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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 OF SICK AND WOUNDED FEDERAL PRISONERS AT CAMP SUMPTER, ANDERSONVILLE, GA., MARCH TO AUGUST, 1864.
Number of Cases of Disease treated during Six Months, with Deaths. — Per Cent, of Deaths from all Causes, and from various Diseases, as Typhoid Fever, Scurvy, Diar- rhoea, and Dysentery. — Inspection and Sanitary Reports on File in the Oflice of the Chief Surgeon 524
XY^'
xvm CONTENTS.
CHAPTER FIFTH.
COKSOLIDATED REPORT OF SICK AND WOUNDED CONFEDERATE SOLDIERS ACTING AS A GUARD TO THE FEDERAL PRISONERS AT CAMP SUAIPTER.
Comparison between the Diseases of the Federal Prisoners and Confederate Soldiers performing Guard Dutj'. — Malarial and Typhoid Fevers more prevalent amongst the Confederate Troops. — Hospital Gangrene amongst the Confederate Troops . . 553
CHAPTER SIXTH.
DISEASES OF FEDERAL PRISONERS AT ANDERSONVILLE WHICH WERE REFERABLE TO CLIMATIC CHANGES, EXPOSURE, ETC.
Diseases of Federal Prisoners confined at Andersonville, which were referable chiefly to Climatic Changes and Influences. — Malarial Fevers; Quotidian, Tertian, and Quar- tan Intermittents ; Remittent and Congestive Fevers. — Sun-Stroke. — Comparison of the Statistics of Malarial Fevers amongst the Federal Prisoners, with the Sick Re- ports of the Confederate Troops.
Diseases amongst the Federal Prisoners which were referable in a large measure to Ex- posure without Proper Clothing and Shelter from the Hot Sun, Rain, Dew, and Night Air. — Pneumonia, Pleurisy, Bronchitis, Catarrh, Acute and Chronic Rheumatism, Pericarditis. — Relations of Rheumatism to Scurvy 566
CHAPTER SEVENTH.
DISEASES DEPENDENT UPON THE ACTION OF SPECIFIC POISONS, AND SUPPOSED TO ARISE FROM CROWDING AND FOUL EXHALATIONS.
Typhus Fever. — Typhoid Fever. — Small Pox. — Measles 600
CHAPTER EIGHTH.
DISEASES OF THE FEDERAL PRISONERS DUE TO LONG CONFINEMENT, DIET, EXPOS- URE, ETC.
Diseases of the Federal Prisoners due to Long Confinement, Sameness of Diet, Salt Meat, Absence of Fresh Vegetables, Milk, and Sugar. — Scurvy and its various Mani- festations and Effects, Scorbutic Ulcers, Dropsy, Enlargement of Parotid Glands, etc.
Diseases Referable in a Measure to Long Confinement upon the same Diet, to Exposure without Proper Shelter, and to Crowding and Personal and General Filth. — Diarrhoea and Dysentery. — Hospital Gangrene. — Illustrative Pathological Observations. — General Conclusions 619
CHAPTER NINTH.
GENERAL CONCLUSIONS.
General Conclusions drawn from the Preceding Investigations upon the Diseases of the Federal Prisoners confined at Andersonville .612
SECTION FIRST
CONTRIBUTIONS
RELATING TO THE
CAUSATION AND PREVENTION OF DISEASE.
The contributions selected for Section First of this volume relate to topics belonging to General Pathology. These topics, for the most part, are etiological, having reference especially to the diverse causes incident to the camp and the field, tending to impair physical endurance, and diminish the power of resisting disease; and these causes are considered with special reference to their practical bearing on Prophylaxis, or the prevention of disease. Causes and preventive means are considered in this section, with some exceptions, in rela- tion to disease in general; individual diseases are considered with reference to their causa- tion and prevention, as well as under other aspects, in Section Second, which is devoted to Special Pathology. The relatively greater importance of the topics embraced in Section First entitles it to precedence in the order of arrangement. The several chapters of this section, embodying, as they do, the experience of distinguished members of the medical profession who served as medical ofHcers during the war of the rebellion, will commend themselvi-s to the attention of the reader, in view of the importance of the topics as regards the preservation of the life and health of the soldier, and thereby the efficiency of armies in active service.
SANITARY MEMOIRS OF THE WAR.
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.
By ROBERTS BARTHOLOW, A.M., M.D.,
PROFESSOR OF PHYSICS AND MKDICAL CHEMISTRY IN THE MEDICAL COLLEGE OF OHIO, ETC.; FORMERLY ASSISTANT- SURGEON U. S. ARMY.
Influences previous to Enlistment. — Qualifications for Military Service, relating to Race, Temperament, Occupation, Age, etc. — Causes affecting Physical Stamina subsequent to Enlistment, relating to Exposure, Diet, Overcrowding, and the Lack of Cleanliness. — The Mental and floral Effects of Association. — Liability to specific Febrile Affections. — Causes affecting the Physical Stamina in Active-Service, Climatic, 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-Urhiary Apparatus, of the Extremities, and Constitutional or General Aflections. — Detection and Treatment of the various Forms of feigned Disability. — Discharges on Surgeon's Certificate.
The various influences affecting the physical endurance of the men composing our volunteer armies, their power of resistance to disease, etc., may be comprehended in four groups, namely : —
1. The influences in operation previous to enlistment ;
2. The causes affecting the physical stamina of the recruit sub- sequent to enlistment ;
3. The causes affecting the physical stamina of the soldier in active service ; and,
4. Moral causes, as malingering, desertion, nostalgia, etc., in operation during the whole period.
I.
Under the first head must be included an outline of the quali- fications of a recruit for the military service : race, tem- Quaiifica-
, . , "^ . , . „ tionsformU-
perament, occupation, age, height, weight, capacity of itary service. thorax, muscular development, and a proper performance of the functions of animal and organic life.
4 QUALITIES OF THE CELTIC RACES.
The races composing our volunteer army consisted, cliiefly, of Kaces com- American, Celtic, Teutonic, Negro, and the mixed Span- voiinier ish-American of New Mexico. The term American *^'^- applies, of course, to the composite race now inhabiting
the continent, and not to the aborigines. It will be useful to con- trast, in no invidious spirit, the aptitude for military service and the power of endurance respectively displayed by these several races. As regards these quahties, they stand to each other in the relation in which they are placed above — the American first and the Spanish-American last.
The mental characteristics that fit the American for the military American scrvicc cousist of a Spirit of enterprise and an intel- acteristics. lectual liardiliood which render him superior to fatigue ; an easy bearing under defeat, and a buoyant self-confidence which misfortunes do not easily depress. The national vanity and love of popularity may have much to do in the formation and develop- ment of these mihtary qualities. So acute an observer as Dr. Jackson ^ formed a very different opinion of the American char- acter. " The people of North America are deficient in two qual- ities that are essential to the formation of military force, namely, the subordination which submits patiently to such forms of mould- ing and discipline as render the human race a machine, obedient to the will of a general to whatever point it may be applied ; or, secondly, the ardent love of country, which, rising to enthusiasm, produces acts of individual heroism beyond the calculations of tac- ticians and superior to the arts of mere mechanism." Events have not justified the harsh criticism of Dr. Jackson.
The physical qualities which fit the American for military ser- American vicc consist, uot SO mucli in muscular development and quauties. height as in the toughness of his muscular fibre and the fi'eedom of his tissue from interstitial fat, whereby active and pro- longed movements are much facilitated. In active service he fails more fi-equently from defects in his digestive apparatus and fi'om a phthisical tendency, than fi:"om a lack of power due to imperfect physical development.
The Celtic races possess similar qualities, and in respect of Qualities of merely physical development are not unequal to the
tnc Celtic k • 1 t t t • rh
races. AmcHcau, but they have less tenacity of purpose and
mental hardihood. As mercenary soldiers they did not exhibit the same zeal, energy, and power of endurance. They submitted with less patience than the Americans to the requirements of discipline,
1 Economy, Formation, and Discipline of Armies, p. 230.
THE MIXED RACE OF NEW MEXICO. 5
were frequently turbulent under hardships and given to complaints about the rations and fatigue duties. Irish laborers were especially notorious for their dishke to fatigue duties. .
The German element of the volunteer army did not equal the American or Celtic in the physical capacity for military German eie- service. There are certam detects ot structure, common army. in a greater or less extent to all Germans, which impair their pow- ers of endurance — a predominance of the lymphatic temperament ; a patulence or unusual weakness of the abdominal rings ; flatness of the feet, and a tendency to a varicose condition of the veins of the inferior extremities.
The German carries into the mihtary service many of the men- tal and moral qualities for which he is most conspicuous in civil life, namely, thrift, fondness for good living, and a love of ease and enjoyment. The first inclines him to serve for hire and to make the most of his opportunities for emolument ; the second produces discontent, and even unfits him for service when the rations are deficient ; and the third renders him restive under hardships and exposure.
The Negro possesses many of the physical qualities pertaining to the hio;hest type of the soldier : sufficient heip-ht, a due The physical
I 1 1-1 1 -111 qualities of
correspondence between height and weight, ample tho- the Negro. rax, and considerable power of endurance. His chief physical defects are small, ill-developed calves and bad feet, and a proneness to disease especially of the pulmonary organs. Having the faculty of imitation highly developed and being fond of the exterior show and parade of military life, he readily becomes an adept in the mechanical training of the soldier. The Negro soldier is, unques- tionably, less enduring than the white soldier ; less active, vigilant, and enterprising, and more given to malingering. The Mulatto is feebler than the Negro, invariably scrofulous, and more fi'equently the subject of pulmonary disease.
The mixed race of New Mexico is inferior to the Negro. Of three reo-iments raised in New Mexico at the beo-innino; The mixed
n ^ -IT nf^ '^ race of New
01 the war and examined by me, scarcely one fifth were Mexico. fitted for service. The chief defects were, feebleness of constitu- tion, the syphilitic cachexia, impaired vision, defoi-mities of the hands and feet, and diseases of the urinary organs. They are cowardly, unrehable, and difficult to control, in consequence of a very mercurial temperament.
It is not easy to determine how far those special physical char- acteristics, denominated temperaments, influence the will, the moral
6 CONDITIONS FAVORABLE TO MILITARY SERVICE.
qualities, and the power of endurance. It is probably true that Influence of the light-haired, blue-eyed — the sanguine, are more sus- m^^ts^'^ ceptible to the influence of malaria, to diseases of the spleen, and to albuminoid degeneration of organs ; the dark tem- peraments to diseases of the hver, to dysentery, and to pneumonia. The influence of temperament over the moral quahties will be considered more properly in the fourth group.
The influence of occupation upon the physical health is obvious Influence of euough. Tliosc wlio pui'suc scdcutary trades, who hve occupation, jj^^cli iu-doors, or who are exposed in the course of their business and pursuits to crowd-poisoning, or to vitiated air from any cause, are by no means so well fitted for military service as those whose employments require them to spend much time in the open air, especially in the open air of the country. Hence farmers, lumbermen, and railroad men are better prepared to endure the hardships of a soldier's life than clerks, weavers, shoemakers, etc.
Thirty years is undoubtedly the most suitable age for military Age suitable scrvicc, for at tliis period the development is complete, service. tlic body is iuurcd to climatic vicissitudes, and is, in most instances at least, more or less familiar with hardships, and the rea- son has acquired somewhat more control over the appetites and passions. The Enrollment Act fixed the minimum age at 20 years, and the maximum at 45 years. This wise regulation was frequently disregarded, except in the case of drafted men. It w^as not un- common to find youths of 15 years and old men of 60 years in the ranks, but more frequently in the hospitals. In the English ser- vice the minimum age is 18 ; in the French and Prussian 20, and in the Austrian 19. As a majority of the most military nations have so decided after considerable experience, the age of 20 years must be regarded as the earliest suitable age for the miHtary service.
The medium height, a weight of 160 pounds, 33 inches in the Other condi- girth of the clicst, and an expansive mobility of 3 inches, favorable to cceteHs paHhus^ present the conditions as to physical health vice. most favorable to military service. Symmetry is by no
means so important as swelling muscles, well-marked bony promi- nences and well-developed joints — for these are the evidences of power and endurance. Great height is fi:equently objectionable, because gained at the expense of the development of the thorax. The rule is, that the girth of the chest at the level of the nipple should equal half the height, but in tall men this rule may be vio- lated. Excessive weight or obesity is still more decidedly disqual- ifying than excessive height.
CAUSES IN PREVIOUS LIFE AFFECTING STAMINA. 7
Perfection of the senses is essential. The organs of special sense should not only be free from disease, but they should have that ready appreciation of their appropriate stimuli, which is a proof of the healthy activity of the central nervous system. The functions of all the organs should be so well performed that the happy balance between waste and supply should be maintained.
