcrowdmg. — Age and Constitution of those attacked. — Symptoms. — Premonitions. — Period of Invasion. — The Intellect. — Muscular Contraction. — Pain. — Decubitus. — Petechife. — Temperature. — Pulse, etc. — Phenomena of Vision. — Deafness. — Phenomena preceding Death. — General Summary of Symptoms. — Duration and Mortality. — Post-mortem Appearances. — Case reported hy Surgeon Joseph Jones. — Note by the Compiler. — Commentary by Dr. Jones. — Commentary by the Compiler. — Dr. Webber's Division into Three Orders. — Surgeon Russell's Observations. — Dr. Upham's Observations. — Dr. San- derson's Report of Autopsies. — Petechise. — Further Autopsies. — Treatment — Sur- geon Russell's Report. — Dr. .L Baxter Upham's Account. — Dr. Webber's Views. — Dr. Sanderson's Report. — Comments by the Compiler. — Etiology. — Climate. — Exposure. — Prisons and Barracks. — Epidemic Constitution. — Sex and Age. — Summary. — Is Cerebro-Spinal Meningitis Contagious ? 383

CHAPTER TWELFTH.

ON THE DISEASES OF NERVES, RESULTING FROM INJURIES.

Purpose of this Chapter. — Previous Publications. — Primary Symptoms of Wounds or other Injuries of Nerve Trunks. — Case of Choreal Affection of Right Fore-arm and Shoulder after Amputation at the Wrist. — Classification of Modes in which Nerves are Injured. — Case of Injury by Contusion. — Crutch Palsy, and Palsy from other Modes of Pressure. — Case of Crutch Palsy. — Injury by Contusion. — Cicatricial Changes producing Ner^'e Injury. — Propagated Disease of Nerves. — Case. — Clas- sification of Local Symptoms. — An Imaginary Case. — Changes in the Nutrition of Parts, the Nerves of which have been Injured. —Muscular Atropy. — Muscular Con- tractions.— Tonic Spasms. — Distinct Nutrient Nerve Fibres. — Certain Diseases of the Skin belong among the Nervous. — Case of Herpes. — Effect of Wounds on the

XXU(

CONTENTS. xvii

Nutrition of the Skin and its Appendages. — Glossy Skin. — Case of Intense Neu- ralgia, with Motor Palsy, etc. — Hypertrophy of Areolar Tissue of the Hand from "Wound of Nerve. — Case. — Inflammation of Joints. — Effect on Secretions. — Le- sions of Sensation. — Classification of these Lesions. — Hyperoesthesia. — Anaesthesia and Analgesia. — Delay in Transmission of Sensations and Volitions. — Slow Pas- sage of Neural Impressions in Injuries of the Medulla Spinalis. — Retardation of Electrical Current. — Burning Pain. — Defects of Motion from Wounds of Nerves. — Different Ways in which Nerve Lesions affect Motion. — Paralysis. — Shortening of Opponent Muscles. — Spasm. — Prognosis of Wounds of Nerves. — Palsy of Nerves at a Distance from the Seat of Injury. — Case. — Treatment as regards Pain. — Case.

— Treatment of Nutritive Changes, and of the Paralysis. — Blisters. — Active and Pas- sive Motion. — Shampooing. — Hot and Cold Douches. — Electricity. — Electro- Muscular Contractility. — Electro-Muscular Sensibility. — The Interrupted Current and Electro-Galvanic Machines. — Direct Galvanism. — Electrization of the Skin. — Electrization of the Muscles. — Application of Electricity to Diagnosis and Prognosis.

— Mode of Employing Electricity as a Therapeutical Agent. — Constitutional Treat- ment of Wounds of Nerves. — Illustrative Cases 412

SECTION THIRD. CHAPTER FIRST.

GENERAL VIEW OF THE MEDICAL TOPOGRAPHY AND CLIMATE OP CAMP SCMPTER, ANDERSONVILLE, GA., AND OF THE COUNTRY IN THE IMMEDIATE VICINITY.

Character of Soil. — Elevation. — Geological Position. — Character of the Waters of Andersonville. — Waters of the Streams, Wells, and Springs within the Stockade (Confederate States Military Prison), and within the Military Prison Hospital. — Veg- etation.— Animals. — Climate 483

CHAPTER SECOND.

DESCRIPTION OF THE CONFEDERATE STATES MILITARY PRISON AT ANDERSONVILLE.

Stockade. — Number of Prisoners confined in the Stockade during the Months of March, April, May, June, July, and August, 1864. — Area of the Stockade in Square Feet at Different Times. — Square Feet of Ground allotted to each Prisoner. — Physical Con- dition, Food, Clothing, Habits, Moral Condition, Diseases, and Deaths. — Scurvy, Diarrhoea, Dysentery, and Gangrene. — Condition of Sick within Stockade. — Morn- ing Sick Reports. — Manner of Disposing of Dead. — Character of Food . . . 501

CHAPTER THIRD.

CONFEDERATE MILITARY PRISON HOSPITAL AT ANDERSONVILLE, GA.

Physical and Moral Condition of Sick. — Defective Hygiene and Police of Hospital. — Accumulation of Filth. — Flies. — Mosquitoes. — Manner of Disposing of the Dead. — Defective Cooking Arrangements. — Improper Food for Sick. — Foul Air of Filthy Tents 519

CHAPTER FOURTH.

CONSOLIDATED REPORT