Besides these physical requirements, there are certain mental states favorable, and certain others unfiivorable, to the proper per- formance of military service. The soldier should possess a cheerful disposition, a calm temper, and that indifference to danger and fatigue which is more frequently the result of mental forces than physical strength.
^e assume that the recruit submitted to the usual inspection conforms to the standard as set forth in the preceding causes in paragraphs. The question then occurs, What causes affecting ^^*^ arising in his previous life and experiences may affect his **^°"°*- physical stamina, independently of the new conditions to wdiich he is subjected immediately on enlistment ? These causes may include certain hereditary diseases, as insanity, epilepsy, scrofula, and tuberculosis ; and such acquired cachexise as the chronic mal- arial poisoning, masturbation, chronic alcoholismus, and incipient disease of important organs. Although not recognizable on ordi- nary examination, these conditions may yet exist in sufficient degree to be readily excited by ordinary causes into well-defined morbid processes.
The operation of these occult causes of disease in recruits ante- cedent to enlistment is shown in the following statistics : In 15,500 discharges on surgeon's certificate, as examined by me at the War Department, there were 154 for mental infirmities, 341 for epi- lepsy, 411 for various cachexias, 44 for bad moral character, and 3593 for diseases of the chest. A large majority of these were either hereditary, or existed in modified form at the time of enlist- ment.
Many of the causes affecting the physical stamina of the recruit previous to enlistment might have been recognized by proper care and diligence in the examination. The neglect to examine men in the beginning of the war, and the lack of thoroughness in the examinations afterward, increased the number of men serving, but diminished the relative efiiciency. The statistics bearing on this point are quite conclusive. Thus, in 15,500 discharges, there were 388 for disqualifications due to age, and 209 for natural feebleness of constitution, both of which are recognized without difficulty.
8 LIFE AT THE DEPOT OF RECRUITS.
II.
The recruit makes a sudden transition from a natural to an arti- sudden ficial state without any preparation for the change. It the recruit may bc achuittcd as true, at least of a large majority of ciai state. the pcoplc of tliis couutry, that the recruit has had suffi- cient food, and in proper variety ; that he has been suitably clothed ; that he has had undisturbed sleep as many hours as his health required; that he has had the necessary air-space in his daily avocations and during his sleep at night; and that he has been able to avoid the more trying vicissitudes of the weather. Those who have not enjoyed similar comforts are, it may be safely affirmed, usually unfitted for military service.
As soon after enlistment as possible, the recruit is hurried to the Life at the dcpot ; he is supplied with army rations badly cooked and recruits. uncleauly served ; he is drilled vigorously several hours each day ; at night, furnished with one or two blankets and occa- sionally a little straw, he is thrust into a tent with a large number of others, or into crowded temporary quarters, where he is sub- jected to horribly impure air, frequently to cold and dampness, and always to excessive discomfort, or he is required to perform a tour of guard duty which interrupts his habit of nightly repose ; but slender opportunities of washing and bathing are afforded him, and he is at all times exposed to the influence of the unwholesome air of badly-policed camps and quarters, and to the emanations fi'om his comrades sufferino; under various contagious maladies.
Scarcely any depot of reciniits was an exception to this descrip- tion during the rebellion. Some of these evils of necessity grew out of the military service, and could not be eliminated from it ; but many more were entirely preventable. To a military man, a recruit is a piece of mechanism, to be adapted to the needs of the military service ; and the shortest method to accomplish this object is the best. Hence, a kneading and compressing process is fol- lowed. With the few recruits for the regular military establish- ment, this process may be pursued with less extensive injury ; but mental, moral, and physical consequences ensue to the volunteers, which limit their efficiency in service, and often prove fatal to them at the outset. It will be useftil to consider, in the first place, the physical consequences which ensued by reason of the improper hygienic management of recruits ; for the mental and moral conse- quences largely depended on the physical.
The several drafts of men after the three months' service were
DIETETIC CAUSES OF DISEASE. 9
so issued that the recruiting and organization of troops occurred mainly in the fall, winter, and spring. The buildings Exposure in at the camps of rendezvous in the various States were etiect's. wholly inadequate, and hence, the recruits, as a rule, were placed in tents. Suitable provision, in these places, could not be made against vicissitudes of weather and dampness. Drainage, ventila- tion, and police of camps and quarters, were usually neglected. Guard duty at night, and exhausting drills, lessened the vital forces. Heated and fatigued by drill, the recruit was too much accustomed to throw himself upon the damp straw or blankets. Catarrhal and pulmonary affections were produced, the more promptly in the case of those recruits — a large number — who were not at all habituated to such experiences.
Dietetic causes were scarcely less important agencies in the production of disease than climatic. Large numbers of Dietetic
, Till 111 causes of
recruits bemg suddenly thrown together at the depots, disease. little provision was made, or, indeed, could be made, for the suit- able preparation of food. The recruits themselves were wholly ignorant of the culinary art; there was neither time nor oppor- tunity to instruct them ; cooks were not provided, and the utensils issued were most inadequate for the purpose. Moreover, the components of the ration were not adapted to the peculiar circum- stances ; they were sufficiently various and in sufficient quantity, but were not in a form available to recruits unaccustomed to the preparation of food. Hence, in the midst of abundance, sufferhig from hunger was not uncommon. The effort to have the cooking done by companies was hardly accomplished, even with troops in the field, by the end of the war ; and this system was not practi- cable with recruits who had no company organization, or, if organized into temporary companies, had no homogeneity nor completeness of detail in respect to company management. It usually happened that a squad of three or four organized them- selves into a mess, each contributing his rations to the common stock, and alternating in the duties of cooking. The results were not satisfactory. An American intrusted with cooking for the first time, thinks only of frying. Flour made into a paste with water was usually fried in the fat of the bacon, or made into loaves with baking powder, if the cook possessed so much skill or experience. Beef was invariably fried, and the beans and rice frequently also. Being unprovided with suitable receptacles for their stores, and unskilled in defining their daily quantitative allowances, they were frequently without food for a day or two
10 DIETETIC CAUSES OF DISEASE.
preceding the time for issue. Improvements were made, especially by constructing ovens and issuing baker's bread in lieu of flour, but the cooking by messes continued the rule throughout the war.
Eating badly-cooked food hastily, and without relish, resulted in indigestion, flatulence, and diarrhoea. Beans probably contributed, more than any single article, to the production of these intestinal troubles. They were almost always insufficiently cooked by recruits, to whom indeed they were not familiar as an article of human food, if we except the troops from New York and the New England States. It has frequently happened to me to observe an increase in the percentage of diarrhoea and dysentery on the day after the issue of bean soup. In a body of four hundred recruits, every man came on to the "sick report" with one of these disorders in the space of three months, and one fifth came more than once. Beans have been continued in the supplies of the commissariat upon a theory of their nutritive value, based upon a proximate analysis ; on account of their portability, and because they do not readily undergo change. Whatever may be their value in these respects, there can be no doubt that they are hurtftil to recruits, who do not have the necessary skill in preparing them, and who, by various causes, are rendered peculiarly susceptible to their UTitant action upon the intestinal mucous surface.
The Napoleonic maxim — the soup makes the soldier — was not sufficiently attended to at our recruiting depots, l^ean soup re- quires more artistic skill in its preparation than other plain soups, but was more frequently made. The distribution of the rations to individuals prevented the preparation of food on a large scale. The waste of this system rendered it more expensive to the gov- ernment than ample provision for cooking would have been. Moreover, the destruction in health and life was hardly to be estimated in the pecuniary sense. If this view had governed the authorities, so great was the cost of a soldier that money would have been well expended which insured his preservation in health and efficiency.
These dietetic causes influencing the health of recruits would not be complete without some reference to the irregular sources of supply, available in the sutlers' shops and booths permitted in the camps. The chief profits of the sutler were derived from the sale of fruits and " fancy groceries " — to use a commercial phrase — which the recruit too eagerly purchased to enrich his meagre diet, or supply the loss of misused rations.
Overcrowding of tents and quarters was a fruitfril source of
MORAL EFFECTS OF ASSOCIATION. 11
mischief. This was especially observable at night and during bad weather. The air of those places became quickly overcrowd- foul — loaded with organic emanations and with carbonic Ln^d*l[uar'i*^ acid, and deprived of much of its oxygen. On entering **^^' the ten\s or quarters under these circumstances, there was imme- diately to be perceived a strong " animal odor," the more diffuse and powerful when the personal cleanhness of the men had been neglected. Headache, nervousness and tremors, a coated tongue and nausea, were frequently experienced by recruits subjected for a single day or night to the influence of such an atmosphere. Moreover, the increased action of the capillaries of the integu- ment, the relaxation of the bronchial mucous membrane, and the diminished urinary secretion occurring under these circumstances, greatly favored the reception of morbific agents, and disposed to attacks of catarrh, bronchitis, and pneumonia, from slight causes. Tliere can be no question that organic matter in a state of minute subdivision, derived from a number of persons crowded into a con- fined space, possesses considerable morbific power, especially in the production of intestinal diseases; for, absorbed into the blood, these particles are excreted mainly through the mucous surface of the alimentary canal.
A lack of personal cleanliness was little less promotive of disease than the causes already enumerated. The water supply, ^a^^ ^f at the inland depots especially, was never equal to the <'^^'^°^i°«s3- requirements ; hence, if the recruit possessed the inclination, he had little opportunity to keep his person clean. Example arid instruction were wanting as well as opportunity. Every thing about him being dirty and disagreeable, the necessity for cleanli- ness was by no means apparent. It was painful to see at all the depots the slovenly, slipshod appearance of the clothing and accoutrements of the recruits, their filthy skins, uncombed hair, and matted beards.
The association of men in masses or herds, rapidly produces mental and moral degeneracy. In their fives being assimi- Moral effects lated to that of animals, their minds conform to the same tion. standard. This brings us to consider the influence of these condi- tions and experiences upon the mental and moral qualities of the recruit. The great change in his habits and modes of life, asso- ciated with so much that was disagreeable and repulsive, induced in the recruit, if not possessed of considerable fortitude and per- sonal resources, a state of deep dejection, hypochondria, and nostalgia. This was especially to be observed in young men and
12 LIABILITY TO SPECIFIC FEBRILE DISEASES.
married men of mature age. If there existed any hereditary tendency to insanity, this state of despondency, hypochondria, or nostalgia, powerfully contributed to its development ; hence, mental disorders arising during the war occurred more frequently in re- cruits than in soldiers of more than a year's service.
The mental impressions of these first experiences of the military service, if not sufficient to induce insanity, lead directly to various mental and moral disorders. Malingering was suggested as a ready expedient for avoiding fiirther service ; desertion was con- sidered if not attempted. The monotony of the life and the unaccustomed restraint, together with the hardships to which they were exposed, disposed recruits, when occasion offered, to run into excesses of drinking and venery. They became intoxicated and indulged in venereal excesses who were not accustomed to do so before enlistment: the forces repressed by military training thus broke bounds and ran riot.
The recruit is thus exposed to ordinary and extraordinary causes
The diseases of discaSC.
ordinary and He is affcctcd by discascs of those organs and systems nary causes, most taxcd uudcr the conditions of his new life and experiences : diseases of the respiratory organs ; eruptive diseases ; intestinal diseases. By reason of overcrowding and other causes, typhoid fever may be developed, or if the depot be placed in a malarious district, malarious diseases may occur. The considera- tion of these may be excluded, because not characteristic of the special conditions under which the recruit is placed.
Catarrh, bronchitis, pneumonia, measles, mumps, diarrhoea, and dysentery, were the diseases which chiefly affected recruits at the depots during the war. It is easy to conceive that exposure to cold, to humidity, to sudden and extreme changes of temperature, — ordinary causes in the experience of recruits, — should produce catarrh, bronchitis, and pneumonia, or should favor the propaga- tion of influenza, diphtheria, and the exanthemata. These forms of disease occur under similar conditions in civil life. Recruits were more subject to them than the same number of civilians of corresponding ages, because they were placed in circumstances more fully exposing them to the action of morbific agents.
The point of chief practical interest in this connection is. What Liability to agency had the new life and experiences of the recruit in di,^eases. produciug or favoring the spread of the specific febrile affections (mumps, measles, influenza, etc.) ? A variety of opinions have prevailed on this point. We may find a solution of the prob-
CAMP MEASLES. 13
lem in the clinical history of measles, — the most wide-spread and fatal of these diseases, — for, since they all present strong analogies in their history, the study of one will serve to elucidate the rest.
A popular and, to a certain extent, professional opinion existed during the war, which referred camp measles to a specific c^mp cause arising in the special conditions in which the recruit ™®*«^e«- was placed. .One observer (Dr. Salisbury^) proceeded so far, indeed, as to fix upon a variety of the penicillium, which he found upon damp straw used for bedding, as the cause. His views were accepted, probably without sufficient examination, by so distin- guished an author and observer as Dr. Hammond.^ On the other hand, they were wholly denied by Dr. Woodward.^ It was gen- erally believed that camp measles differed from ordinary measles in occurring several times in the same individual.
Some interesting statistics have been collected in elucidation of these questions.
Eight hundred cases were treated in two hospitals under my direction in a period of four months — January to April, 1864. The average mortality was 22 per 100. Of 100 cases set apart for special examination, 96 were recruits, and 28 of these were 18 years of age, and 68 from the ages of 17 to 20, inclusive. In one regiment, which came specially under my observation, every man contracted measles who had not had it in early life. This was the rule in all regiments exposed to the poison. This state- ment is supported by the fact, that in 100 cases 91 had not suf- fered at any period in life firom measles, and only 9 supposed they had had this disease, but were not at all certain.
These facts in the clinical history of measles would seem to indi- cate that this disease was propagated by contagion, and that it occurred amongst young recruits because they had not hitherto been exposed to the specific poison, and that the epidemics were more severe amongst these subjects because they were placed in the most favorable condition for the development of the morbific matter. The skin, bronchial mucous membrane, and intestinal tract, whose several surfaces may be considered as organs perform- ing offices in some respects vicarious of each other, were deranged in their normal relations, and rendered exceedingly susceptible to the action of poisons or common causes of disease.
It is thus evident how a large class of diseases arising from specific and ordinary causes were favored in their development by
1 American Journal of the Medical Sciences, 1863.
2 Treatise on Hygiene. s Camp Diseases.
14 CAUSES AFFECTIKG PHYSICAL STAMINA IN SERVICE.
conditions and experiences affecting the recruit. These con(Htions and experiences produced a morbid state, in which a feeble, con- tagious influence only was necessary to give rise to formidable epidemics of influenza, mumps, and eruptive fevers.
The operation of the dietetic causes already discussed, are appar- ent enough. Improper alimentation acted the more promptly in the production of intestinal disorders by reason of the derange- ment in the vicarious oflice of integument and mucous membrane alluded to in the last paragraph. It may be safely assumed as a fact, that few recruits passed through the first experiences of the mihtary service without suffering from diarrhoea or dysentery^ This is shown to be the case by the statistics of the first year of the war. Thus, in the armies of the interior region the proportion of these diseases was 994.77 per 1000 of mean strength.
III.
The influence of the various conditions and experiences affect- Causes affect- iug the recruit were not always manifested in the forms Btfminrin* dcscribed in the preceding section. It was to be observed Tice. " at every recruiting depot that many recruits fell out of condition who were not affected with a well-defined morbid process to which a specific nomenclature could be applied. Many of them suffered lesions, eventuating in permanent organic changes, which appeared after entering upon active service. Diseases of the lungs and kidneys, diarrhoea and dysentery, may be classed in this cate- gory.
The mortality, or the various degrees of disability, arising from camp measles, are not to be represented in the tables of immediate loss. Many cases of pulmonary tuberculosis and dysentery, which subsequently proved fatal or required discharge from the service, originated in camp measles at recruiting depots. Mumps is to be regarded from the same point of view. Whatever ill effects occur beyond the immediate sickness, are not developed at the time, but the seed is sown which ripens into a plentiftil harvest. Various glandular affections and diseases of the testes, especially varicocele, may be traced back to an attack of mumps.
In this section, those causes of disease which result fi'om actual service are to be discussed. They may be conveniently considered under the following heads, namely : —
Climatic; Accidental; Dietetic;
Specific ; Moral ; Compound.
It is assumed that the soldier has passed through the chrysalis state
INFLUENCE OF SEASONS. 15
of recruit, unliarmed by the causes of disease to which he was then subjected.
The climatic causes affecting the physical endurance of the sol- dier, were the first to which he was exposed during the climatic rebellion. A vast majority of those who entered the ^"^"^e^- military service were to a great degree unaccustomed to changes of climate. Men, indeed, possess an inherent indisposition to un- dergo these changes. This fact finds an expression in the well- known law of emigration, that movements of populations take place along the isothermal lines to which they are accustomed. This law is probably founded in a necessity of the human constitu- tion, which requires for its highest development uniformity in the conditions surrounding it. An opinion has widely prevailed that our troops during the late rebellion experienced no ill effects from the changes of climate. This opinion has no foundation in fact. But whatever ill effects were experienced from this cause were not sufficient in extent to have occasioned very decisive results. Still, this influence of climate is rendered apparent enough by contrast- ing the mortality rates of troops operating in widely separated par- allels of latitude. Thus whilst the average annual mortality of the United States army during eighteen years of peace service was 24 per 1000 of mean strength, durmg the Mexican war it rose to 103.8 per 1000. Contrast the mortality of the Mexican war with that of the first year of the rebellion — 103.8 : 67.6. The differ- ence, amounting to 36.2 per 1000, was largely due to the influence of change of climate. This influence was also exhibited in the mor- tality rates of the armies operating in different sections of the coun- try. Whilst the mortality of the army of the Potomac and the troops on the Atlantic coast was 33.40 per 1000 of mean strength, that of the armies operating in the interior — on the Mississippi and its tributaries — was 82.19 per 1000. In estimating these re- sults it must be understood that the influence of climate was only one of numerous elements to be considered ; but it was, neverthe- less, a substantive element.
The mortality rates and the percentage of sickness as influenced by season, illustrate the mode in which chmate affects the influence of physical endurance of men in active service. Whilst the s*"'^'*"^- maximum mortality of the armies of the interior region was attained in January, February, and March, the period of greatest sickness was in the months of August, September, and October. On the other hand, April, May, and June were the months of greatest mortality, and July and August of greatest sickness in the armies on the Atlantic coast.
16 DIETETIC CAUSES.
The particular forms in which these cHmatic causes expressed themselves were catarrh, bronchitis, pneumonia, diarrhoea, and dys- entery.
The dietetic causes affecting the physical endurance of men in Dietetic activc scrvice were similar in character to those of re- causes. cruits. So loug as the supplies of the commissariat were
regularly furnished, the effects were the same ; but they were more evident in the former, because the cause was longer in action. In addition to this circumstance, soldiers in the field experienced various vicissitudes in the character and quality of their supphes. The amount of aliment furnished to the various armies was deter- mined by the transportation available for bringing it forward, and by the so-called " miHtary necessity." The armies operating in the interior region were more affected by deficiencies in commissa- riat supplies than those on the Atlantic coast. Thus, the army under General Buell was for many days subsisted on com chiefly, and such precarious supplies as could be procured from an impov- erished country. General Grant's army, in the campaign before the investment of Vicksburg, was reduced to similar dietetic expe- dients. The army encamped at Chattanooga, pre^dous and for some time subsequent to the battles of Mission Ridge and Lookout Mountain, was restricted to httle more than one fourth rations in consequence of deficient transportation. Irregularity and defi- ciency of supplies were, then, important dietetic causes, but they can hardly be considered the chief causes. For men exposed as our soldiers were to various morbific agencies, the diet was not sufficiently varied. Hard bread, pork, beans, and coffee, which were practically the elements of the diet, did not fulfill all the ne- cessary conditions. Antiscorbutics came to be furnished afi:er the first year of the war, but the chief antiscorbutic — the potato — was practically unavailable from the difficulty of transporting and preserving it. Cabbage, pickled, was also supplied ; but however valuable as an antiscorbutic, it was indigestible and provocative of intestinal disorders.
Inexpert preparation of food, cooking by messes instead of com- panies, and the use of baking powders, may be classed as dietetic causes. The latter was by no means unimportant. Whenever flour was issued, and sutlers' supplies could be obtained, the men were accustomed to prepare bread with baking powder — a vile compound of flour and soda remarkable for hardness and indigesti- bihty.
The unripe fruits obtained in the regions where the various com- mands operated also acted as a dietetic cause of disease.
CROWD-POISONING. 17
«
In considering the accidental causes^ we necessarily exclude trau- matic lesions as not coming within the scope of this chap- Accidental ter. Various influences are to be discussed under this *^^"''®^- head, namely : all those conditions comprehended in the term, had hygiene ; exhausting marches, fatigue, scorbutus, etc.
Troops on the march, cceteris paribus, are more favorably situ- ated as respects hygienic conditions than troops in camp, ^t^^ ^^^.^^^ Fatigue and limited subsistence stores are frequently less ^inhanThe injurious than the various influences of the camp. The '^^^^ injurious effects in camp are exhibited in proportion to the disci- pline of the troops. There is a direct ratio, usually, between the sickness and mortality of the camp and the degree of attention to police and sanitary regulations. The morbific influences of the camp, excluding malaria and scorbutus, are such as arise from de- ficient drainage, bad police, contaminated water-supply, and crowd- poisoning.
Dampness of the soil and humidity of the air affect the respira- tory organs and the alimentary canal, producing catarrh. Dampness of pneumonia, diarrhoea, and dysentery. The accumulation it'^y/iLTim- of the debris of camps, of offal and of sinks, produced P^'^e^^'e^'- that condition of the atmosphere in which fevers of the continued type occuri'ed. The neglect to dig sinks, or to preserve in a proper condition those already constructed, proved injurious in numberless instances. The air of the camps was polluted not only by this cause but by the decomposing offal from the kitchens, which, thrown on to the ground, underwent decay with other vegetable organic matters in the soil. The water-supply was frequently contami- nated in the same manner. When large bodies of troops were encamped on small streams the water quickly became infected, if not by the direct addition of camp filth and the contents of the sinks, indirectly through the surface ch'ainage. The character of the water itself constituted in some instances a source of disease. Streams flowing through alluvial bottoms became saturated with organic matter of vegetable origin. The large percentage of lime which the water of many parts of the interior region contained, rendered it unsuitable for drinking purposes. The accidental im- purities were more important in respect to the causation of disease, than the natural constituents of the potable waters.
The effects of crowd-poisoning were chiefly exhibited in the win- ter camps. After the first year of the war the camp and c^owd- garrison equipage issued to the troops was never adequate po^^^^i^s- to the necessities of the case. Huts were accordingly chiefly used.
18 SPECIFIC CAUSES OF DISEASE.
These were constructed of such materials as were available at the point selected for the camp. In many instances they were small huts or caves built of mud and covered with a portion of shelter tent large enough to permit three to live in them, giving each not more than fifty cubic feet of air-space, and frequently not more than twenty. Air was excluded as much as possible to permit the fire on the rude fire-place to warm the interior. Into these the men crowded during unpleasant weather and at night. The foetid odor and suffocating vapors which were produced in these places appalled one not accustomed to them, and were injurious to all subjected to their influence. This deteriorated atmosphere affected the blood and was powerfully causative of fevers.
This description is not fanciful nor exaggerated. I draw the facts of the description from the winter camp of the army of the Cumberland at Chattanooga, where the soldiers were situated as favorably as any other troops as respects hygienic conditions.
Severe and prolonged marching does not affect the health of Effects of troops so much as camp fife. When the conditions of the iS^ ^^^ camp are associated with exhausting fatigue duties, as in marches. sicgcs, the health of men rapidly deteriorates. The car- rying heavy equipments on long marches produced, especially in the young, deformity of the chest and hypertrophy of the heart. The pressure of the belt when the cartridge-box was filled, was in- jurious to the stomach and liver, and was no doubt a frequent cause of functional derangement of these organs.
A scorbutic taint was to be observed in troops who had served Scorbutic i^ *^^ South for a considerable period ; but unequivocal *^'°*- scorbutus rarely. The symptoms of this condition were
not to be separated from others intermingled with it. But an im- poverished state of the blood due to defective ahmentation, un- doubtedly existed to a large extent. It exhibited itself in various forms, but especially in increasing the fatality of diseases, and in impressing an adynamic character on those of mild and tractable form. As a distinct, substantive affection, it existed to the extent of 1338 in the first year, and 7395 in the second year of the war.
The specific causes of disease to which the soldier was subjected Specific form a large and influential class. Chief amongst these disease. was malaria. Beside the tjq^ical malarial diseases, the malarial element existed as a complication in a large number of diseases. It has been elsewhere shown the important role which this poison performed in army diseases.
CAMP, OR TYPHOID FEVER. 19
• The long-continued action of malaria, without inducing fever,
is to be separated from the characteristic febrile move- ^aiariai
ments resulting from the rapid imbibition of this poison, p^so'iins-
The general prevalence of malarial poisoning is exhibited in the fact that 262,807 cases of malarial fevers were admitted on the sick report during the years 1862-63. There are no data for esti- matino- the degree in which the malarial element existed as a com- plication in other forms of disease. Taking those for a standard in which more or less malarial complication existed, — camp fever, dysentery, — we may obtain an insight into the great importance of this element without being able to express the influence numer- ically. Thus during the first two years of the war, 213,260 cases of the various forms of camp fever — typhoid, typho-malarial, and remittent — occurred. Again, the same influence is expressed in the number of cases of diarrhoea and dysentery, which for the first two years of the war reached the enormous number of 725,675 cases. The influence of season upon the degree of prevalence of these disorders tends to show rather more specifically the operation of a malarial element in their causation ; July, August, September, and October were the months of greatest prevalence of diarrhoea and dysentery.
Although the relation of malaria to various forms of army dis- eases cannot be expressed numerically, there are data for determin- ing the relation in many cases. The influence of chronic malarial poisoning results in a series of well-defined anatomical changes which may be traced in the lesions with which they are associated. Tliis is well seen in army diarrhoea. The changes induced by ma- laria in the glandular apparatus of the intestinal canal are closely connected with, if they do no> precede, those belonging essentially to this disease. Again, thii ^-elation is exhibited in the morbid anatomy of the so-called typho-malarial fever — where the malarial element expresses itself in well-marked pathological changes which may be separated from those due exclusively to the typhoid disease.
The camp fever of the army was, essentially, typhoid ; it was modified by various accidental and specific causes. We Camp, or have just alluded to one of the specific modifying causes fever. — malaria ; the most important of the others was scorbutus. Ty- phoid fever prevailed under the same conditions in our armies as in our civil populations. Overcrowding, animal and vegetable decom- position, impure water, etc., were the conditions -chiefly concerned in the army. Hence it was a disease of the winter camps rather than of smnmer campaigns. It was a specific disease arising from
20 COMPOUND CAUSES OF DISEASE.
a specific cause, in which a malarial or scorbutic element existed as an accidental constituent without being at all causative.
Measles, mumps, erysipelas, small-pox, diphtheria, etc., belong to Measles ^^^^^ Order. Of these, 78,809 occurred in the first two Sy^S'as, years of the war. Measles, the most important of these, ®*'^' we have already shown, is a disease of recruits and young
soldiers chiefly.
The enthetic diseases, gonorrhoea, syphilis, etc., existed to the Enthetic cxtcut of 63,265 cascs in the first two years of the war. diseases. Thcsc discascs prevailed chiefly amongst the garrisons of large towns.
The moral causes include nostalgia, malingering, etc., which are Moral causes ^^ ^® discusscd iu a Separate section as causes in oj^era- of disease, ^'^j^ duHug tlic wholc scrvicc of tlic soldicr. They only require mention in this place.
Under the term compound cause it is intended to express that Compound compositc morbid state produced by climatic, dietetic, ac- dLsease. cidcutal, and some of the specific causes. In a study of the etiology, symptomatology, and even the morbid anatomy of army diseases, it was not possible in every case to separate one class of actions or causes from another. In this compound morbid state, scorbutus, or the scorbutic taint, so called, and malaria, played the most important parts. To the lowered vitality of the blood and softened solids of scorbutus were added the visceral and other changes due to malaria. A special cachexia was thereby devel- oped, which not only favored the action of common causes of dis- ease, but greatly influenced the mortality from all causes. Its influence was largely seen in the results of surgery in the war. The power of resistance to wounds and injuries was diminished in consequence of the lowered vitality induced by this cachexia. It prevented the reparative process, converting simple injuries into fatal ones ; it produced secondary hemorrhage, sloughing of tissues (pseudo-hospital gangrene), and septicaemia, and promoted the spread of hospital gangrene, pyaemia, and erysipelas.
The diseases and surgery of the war must be studied in the light of the conditions induced by this compound morbid state. Any statistics or deductions of experience must be valueless which do not express the influence of this state.
IV.
The moral causes afiecting the physical stamina of the soldier include cowardice, weakness of will, nostalgia, and malingermg.
iq^OSTALGIA. 21
Tlie first two cannot be expressed numerically. There are no data for estimating their precise importance. Cowardice Moral causes usually finds an expression in malingering, weakness of pJ^S will, and nostalgia, but the immediate relation is not fre- ^''*"""'»- quently demonstrable.
In the first two years of the war, there were reported 2588 cases of nostalma, and 13 deaths from this cause. These
-I -1 p n 1-1 1 Nostalgia.
numbers scarcely express the lull extent to winch nostal- gia influenced the sickness and mortality of the army. To the depressing influence of home-sickness must be attributed the fatal result in many cases which might otherwise have terminated favor- ably. By the same cause may we ascribe a predisposition to have been produced favoring the reception and development of various morbific agents. Again, it is difficult to define the precise action of nostalgia, and to separate the morbid phenomena produced by it from those of an analogous character, produced by wholly different causes. In my opinion, it more probably existed as a complicating element in various morbid states than as a substantive disease. Viewed in this light, the foregoing figures would veiy inadequately represent the importance of nostalgia as influencing the stamina of the soldier.
The term nostalgia is derived from two Greek words, signifying, in our vernacular, home-sickness.^ The derivation of the word indicates the pathology. It is a mental disorder, and belongs to the class melancholia. Certain physical symptoms precede, accom- pany, or follow the development of the mental aberration : heat of head ; increased rapidity of the circulation ; constipation ; gas- tro-intestinal disorders of various kinds ; a low febrile state simu- lating typhoid. The mental despondency and the exaltation of the imaginative faculty increase with the decline in the physical strength. Weeping, sighing, groaning, and a constant yearning for home ; hallucinations and sometimes maniacal delirium, are the particular forms in which the disorder of the brain expresses itself.
Does the mental state precede the development of the physical symptoms? Is this sufficient of itself to produce that train of gastro-intestinal disorders and febrile phenomena which character- ize the progress of the case ? My own experience leads me to the conclusion that derangement of the health, particularly of the pri- mary assimilation, leads to the disorders of intellect, and that in those cases in which the affection of the mind precedes the physical
1 rocTTo?, return ; cOydy, sadness.
22 NOSTALGIA.
disorders, there is much reason to suspect a predisposition to men- tal derangement to have existed.
These questions are not without interest in view of the causes and degree of prevalence of nostalgia during the war.
The primal cause is, undoubtedly, absence from home in new and strange surroundings. Various authors have affected to discover a cause in the character of the new country. Thus it is said that the mhabitants of mountainous districts are more prone to home- sickness than the denizen of the plain. The experience of the war hardly confirms this view of the influence of external nature. Both in the first and second year of the war, the number of re- ported cases were in a precise ratio to the number of troops em- ployed. There was no difference, as far as the statistics show, between the troops on the Atlantic coast and those in the interior region as to the prevalence of nostalgia. Hence it may be assumed that the face of the country in which the troops operated had no influence in the production of this disease.
The cases which occmTcd under my observation were derived fi'om two classes : young men of feeble will, highly developed im- aginative faculties, and strong sexual desires ; married men, for the first time absent from their families. The monotony of winter camps favored the development of the peculiar mental and phys- ical effects of nostalgia, whilst active campaigning prevented their occmTcnce. Having too often no physical nor mental occupation, the minds of these unfortunates reverted homeward. They fell into reverie, and allowed their imaginations to run riot amid the images of home conjured up. Then followed melancholia, hallu- cinations, and physical phenomena due to disorder of the nervous system, such as borborygmi, constipation, indigestion, uTegular ac- tion of the heart, disturbed sleep, etc. This interdependence of the morbid physical state upon the mental was rather exceptional. Some derangement of the health in the main, preceded the mental phenomena. According to my observation, deranged sexual func- tions were more fi-equently precedent to the mental changes than any other single physical condition. Masturbation and spermator- rhoea produced a mental state more favorable to nostalgia than any other cause. This relation may not be expressed numerically, but if the history of the 2588 cases could be arrived at, the intimacy of the relation existing would be surprising.
Only 13 deaths in 2588 cases ! This result might well cause us to question the accm'acy of the diagnosis. Of all diseases, nostal- gia is undoubtedly the most fatal ; none are less amenable to treat-
FORMS OF MALINGERING. 23
^P ment. A cure can only be wrought by sending the patient to his home. As this was not frequently possible during the war, it may be concluded that many cases reported as nostalgia were not really
ISO, and that many fatal cases were reported under other names, probably as common continued fever. But this view is necessarily of limited scope. I have already remarked that, as a substantive disease, nostalgia was not common, but, as a complicating element in other diseases, very common. A rational man in a good state of health may bear up pretty well under ordinary home-sickness, but when his reason is weak- ened by disease, and his imagination excited by the monotony of the sick-bed, then it is that he becomes a prey to the hallucinations of nostalgia. Consequently it was in the general hospitals that this disease was most frequently observed as a complication of other maladies, and not as a substantive disease. In these cases the precise importance of it in determining a given result could not be estimated. The melancholy and mental depression associated with it must have favored the progress and increased the severity of various diseases. Nostalgia may be considered also in the hght of an element in that composite morbid state alluded to in the pre- ceding section, united in many cases with malaria, scorbutus, the effects of crowd-poisoning, etc.
The most important of the moral causes affecting the physical endurance of the soldier, are those which may be com- Feigned prehended in the group — Feigned Diseases. Our *^^^^^^3- army furnished these cases on a stupendous scale. As this part of my subject will not be discussed elsewhere in these volumes, it is proper that it should be treated of here, at a length correspond- ing to its importance.
To judge of the prevalence of malingering in our army, we must first understand the particular forms which the Forms of feigned maladies assumed. To study them intelhgently ""a^ag^rins- we must arrange them in classes and orders.
The authors of the article on Feigned Diseases in the " Cyclope- dia of Practical Medicine " ^ have proposed some useful distinctions between the several groups : —
1. Feigned, strictly so called, or those which are altogether fic- titious ;
2. Exaggerated diseases, or those which, existing in some de- gree or form, are pretended by the patient to exist in a greater degree or in a different form ;
1 Vol. ii. p. 123. Phil. ed.
24 CAUSES OF MALINGERING.
3. Factitious diseases, or those which are wholly produced by the patient, or with his concurrence ;
4. Aggravated diseases, or those which, originating in the first instance without the patient's concurrence, are intentionally in- creased by artificial means.
These terms are based upon well-marked distinctions, and are so useful that we shall employ them in the same sense. It is obvious, however, that it would be impracticable to make them the basis of a classification. In the article in the Cyclopgedia, no attempt is made to arrange feigned diseases in classes according to their affin- ities, but they are discussed simply in alphabetical order. In Gavin's prize essay ,^ a very artificial arrang(?ment is adopted, founded upon the symptoms referable to the feehngs of the pa- tient, and to those cognizable by the senses or acquired information of the physician, and on the means of diagnosis. Mr. Marshall^ treats of feigned and real disabilities together. Ballingall ^ treats of them according to the region of the body in which they occm'. So also Dr. Cheyne * in his very admirable letter to Dr. Renny. The authors of the article on Malingering in the "American Jour- nal of the Medical Sciences " for October, 1864, discuss the sev- eral forms of feigned diseases that came under their observation without any systematic arrangement.
To facilitate the consideration of the subject of malingering during the war, I shall treat of the several topics in connection with it in the following order : —
1. Causes of Malingering ;
2. Degree of Prevalence ;
3. Forms of Disability Assumed.
a. Of the Cerebro-Spinal System ; h. Of the Thoracic Organs ;
c. Of the Digestive System ;
d. Of the Genito-Urinary Apparatus ;
e. Of the Extremities ;
/. Constitutional, or General. The causes of Malingering may be referred to either the men- Causesof ^^ ^^^ moral characteristics of the soldier, or to some malingering, ^ccideut of servicc. The first will, necessarily, include the influence of race, temperament, moral and intellectual train- ing, etc.
1 On Feigned and Factitious Diseases, p, 5.
2 On Enlisting and Discharging Soldiers.
8 Outlines of Military Surgery. Edinburgh, 1855. 4 Dublin Hospital Rejwrts. Dublin, 1827. Vol. iv.
INFLUENCE OF RACE. 25
^W There are no data for expressing numerically tlie influence of race, and hence we resort to the opinions based upon influence of pretty extensive personal observations. As our army, ^'^'''*- during the late war, was constituted mainly of Americans, Ger- mans, and Irish, the comparison is restricted to these three nation- alities.
My own opinion is, decidedly, that the Germans were more given to malingering than the Americans and Irish. A larger pro- portion of them were mercenary soldiers attracted into the service by advance pay and bounty. They love ease, and the simple enjoy- ments to which they are accustomed at home, and have but little aptitude for military service. They do not have the physical en- durance of Americans or Irish, and are not possessed of the same degree of mental resiliency. They were much given to feign chronic rheumatic disease, affections of the urinary passages, and diarrhoea.
The Irish soldiers in the English service, according to Marshall QOp. cit.')^ are much addicted to mahngering, and the " poorer class of laborers " are the worst in this respect. It has seemed to me that the Irish were less given to malingering than the Americans, but this opinion is not supported by any statistical evidence. They have, as a class, great hardihood, fondness for adventure, buoyancy of spirits, and a natural aptitude for military life and training. A large number entered our service as purely mercenary soldiers, and hence were not indisposed to avail themselves of all the in- dulgences to be procured by sick men. The class of Irish la- borers, especially, objected to fatigue duties, and would malinger to avoid them, when they would not think of doing so to avoid active and even dangerous military duty. " Sun-stroke " and pain in the back, were probably more frequently feigned than any other maladies by the Irish.
The Americans, being vastly in the majority in our army, fur- nished the largest number of feigned cases ; but it is not true that they were in relative proportion the larger, except it may be by comparison with the Irish. The Americans were not to so large an extent mercenary soldiers. Indeed, a considerable percentage entered the service from motives of duty only. Nevertheless, advanced pay and bounty were not without influence upon large numbers who entered service neither in consequence of patriotic zeal nor fondness for military life. In the beginning of the war, the wide-spread enthusiasm forced many into the army who were every way disinclined and unfitted for it. At the same period dis-
26 VARIOUS CAUSES.
charges on surgeon's certificate being given in most reckless pro- frision, all wlio were disposed to feign the most simple ailment fomid no difficulty in quitting the service. Many of this class en- listed again and again, to be discharged on some fictitious disease. When the professional " bounty-jumper " found his occupation too hazardous, he became a malingerer. The Americans who feigned disease consisted chiefly of mamed men separated fi'om their fam- ilies and homes for the first time. The particular forms which the feigned diseases of Americans assumed were affections of the re- spiratory organs, diarrhoea, dyspepsia, heart-disease, etc.
The influence of moral and intellectual training was strikingly Influence of exhibited. It was not common to see a well-educated Steuiauli Ji^ai^ amongst the mahngerers. There were, however, training. occasioual cascs. One of the most expert malingerers that came under my observation was a Michigan school-teacher. Generally, the men who feign disease belong to the lower orders, to the class of common laborers, and are ignorant and uneducated. In this view, I exclude, of course, the " bounty-jumpers " and malingerers by profession, who added to their evil tendencies the skill acquired by education. The disposition to malinger did not come of the associations of the camp, but was the natural direc- tion of an originally bad character. As a general rule, it may be affirmed that men will feign disease in the army who are guilty of similar deceptions in civil pursuits.
So far as temperament is an expression of innate moral and Influence of intcUectual qualities, it influences the conduct of men. ment. ' Duiiug tlic War, the practice of malingering seemed asso- ciated with the bilious and nervous temperaments, whilst the san- guine was comparatively exempt. " The typical malingerer has dark-brown or hazel eyes, dark hair and dark complexion ; his face is stealthy, dogged, lowering; his eyes suspicious, fartive, restless ; and his manner habitually constrained." ^
If a man have the mental and moral characteristics for feign- ing, slight causes suffice to develop them in some practical direc- tion.
A variety of other causes may be enumerated as producing Various malingering. A considerable number of men, not inher- causes. eutly vicious, but who were merely lazy and spiritless,
feigned disease to avoid the fatigues and hardships of the service. Cowardice was a not micommon cause. On the field of battle, a
1 Bartholow, Manual of Insiruciions fur Enlisting and Discharging Soldiers, p. 9G. Phil- adelphia, 18G3.
PREVALENCE OF MALINGERING. 27
number escaped to the rear with feigned or factitious injuries. Personal difficulties with their comrades, punishments, capricious conduct of their officers influenced many ; .and pique, disappoint- ment as to promotion influenced others. The most powerftd of all causes affecting those not disposed to malinger in consequence of deficient moral sense, was the influence of wives and relations. To the reception of a piteous or complaining letter from home could often be traced the commencement of the deception. The readi- with which discharges were obtained dui'ing the first three years of the war, and the numerous successful instances of im- posture contributed to the prevalence of mahngering by suggesting the idea to those who had not previously conceived it, and by en- couraging those whose timidity, rather than want of inclination, prevented engaging in a course of deception. Beside, such defects in military organization and such disregard of military law, as per- mitted or could not check the wholesale depletion of the ranks of the army by discharges on surgeon's certificate, disgusted those who would otherwise have been wilHng to bear for the sake of the cause all needful hardships.
The organization of general hospitals in the several States for the reception of the soldiers of the State was an ill-ad- Bad effect of vised measure, which greatly contributed to the produc- hospitals. tion of malingerers. Large numbers feigned disease to be sent to the hospital nearest their homes.
But from whatever cause the disposition to malinger arose, the success of the attempt depended much upon the skill and firm- ness of the regimental and medical officers, and upon the degree of discipline. When a malingerer once succeeded in passing beyond the control and observation of those who knew him, his subsequent operations were much less difficult. Unfortunately, the medical officers of the regiment and the enlisted men were frequently neigh- bors and associates before the war, and hence the same control could not be exercised as if they had been strangers to each other. In the regiment all cases of malingering should be confronted and disposed of.
There are no statistics showing the extent to which feigning disease was carried in our army. This may be approxi- Prevalence
1 1 I'PiTi 5°f malinger-
matecl to by an analysis or the discharges on surgeon s ing. certificate. The data upon which my conclusions are based, were derived from an examination of fifteen thousand certificates on file in the Adjutant-General's Office, Washington, and from Circular No. 6, Sm-geon-Generars Office.
28 MALINGERING SHOWN BY SICK REPORTS.
As a general rule, soldiers feign those diseases with which they are most familiar, whether by personal experience, or by obser- vation. This is seen in tlie character of the disabilities feigned by the diiferent nationahties : thus the Germans were given to chronic rheumatism ; the Americans to diseases of the respirators^ organs, diarrhoea, dyspepsia, heart-disease, etc. ; and the Irish to " pain in the back," sun-stroke, chronic rheumatism, etc. The correlative fact is, that those diseases are feigned which are easily simulated and not readily detected. Comparing these two facts with the statistics of discharges on surgeon's certificate, an approx- imation sufficiently close for our purpose may be arrived at. In illustration of this, we may take rheumatism, consumption, debil- ity, and epilepsy, for example. Thus, the discharges for rheu- matism for the first year of the war were 3585 ; for consumption, 3161 ; for debility, 3139 ; and for epilepsy, 669. So numerous were the discharges for chronic rheumatism, that an order was issued by the War Department, at the close of 1862, forbidding any discharges for this cause. The discharges for " incipient phthisis " became so fi*equent, and exemptions under the Enroll- ment Act for this disease so numerous, that it was not permitted as a disqualification in the draft of 1864.
In the first year of the war, there were a large number of dis- infirmities chargcs for infirmities which existed at the time of en- Stmeat. listmcnt (concealed infirmities). Insanity, epilepsy, and hernia may be classed in this category. There were 246 cases of insanity, 669 of epilepsy, and 2300 of hernia discharged in the first year of the war, a vast majority of which existed at the time of enlistment, but were concealed. These concealed infirmities became much less frequent after the first year, and were replaced by feigned or factitious diseases, — rheumatism, heart-disease, in- cipient phthisis, deafness, defects of vision, etc., feigned ; vari- cocele, hemorrhoids, old wounds and injuries, etc., exaggerated ; and chronic diarrhoea, ophthalmia, etc., produced. The improve- ment in the art of feigning became very manifest as the war pro- gressed. Whilst the discharges for heart-disease amounted to 30 per 1000 in 1862, in 1863 they reached the large proportion of 137 per 1000. The same increase was observed in respect to phthisis.
The reports of sick, as well as of discharges, furnish some inter- Maiingering cstiug Statistical facts bearing on the question of malin- lick^reportB. gcriug. In two ycars, 162,276 men came on to the sick report with rheumatism and neuralgia, being an average of 185
HEADACHE AND NEURALGIA. 29
per 1000 of mean strength. In the second year of the war, there were reported 40,758 cases of constipation, 20,645 cases of head- ache, and 775 cases of deafness. There were also reported, the same year, 9977 cases of hernia, and 2585 cases of epilepsy, many of which, undoubtedly, should be considered as concealed infirmi- ties. Whilst in the first year of the war 330 cases of paralysis came upon " sick report," in the second year they rose up to 1164. Again, whilst the cases of neuralgia, in the first year of the war, amounted to 7546, in the second year they reached 18,533, an increase considerably out of proportion to the increase in the numerical strength of the amiy.
It has been already remarked, that soldiers feign those diseases with which they are most familiar, provided the simu- Forms of lation is easy and the detection difiicult. The cases of ass^eZ feigned diseases proper were not nearly so numerous as the exag- gerated ailments. Many who became acquainted with the ease and comforts of the hospital whilst suffering under some petty ail- ment, continued to complain after recovery to avoid a return to duty. The cases of factitious disease were infrequent.
Of the Cerebro-Spinal System. — Durmg the first two years of the war, there were reported 27,779 cases of headache. Headache Many of these were malarial in character, no doubt, gia. and many were due to indigestion ; nevertheless, a large propor- tion were feigned or exaggerated, to escape some temporary un- pleasant duty, or to procure admission into the general hospital. Neuralgia, and pain affecting the distribution of the fiflh pair, were simulated as well as exaggerated. The 26,079 cases reported in two years contained many of this character. They were difficult of detection, because all the phenomena were purely subjective. No difficulty existed when the neuralgia produced objective signs. " When a man positively affirms that he suffers great pain in some portion of the body," says Dr. Woodward,^ " it seems to the pop- ular mind absurd for a surgeon to affirm that he does not." It was one of the most common experiences during the war, for the sm-geon to meet cases of pretended pain without any evidences of suffering. That the majority of these cases came upon sick report merely for the purpose of escaping a temporary duty which was unpleasant, is shown by the statistics of discharges. Thus, of the 7134 cases of headache, and 7546 cases of neuralgia, occurring in the first year of the war, only 8 of the former and 39 of the latter were finally discharged. Excluding those who were prob-
1 Camp Diseases, p. 326.
so INSANITY.
ably the subjects of malarial poisoning, and those who suffered from carious teeth, there must remain a considerable number who feigned or exaggerated this disability. But that they did not per- sist in feigning, is evident both by the statistics of discharge and by the observations of myself and others.
I have met with numerous cases of vertigo which were referred to an attack of " sun-stroke " as the cause. These oc- curred chiefly among the Irish soldiers, who, as laborers, are more or less familiar with the phenomena accompan^^ang an at- tack of coup-de-soleil. In the first year of the war there were re- ported 420 cases and 17 deaths from this cause, and 1199 cases and 57 deaths in the second year. The cases which came under my observation were more probably feigned than exaggerated. "In none of them were there any appreciable lesions or impairment of any of the fimctions or organs. All of them complained of strange sensations in the head, and vertigo. A singular expression was imparted to the countenance of two of them by wearing a hand- kerchief around the head ; and a third wore green glasses." ^ Many cases of feigned sun-stroke originated in the temporary loss of consciousness produced by heat, fatigue, and anxiety, in which no lesion of the nervous centres occurs, but recovery ensues promptly. The dread of return to duty induced them to feign symptoms, alleged after-effects of the seizure.
Insanity was occasionally feigned in the beginning of the war. The number of discharges for this cause exceeded the number of cases reported. Thus the number on sick re- port was 227, and the number discharged 246. According to my own statistics, the discharges for this cause were for the first year 11 per 1000, and the second year 7 per 1000. The decrease is to be attributed to two causes — the elimination of the real cases, and the diminution of feigned cases. The regulations of the army forbid the discharge of insane soldiers, and require them to be sent to the government asylum ; but this regulation was not observed with any degree of particularity until the last year of the war. But to the increasino; observance of the remilation is to be attrib- uted the cessation of feigned cases. Drs. Mitchell, Morehouse, and Keen are in error in asserting that no cases of feigned insanity occurred during the war. They overlooked my observations on this point. It is certainly time that the higher forms of insanity were not attempted by malingerers. I found in one instance a certificate of disability on which a man had been discharged for
1 Manual of Instructioivi for Enlisting and Discharging Soldiers, p. 116.
EPILEPSY. 81
inability to learn his military duties ; liis intellect and intelligence being, on all other points, sufficiently good ! This was undoubt- edly a case of malingering. Several of a similar character have been observed by me. Dementia, or imbecility, are the forms which the malingerers assumed, and they usually contented them- selves with feigning loss of memory, inability to learn the manual, immobility of manner, and filthy personal habits. Drs. Mitchell, Morehouse, and Keen say, in reference to our soldiers, " any one who would feign insanity and submit to its restraints and associa- tions to avoid work and obtain ease, must be, in reality, a mono- maniac." Our malingerers, however, did not attempt the higher types of insanity. This would have been undergoing unnecessary trouble to accomplish their object, and might have subjected them to the risk of being sent to the asylum.
Paralysis was a very common feigned disability, in its several forms of hemiplegia, paraplegia, and paralysis of a single limb or set of muscles. Quite a number of cases of para- plegia came under my observation. The usual history was, that they had suffered a blow upon the spine by a shell or by a fall, or that they had had lumbago, or that the paraplegia had followed ex- posure to cold and wet. The most usual form of feigned paralysis, however, was loss of power in one of the upper extremities. This occurs so rarely as a real condition, unless associated with obvious lesions, that a vast majority of these cases were feigned. Drs. Mitchell, Morehouse, and Keen have observed several cases,^ and I have met with a number. In the first year of the war 330 cases of paralysis came upon sick report, and 252 were discharged from the service. In the second year 1164 cases were reported. A certain proportion of these were feigned, but as to the exact number we have no means of determining]:.
Epilepsy chiefly occurred as a concealed infirmity. In the statistics collected by me, I find that the discharges for epilepsy reached 22 per 1000. The discharges for this ^^'^^^'^' cause in the first year were 669, whilst 2585 cases came upon sick report. This extraordinary discrepancy — for in the beginning all cases were discharged — can only be accounted for on the theory that many of them were feigned and the imposture detected. Five cases came under my own personal observation. There was no difficulty in detecting the imposture in these cases. Messrs. Mitchell, Morehouse, and Keen are severe upon those authors who regard the assumed disease as easy of detection, and " speak of it
1 Am. Joum. Med. Sciences (Op. cit.).
32 DEFECTS OF VISION.
with a flippancy which shows conclusively that they have seen but little of the disease." This criticism is hardly just. In those feigned cases in which these very accurate gentlemen had much difficulty in making a diagnosis, it is not beyond the limits of pos- sibility that they were deceived. The malingerers in our service were not sufficiently expert to produce so exact a portraiture as these gentlemen describe, and which confused even them. In my cases the epileptic paroxysm consisted in violent convulsive move- ments carried on with the most obvious effort of the will.
Deafness has been frequently feigned ; it was also, in the begin- ning of the war, a concealed infirmity, and during the whole war, exaggerated. The statistics of discharges for this cause prove this. There were reported in the first year 273 cases and 260 discharges ; in the second year, 775 cases came on to the sick report. In 10,991 discharges on surgeon's certificate examined by me, there were 169 for deafness. Notwithstanding the statement of Messrs. Mitchell, Morehouse, and Keen, there can be no doubt that this disability was frequently feigned or exag- gerated. It is probably true that exaggerated cases were more numerous than the feigned. A diminution in the accuracy and delicacy of the organ of hearing is a not uncommon sequela of the eruptive fevers, without the occurrence of inflammation and its results, and may occur in typhoid fever. Such dullness of hearing was exaggerated into complete abolition of the faculty. Defects of T\\Q defccts of visiou feigned belonged to the three
^^°'^' classes : feigned, exaggerated, and factitious.
Ptosis was feigned several times in my experience. One fla- grant case was seen by me in which a man had escaped duty four months, and finally reached the general hospital, in which a simple closure of the palpebrss was the only symptom. He was tenderly cared for and led by a comrade who had " diarrhe ! " Ophthalmia tarsi was frequently exaggerated, and was probably also occasionally produced, or at least aggravated. The same re- mark is true of granular lids. Ten cases were observed by me in which I suspected the disability had been aggravated, but I was never able to determine the fact positively.
Myopia was a very common exaggerated ailment. This may not be demonstrated numerically, but every observant medical officer was cognizant of the fact. It was sometimes also a factitious disability, if such a term may be applied to the production of such merely objective signs of myopia, as holding objects close to the eyes and corrugation of the eyelids. As a small degree of myopia
DISEASES OF LUNGS AKD HEART. 33
did not constitute a case for exemption, those forced into the ser- vice under the Enrollment Act almost invariably exaggerated their infirmity, to procure a discharge. Several cases came under my observation in which myopia was concealed at the time of enlist- ment, and afterwards exaggerated. One of these, who had done no service, remained several months in a hospital under my charge, and whenever desired to give an account of his ailment, produced fi'om his pocket a much worn bed-card, on which was inscribed — " Retinitis."
Total blindness was not frequently simulated. Such a condition would have been too inconvenient to suit the purposes of the ma- lingerer. Partial loss of vision was the form of disability assumed. This was feigned outright, or predicated upon visible defects of the eye, as opacity of the cornea, pterygion, etc. In the first year of the war, there were discharged for diseases of the eye 529 cases, of which Amaurosis and Ophthalmia furnished nearly one half.
One case of exaggerated disability of the nose came under my observation — a small polypus — for which the soldier escaped duty for a long period, and was probably eventually discharged.
Dumbness has also been feigned. In one case, the man alleged that his dumbness was produced by the concussion of a shell. He carried a pencil and paper, ostentatiously pro- ducing it when questioned to write down his answers. Another, with a similar history, relied upon some guttural sounds and pan- tomime to make known his wants.
Of the Thoracic Organs. — The discharges for aphonia in the first year of the war amounted to 42. In 15,500 dis- charges examined by me, there were 28 for this cause. It was a comparatively frequent feigned disability. In the cases seen by me, the patients professed to have lost the voice suddenly, and were unable to assign any satisfkctory reason for the occur- rence. When questioned, they replied in a whisper. A majority of those discharged were doubtless feigned.
The discharges for diseases of the lungs and heart included a number of feigned, factitious, and exaggerated cases. Diseases of A condition simulating " incipient phthisis " was both SV feigned and factitious. In the first year of the war, 5599 cases were admitted to the sick report, and 3161 were discharged on surgeon's certificate. A large number of these were classed as cases of incipient phthisis. No disease was more successftJly simulated during the war. Many of these factitious cases pre-
34 LIVER COMPLAINT.
sented considerable difficulty In diagnosis, for It must be admitted that the physical signs of Incipient phthisis are by no means con- clusive. Cough kept up persistently by the voluntary efforts of the patient ; the addition of blood from the mouth or nares to the expectoration ; confinement In a hospital ward, and the deteriora- tion in health consequent thereon ; spermatorrhoea or masturbation may be united in any case to produce a set of symptoms, with difficulty distinguishable from those of the early stages of phthisis. A congested state of the throat, with nervous cough, indigestion, and emaciation, results from profuse tobacco chewing, and this state also may be confounded with incipient phthisis. These two classes of cases were exceedingly common.
In 10,446 discharges examined by me, there were 629 for heart- disease. In 1131 discharges during the months of January and February, 1863, there were 217 for the same cause. A large number of these were cases at the convalescent camp near Alex- andria, Va. This extraordinary Increase in the relative proportion of heart cases to other forms of disease Is solely attributable to malingering. Functional derangement of the heart was produced by various causes, amongst which may be enumerated all of those agencies causative in factitious phthisis. The functional derange- ment produced by these causes was not to be distinguished from that produced by lowered vitality of the blood, resulting from a scorbutic taint, malaria, etc. The malingerers feigning heart- disease had, frequently, not been exposed to these causes of disa- blHty, and had enjoyed, for a more or less considerable period, the good diet and comforts of the general hospital.
Of the Digestive System, — The statistics of the first year of the war Indicate a large number of concealed, feigned, and exaggerated cases. Thus, there were discharged for dys- pepsia 69 cases. This Is an unusual disease in the army, and rarely disabling. Amongst these 69 cases were some cases of the concealed, many more of the exaggerated, and probably a few of the feigned class. During the war, when the malingerers became more skillful, factitious dyspepsia was not uncommon. In two in- stances the power of vomiting at will was observed by me. Messrs. Mitchell, Morehouse, and Keen record another case. They were not common.
Chronic diseases of the abdominal viscera, splenitis, hepatitis, dlar- Livercom- I'hcea, wcrc frequently feigned. " The liver complaint " plaint. ^^.g^g ^ popular dlscasc amongst malingerers. Diarrhoea
was more frequently than either of those named a feigned or fac-
I
INCONTINENCE OF URINE. 35
titious ailment. In two instances the factitious disease was ex- plained by the discovery of " Wright's Indian Vegetable Pills," concealed about the persons of the invalids. In the first year of the war there were admitted to the sick report 215,214 cases of diar- rhoea and dysentery. A number of these were feigned, but the exact number cannot be ascertained. The cases of diarrhoea, without any impairment of strength or nutrition, were numerous in the general hospitals.
5713 cases of piles were reported, and 215 discharges for this cause in the first year of the war. This disability was
Piles.
very commonly exaggerated. Some instances of feigning also came under my observation. In these cases the malingerers contented themselves with asserting that the piles were internal and bleeding.
Of Urinary and Gfenital Apparatus. — The feigned diseases of this system were both simulated and exae'^erated.
. , ^ , . T . Hematuria.
Amongst tiie former were Hematuria, spermatorrhoea, m- continence of urine, gravel, " kichiey disease," etc., and amongst the latter varicocele, spermatori'hoea, hydrocele, stricture of the urethra, etc. I have met with three cases of feigned hematuria, in which the deception consisted in mixing blood from the mouth with the urine. These mahngerers complained of exquisite pain in micturition, and presented as evidence bloody urine. They were also loud in complaints about weakness of the back, which required them to go much bent. There was no harmony between the severe s^nnptoms complained of and the general good health of these men.
Several cases of feigned spermatorrhoea have, from time to time, been under my observation. In one case hereditary tend- gpermator- ency was alleged. Two classes of cases were observed '^'**^" during the war : those entirely feigned and factitious ; those exist- ing in slight degree exaggerated, either in consequence of the fears of the patient or to procure a discharge.
In the first year of the war 170 cases of incontinence of urine were reported ; but in the second year the number inconti- rose up to 1280 cases. This extraordinary increase in unne. numbers indicates a 2;reat increase in feimied cases. There were discharged the service in the first year 36 cases. These figures accord with my own observation ; for incontinence of urine has seemed to me to be one of the most fi^equently feigned of the whole class. In the cases seen by me the malingerer made no pretense of being afflicted with any other trouble. When com-
36 HYDROCELE AND STRICTUKE.
plicated with calculus, paralysis of the bladder, or disease of the spinal cord, there can be no difficulty in determining the reality of the alleged suflPering or disability.
Gravel also was frequently feigned. An officer attempted to pass off bits of plaster as small calcuH which he had
Gravel.
discharged from the bladder. The cases seen amongst soldiers were feigned outright. For stone and gravel 93 came on to the sick report in the first year, and 867 in the second, whilst only 8 were discliarged for this cause in the first year. Tliese figures indicate that this disability was frequently feigned.
" Kidney disease " was a tenn much in use by malingerers to j^i^^gy express a condition which seemed to them to authorize a disease. discharge. Pain in the lumbar region which prevented them going upright ; pain and difficulty in urination, and debility, were the symptoms expressed. Of the reality of some of these cases in which oxalate of lime, excess of urea, and excess of uric acid, were manifest, there can be no doubt. In such instances there were abundant evidences of lesions of primary and second- ary assimilation, or of both. In the feigned cases these evidences were wanting.
There were 988 cases of varicocele reported in the first year of the war, and 3504 cases in the second year ; and in the first year there were discharged 287 cases. In 10,991 discharges, I found 116 for varicocele. This disease was therefore very commonly exaggerated. A large proportion of the cases discharged were for inadequate reasons. Varicocele may exist to a considerable extent without impairing the physical efficiency. When both testes are affected, such serious mental and moral con- sequences may ensue as to require discharge ; but few cases of this kind were to be observed in the large number who came on to the sick report. That a slight degree of enlargement of the veins was sufficient to procure exemption from duty, is evident enough on comparing the statistics of this disease for the first two years of the war.
Hydrocele and stricture of the urethra may be classed amongst Hydrocele the exaggerated disabilities, but they were not met with ure. frequently. A few instances of feigned stricture have
been observed by me.
Of the Extremities. — As the integrity of the extremities is essen- tial to the proper performance of mihtary duties, feigned and exag- gerated diseases, and injuries of these parts, presented a promising field for the exercise of the malingerer's art. Hence, the affections
LAMENESS. 37
of the extremities were feigned and exaggerated, and were also occasionally factitious.
Spurious anchylosis or contraction, the alleged result of rheu- matic disease, was a very common feigned disability, ppuriousan- The elbow, wrist, and knee were, in my experience, <^^yi°^'s- the joints usually selected for the deception. There were, during the war, some very remarkable instances of persistent feigning of immobility of a joint. In one case, a man carried his knee flexed upon his thigh nine months ; in another, a man carried his fingers flexed for eighteen months for a simple wound of forearm, involv- ing only the integument. Contractions, following gimshot injuries of soft parts, were very frequently exaggerated, and were also aggra- vated by the opposition of the patient to the means of cure. Many cases are involuntary, the patient nursing a wounded limb to pre- vent the pain of motion, and persisting in this treatment until contraction results ; but many willfully resisted the efforts of the surgeon to bring the hmb into use, thereby inducing such loss of function as to incapacitate for further military service. In addition to these, the cases of feigning in which no lesion existed were quite numerous. In such instances the patient professed to have lost motion, and when effort was made to ascertain the truth, simply resisted, by the exercise of his will, the attempt. The extent to which malingering was carried in this direction is conclusively shown in the statistics of discharge for anchylosis, of which there were 199 cases in the first year of the war.
Lameness was assigned as a cause of discharge in 71 cases in 10,991 certificates of disability. During the war it was only necessary for a man to assume a cane or a crutch and to limp in order to procure admission to the hospital. From general hospital to convalescent camp, these cases were continually transferred, and, although repeatedly exposed, they could always procure sympathy and countenance in a new place. On the way to the front after having been caught feigning, and exposed, it was only necessary to assume the inevitable cane and to limp, to be admitted to some other malingerer's asylum. Old fractures and injuries which had occurred long anterior to admission into service, were frequently exaggerated. If the mahngerer were so fortunate as to retain any evidence upon his person of former injury, as a cicatrix, or deformity of a bone, he was quite certain to parade it, to exaggerate his sufferings in consequence of it, and to demand a discharge for disability, having faithfidly tried to serve his country, notwithstanding he was physically disqualified.
od DEBILITY AND RHEUMATISM.
In the same category may we class varicose veins. The nmn- varicose ^^^ ^^ thcse cascs on sick report was enormous ; in the veins. gj.g^ year 776, and in the second year 3344. At first
the concealed cases were eliminated, the discharges in 10,991 cer- tificates being 213 for varicose veins ; but afterwards the exagger- ated cases came forward to claim exemption from duty.
Another form of feigned disability of the extremities, very curious Swelling of as to its causc and character, was swellincr of an inferior
an inferior . . in
extremity, extremity. This I observed m a number of cases, of which there were ten at one time in a hospital mider my charge. Messrs. Mitchell, Morehouse, and Keen also observed one case. This swelling was alleged to have existed for a considerable time, and no explanation of the mode of its production Avas vouchsafed by those affected. " Careful search at miexpected times, even at midnight, never disclosed the slightest trace of a ligature or press- ure upon the veins. The swelhng seemed to be produced by keeping the leg habitually crossed upon the other, or, as the report- ers of the case above mentioned suggest, by keeping " his leg rest- ing on his crutch."
Constitutional or General. — In 28,640 discharges on surgeon's Debility and Certificate for the first year of the war, there were 6724 rheumatism. £^j, debility and rheumatism, or nearly one in four. These figures include a large number of feigned and exaggerated cases. Debility was a term applied to the low vital condition re- sulting from fever and from a variety of morbid states. But, to a considerable extent, it was also a factitious state, arising from all those abuses to which soldiers are addicted — indulgence in alco- holic drinks, masturbation, excessive tobacco chewing, etc.
But debility was a less frequently feigned ailment than rheuma- tism. In the first year of the war 44,762 cases of rheumatic dis- ease came upon sick report, and 3585 cases were discharged. In the second year the cases reached 81,435. So numerous were the cases and discharges for rheumatism that a general order was issued by the War Department forbidding any discharges for this cause. A large number of these cases consisted of lumbago, or were " back cases," as they were familiarly styled in the general hospitals. Every hospital had its quota of these cases. They re- ferred their sufferings to exposure or to injury. To give color to the expressions of pain, they Avould flinch and cry out when the back was examined ; they went about half bent, and they used, in the most ostentatious manner, crutches or a cane. When closely examined as to all the ch^cumstances under which the injury or dis-
DIAGNOSIS AND TREATMENT OF FEIGNING. 39
ability occurred, they were frequently betrayed into the most im- probable and often ludicrous statements. The incongruity between the history, expressions of suffering, and general good condition of these back cases was often strongly marked.
Dr. Woodward ^ is disposed to refer many of these cases of lumbar pain and weakness to the existence of a scorbutic taint. He reiterates this statement in Circular No. 6 of 1865, p. 134 : " The scorbutic taint manifested itself very generally in the form of rheumatic pains in the back and limbs, associated with the scor- butic, clay-like appearance of the skin, sometimes even with spongi- ness of the gums, much more rarely with petechiae, scorbutic dis- colorations about the flexures of the knees," etc. The back cases so commonly seen in our general hospitals do not answer to tliis description. Such evident marks of disease could hardly be mis- taken by any intelHgent medical officer for malingering.
Contractions of muscles and immobihty of joints, the alleged result of rheumatism, were exceedingly common. These contractions cases were to be seen in the general hospitals, limping in °^ °i»sc]es. the most painfrd way and complaining piteously, whilst enjoying the most robust health. Such cases could not be confounded with pains attendant upon scorbutus.
The feigned diseases described in this section are the principal forms that occurred in our service during the late war. I have discussed those which have fallen under my own observation, and have purposely excluded all references to mahngering as it occurs in foreign armies.
No reference was made to the diagnosis and treatment Diagnosis of the various forms of feigning. Some general remarks ^enS*" on these subjects will not be inappropriate. feigning.
The cases of successftil imposture were not frequent. Surgeons usually recognized them, or at least suspected them for good rea- sons. Numbers were discharged who succeeded simply by virtue of obstinate perseverance, the surgeon being the first to give in. The duties which the surgeon was required to peixbrm in relation to malingering were very unpleasant. To detect and expose im- posture was unpopular, and also exposed the surgeon to misconcep- tion and abuse. The citizen soldiers who feigned disease relied on the services and sacrifices of their faithful comrades to secure them immunity from exposure and punishment. They traded on the blood of the fallen. Notwithstanding the difficulties in the way, the surgeons, as a general rule, strove faithfully to maintain the discipline of the army, by discountenancing imposture.
1 Camp Diseases (Op. cit.).
40 GRANTING OF CERTIFICATES OF DISABILITY.
In the diagnosis of malingering the medical officers relied upon the indications afforded by the incongruities of the patient, upon systematic surveillance, upon strategy, and upon the use of anaes- thetics. Patients who feigned disease, except in exceptional cases of expertness, rarely told a consistent story as to the causes, progress, duration, and symptoms of their malady. The state of good health in many of them was in striking opposition to their expressions of pain and suffering. Subjected to surveillance in the general hos- pital, all but the most expert malingerers were usually easily caught in some acts inconsistent with their professions of disease. The address of the surgeon himself, in cases of amaurosis, paralysis, and lameness, was often quite sufficient of itself to expose a ma- lingerer. The most important means for the detection of feigning is the inhalation of ether. This was largely resorted to during the war, and proved to be adapted to a very wide circle of feigned cases.
To detect imposture, to separate real from simulated cases, re- quired a competent knowledge of disease under all its varied as- pects. Whenever a malingerer succeeded, the surgeon had either been wearied or deceived.
During the war the newspapers teemed with complaints of the Complaints harshuess and severity of medical officers. These were, and severity usually. Written by malingerers themselves, but they none officers. the less excited the indignation of the public. These ac- cusations were almost invariably unjust. If the medical officers failed in the performance of any of their duties, the failure was due rather to defects of training than to inhumanity or prejudice. As a class, they were the best friends of the soldiers during the war. Their labors and sacrifices were all directed to improve the health, and cure the diseases and injuries of the soldiers. Yet it was a sad fact, that the regimental surgeons who were engaged in these humane offices were less popular than those whose duty made them agents for destruction of health and life.
Discharges on SurgeorCs Certificate. — Soldiers were discharged Granting of ou the Certificate of the surgeon setting forth their ma- disabiiity on biHty to perform military duty. In the first years of the grounds. War Certificates were often granted for insufficient causes. General Order 212 of 1863 defined the disabilities for which sol- diers could be discharged, and the irregularities which previously existed were thereby corrected. No certificates were sufficient until they had received the approval of the medical directors of corps, army, and department. Early in the war regimental and district
PiVH
GRANTING OF CERTIFICATES OF DISABILITY. 41
commanders often exercised the authority to discharge, and many- men were thus dismissed without the least regard to the require- ments of law. The most serious abuse existing in this respect was the disposition of the certificate of disability, which was frequently given to the soldier discharged instead of being forwarded to the adjutant-general. Hence the statistics of discharges on surgeon's certificate for the first two years of the w^ar do not accurately represent the whole number of discharges.
Notwithstanding the pension laws and the army regulations based upon them require that the degree of disabihty shall be stated nu- merically, this was constantly disregarded in the first two years of the war. And throughout the whole war there was no uniformity in the views of medical officers in respect to the degree in which any particular disease or injury incapacitated a man for earning his subsistence by manual labor. In the French military service, precise rules govern those empowered to discharge for disability. Similar regulations should be introduced into our service. Uni- formity in expressing the degree of disability for any particular disease, and especially injury, would insure justice to the soldier, and protect the interests of the government.
CHAPTER SECOND.
REMARKS ON VARIOUS CIRCUMSTANCES RELATING TO THE CAUSA- TION OF DISEASE, ESPECIALLY AMONG VOLUNTEER TROOPS, BASED ON PERSONAL OBSERVATIONS IN THE FIELD, DURING THE YEARS 1861-65.
By a. J. PHELPS, M. D.,
SURGEON UNITED STATES VOLUNTEEKS.
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 Ser- vice. — The First Duty of the Medical Officer. — Bad Effects of the Volunteer Plan for Re- cruiting an Army. — Sketch of the Early Historj' of an Ohio Regiment, as representing the History of New Regiments generally. — First Organization of Buell's Army, or " The Army of the Ohio," and Appointment of Division and Brigade Suro;eons. — Increajje 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 Cooperation be- tween Commanding Officers and their Surgeons. — Account of the First General Hospital of this Anny. — The Severe Services and Bad Nourishment of the Army before Corinth.
— The Type of Disease that prevailed 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 18G2; 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 Chattanooga. — The Battles of Mission Ridge and Lookout Mountain. — The March to the Relief of Knoxville ; remarkable Health coexisting with Destitution of all Kind of Supplies. — Still further Improvement in the Medical Department.^
The promptitude with which our country, in the year 1861, Aptitude of boundcd from the attitude and pursuits of a long reimi
the Ameri- O &
can mind. of pcacc iuto the conditiou of active and vigorous war, struck the world with astonishment. In a day, the current of its
1 It is proper to state that a considerable portion of the paper by Dr. Phelps related to topics belonging so exclusively to surgery, that insertion in this volume would have been inappropriate. That portion was transferred to the editor of the surgical volume. The follow- ing are the topics to which the portion thus transferred related : " The battle of Perrysville," " Order issued for the government of medical officers on the battle-field previous to the battle of Stone River," " Train of reserve medical supplies to be left on hand for a batile," " Battle of Stone River," " Recovery of the wounded ; experience in favor of tent hospi- tals," "Best practical method of the time proposed for conducting the medical department under all the contingencies of a battle," " Condition of the wounded recovered from the enem}'," " The obstacles in the way of the cure of our wounded," "Plan proposed for treating the badly wounded by means of a general field depot near the battle-field." " Army t)f the Potomac; Grant's campaign against Richmond." — Editok.
FIRST DUTY OF THE MEDICAL OFFICER. 43
whole energies was diverted into preparations for war ! All classes were affected alike ; all trades and professions yielded with equal enthusiasm to the call for troops. Since then, millions of soldiers (2,759,049) have joined the army, fought many of the bloodiest battles of history, and, with the loss of a vast number of lives by disease and wounds, the object of the war has been accomplished, and a large proportion of those who remained have disappeared in the by-ways of peaceful pursuits ! And this army was accom- panied by thousands of medical officers, called from civil life to treat milhons of cases of disease and wounds.
This vast amount of labor and responsibihty devolved at once upon the medical profession ; and the newly appointed Early embar- medical officer was ushered without preparation into the'Te"wi/^ positions of weighty responsibility. He had to learn his me£l?*^offi- duty, and to practice it at the same time ; and he soon dis- *'^'^- covered that he had but httle written authority to consult, and that experience must be his teacher. It cannot be said of the corps of regular surgeons, who had been educated in the service, that they were to a much greater degree quahfied for the emergency. Their services had generally been performed at small frontier posts, where the routine of duty was so limited as to tend by long habit to disqualify for the greatly enlarged and practical effort that was now required ; and, while we naturally looked to them as directors and instructors, we were disappointed to find that they had no in- structions to give other than those which were to be found in the Army Regulations. These " Regulations " embraced but little more than directions how to procure medical supplies, by requisi- tion, and to prescribe the forms for certain reports ; and howsoever well they might have answered the requirements of the army in time of peace, they were totally inadequate now with an army of hmidreds of thousands in active service. The new medical offi- cer, therefore, was thro^vn from the first upon his own resources ; and whatever of excellence characterized the medical department of the army at the close of the war, was the result of the apti- tude of the American mind to adapt itself to any emergency that calls forth its action.
The first duty of the medical officer was the examination of recruits. The plan of voluntary enlistment, relied upon First duty of
p . . . Ill the medical
by our o;overnment lor raismo; its army, brouo-ht to the officer, bm
•^ . .* ^ n p " 1 • 1 effects of tiie
recruiting oince all sorts oi men who were anxious and volunteer determined to go into the service. The surgeon was m- recruiting. fluenced in the examination by the prevailing impression that for
v^
V
\
44 BAD EFFECTS OF THE VOLUNTEER RECRUITING.
the volunteer service it was not necessary to be as severe as if ex- amining for the regular army. This was a great error to com- mence with, and aside from the bad effects for the government, it proved fatal to thousands of patriotic, but feeble and unhealthy men, who might now have been living and pursuing useful occupations. Feeble boys, toothless old men, consumptives, asthmatics, one- eyed, one-armed men, men with different length of legs, club- footed and ruptured, and, in short, men with every variety of disability, and whose systems were replete with the elements of in- cipient disease, were accepted as recruits, and started to the field only to become a tax upon the government, and to encumber the movements of its armies. It has been said by an eminent officer, whose services have been constantly in the field (Major General Thos. J. Wood), writing on mihtary organization, " that statistics derived from the observations of the closest observers, Hneal and medical officers, disclose the startling fact that, as a rule, through- out the entire war, not more than thirty-five per cent, of the muster-roll strength of the armies of the Union appeared on the battle-field bearing muskets ! " Many causes operated to produce this discrepancy, but none so potent as the loose manner of recruit- ing that prevailed ; and it is surprising that after all the embarrass- ments to the service that resulted fi'om this cause, effective meas- ures were not taken sooner to correct the evil. But various influ- ences continued to operate throughout the war inimical to the thorough inspection of the recruit. Governors of States, in their great anxiety to fill their quotas promptly, grew intent upon meas- ures that would be most sure to bring forth numbers, unmindful of the fact that, not numbers alone, but healthful vigorous men, give strength to an army. Even as late as the fall of 1864, in the last levy under the Conscription Act, the looseness of recruiting existed to such an extent that the Secretary of War deemed it necessary to publish Circular No. 67, of date August, 1864, requiring a re- examination, by experienced medical officers, of all men, at the sev- eral States' rendezvous, before being sent to the field ; ordering all to be discharged, accoi-ding to the provisions of the regulations, who were found to be unfit for active field service. I was President of the Board of Examiners for Ohio, where we reexamined about 8000 men, and discharged 266. The ratio of men rejected by the Board was much greater during the first period of our examinations, but grew less as it became known to the recruiting and mustering officers and boards of enrollment throughout the State, that their recruits would be reexamined at the general rendezvous before
EARLY HISTORY OF AN OHIO REGIMENT. 45
feing forwarded to the field. By citing these facts no reflection is intended upon the honesty and skill with which the great major- ity of these officers performed their duties.; yet among the dis- charged reciniits were found every variety of physical disqualifica- tion ; and some of them exhibited the most culpable carelessness, or the most stupid fi^-aud upon the part of the recruitmg officers. And the facts are highly significant as showing how necessary for the good of the service are the most stringent recruiting regulations, to insure sufficient caution on the part of officers in the performance of this most important duty.
The 33d regiment of Ohio Volunteers commenced its organiza- tion in the summer of 1861, and started into active ser- Eariy his- vice as a minimum regiment about the middle of the ohioregi- ensuing October. It was recruited generally from the ™sentin"t]£ rural districts of Southern Ohio, and was composed of new^regu medium-sized men, the nervous temperament predomi- aiTy . ** ^^"^^"^ nating. The medical examination of the men consisted of but little more than opening and shutting the hands, bending the elbows and knees, and rotating the shoulder-joint, with a casual glance at the teeth and eyes, and a question as to age and previous general health. They were then, with few exceptions, mustered in to the service. The only regular officer in the regiment was the Colonel (Brig.-Gen. J. W. Sill, killed at Stone River). It was rendez- voused near Portsmouth, upon the Ohio River, in a miasmatic lo- cality. The camp was supplied with water freely impregnated with various salts, and was located, not for the salubriousness of the region, but for geographical convenience. Intermittent fever and diarrhoea made their appearance to a considerable extent in the regiment before leaving camp, and the men generally were not in a good hygienic condition, on account of the malarious poisoning. Its first service was in Eastern Kentucky, under General Nelson, and it was accompanied by the 2d, 21st, and 59th regiments Ohio Volunteers, and several detachments of Kentucky troops. The campaign w^as a severe one, on account of rainy weather and hard marches through a mountainous region. Thirty or thirty-five of the brigade w^ere wounded in a skirmish, and a large number of all the regiments fell sick with charrhoea and measles. During this short campaign, each regiment conducted its medical affairs inde- pendently. We had sufficient medical stores for years, but few of other necessaries for our sick. We lacked hospital tents, ambu-
46 EFFECT OF MARCHING ORDERS ON HEALTH.
lances, etc. On our return, bj way of the Big Sandy and the Ohio rivers, we were ordered to Louisville, Ky., and were en- camped in a low marshy place, that was knoM^i long afterward as " Mud Camp." We remained here only a short time, and were ordered to Bacon Creek, in supporting distance of the troops at Mumfordville, on Green River, where we remained until the 10th of February, 1862.
OrganiKition In the mcau time Buell had come into command, and
of the " Ar- . . p , . . i • i
my of the beo;an the reo;ular organization or this army into brigades
Ohio," and »_..»_ ^ . •( ^^^
appointment aiid Qivisious, auQ surgcons wcrc assigned to stati duty
of division i • i i t • • i i
and brigade at brigade and division head-quarters.
surgeons. *-" ^
At the same time sickness continued on the increase. Large Increase of numbers wcro attacked with measles, mumps, small-pox, sickness. asthcuic diarrhoea, camp fever, etc. In my own regi- ment, I had nearly three hundred cases of measles alone, and, on account of all forms of disease, it was reduced to a mere camp- guard. The sick reports in the Surgeon-General's Office, from Bacon Creek, Camp Nevin, and Green River, and from the numer- ous and overcrowded hospitals at Louisville, testify to the ravage of disease at this time, and to its exhausting effects upon the army. According to my observation among the regiments composing our (Mitchell's) Division, those that had served during the first three months of the war did not suifer to the same extent from sickness as those that were recruited in the late summer and fall months ; and from this fact I deduce the opinion that all new levies of troops should be made in the spring-time of the year.
AVe soon discovered, from the large per cent, of mortality that Superiority attended the cases sent to general hospital, that they pitais. would have recovered better in camp ; and accordingly,
we secured all the tents that we could, and sent no more sick away, unless compelled to do so for want of room. I have never since seen cause to change my decided preference for canvas for hospital purposes.
When the order came for marching upon Nashville, a striking Effect of improvement in the health of the troops took place. The d!Jron°the' signal for breaking camp seemed like electricity to revive troops. into activity energy long dormant, and I take it as a fact
BATTLE OF PITTSBURG LANDING.
ill Qstra ting the beneficial effect of ideas and new mental impres- sions upon health. That the long repose of a large army in camp is unfavorable to its health, notwithstanding the best hygienic reg- ulations, is a fact too frequently observed throughout the war to require argument.
Another circumstance occurred about this time which bears upon the size of men who can best endure the vicissitudes of size of men army life. It occurred with the 10th regiment Wisconsin for service. Volunteers. When this regiment joined us on the march to Bacon Creek, it was full to the maximum, w:ith generally very tall and athletic men. It was a splendid looking regiment, and maintained its size quite well while we remained in camp, but the march that proved a stimulant to the health of my own regiment had the oppo- site effect upon it ; its largest men fell out of ranks by platoons, and I believe that it never did recover its proportionate strength, as compared with other regiments where the size of the men was not above medium.
Line of March of Troops from Nasliville. When the main army left Nashville and moved on to Pittsburg Landing, our division marched on Huntsville. In the mean time I was commissioned into the general staff, and received orders to report to General Halleck, in the field, before Corinth ; but not until after I had, under the direction of the division medical di- rector, opened the Huntsville General Hospital.
The battle of Pittsburg Landing, or Shiloh, will be recorded in the history of this war as one of its most terrible scenes. Battle of I saw nothing of this battle save the scarred trees, the Landing'!^ shallow graves, and numerous little mounds bursted with the bloat- ing carcases of slightly buried horses. As I rode from the river to the front over the field, I smelled the dull, heavy odors of the old camp and of the march. The sun was hot, and the paludal water, which was the sole dependence of the troops, rested in pud- dles or shallow ditches, equally common to beast and man, and I felt that disease and death must be holding high carnival in such an atmosphere and place as that. This I found to be true. We heard much of the battle that had been fought, and as we reflected upon the tales told us of the suffering and slow rehef on the battle- field, we thought surely "some one had blundered!" A grave
48 FIRST GEIfERAL FIELD HOSPITAL OF THIS ARMY.
fault existed somewhere ; and although I knew that the medical department of the army did not at that time hold the high place in the consideration of the commanding generals that it should have done, yet I am of the belief that the chief medical officers present did not comprehend the full extent of the preparation required for a large battle, so as to have properly prepared for it. There had been no organization of the medical department, especially for the field of battle ; and the natural result is w^hat is shown to have oc- curred, namely, confusion amongst the medical officers, slow relief to the wounded, unjustifiable operations, and a lack of supplies. The news of the battle went to the North, and the boats that brought supphes carried ofi" the wounded. No attempt was made to treat the severely wounded men near the field, where rest could be maintained, which is so essential to the cure of such cases ; but all were sent North, and the sufferer had not the alternative of choosing between transportation North and death, and remaining upon the field wdth a reasonable chance of recovery, even though it were under the rudest shelter that the bedding found would have afibrded.
As I have intimated above, during the first two years of the w^ar, Want of CO- thcrc did not exist that harmony between the generals tScOTi-*^ commanding and their staff* medical officers necessary to ™cersTnd*' tlic efficiency of our department. Whether it was be- geons. cause medical officers unwisely coupled to the proper
claims of their department authority that did not belong to it, and thereby themselves provoked an opposition deleterious to its inter- ests ; or whether it was owing to an arbitrary disposition wdth offi- cers commanding to regulate every staff department according to their own ideas of what was necessary, the fact w^as, there existed a want of harmony, if not open antagonism. In justice to the gen- erals upon whose staff I have served, I must say that it was my good fortune never to find any difficulty in obtaining their hearty cooperation in carrying out any measures that I deemed important to the health, comfort, and proper care of the soldier.
Profiting by the dear-bought experience of Shiloh, and in antici- First general patiou of a scvcrc battle at Corinth, orders were given, ofthis°fSiy. about the time that I arrived there, to establish large field hospitals in the rear of each of the armies. It w^as not de- signed to send to the rear any w^ounded whose lives or limbs would
SEVERE SERVICE BEFORE CORINTH. 49
have been seriously endangered by the transportation. The hos- pital for Biiell's army, which was placed under the charge of Sur- geon A. P. Meglert, U. S. V., and myself, was intended to accom- modate 2500 patients. Elaborate drawings of this hospital, and a description of its construction and administration, were afterwards forwarded to the Surgeon-General of the army. The plan was in general terms as follows : It consisted of sections, each section complete in its own administration, with one senior medical officer, two assistants, and the necessary attendants, and made to contain about one hundred and twenty-five patients. Each section con- sisted of four wards, arranged two on either side of an avenue, or space, in which were located the quarters of its medical officers and attendants. These sections were repeated in a line with each other. The kitchens and very narrow and deep latrines were located on one flank, while on the other were located the quarters of the chief medical officers, purveyor, commissary, and the guards. In the absence of hospital tents, the wards were made of tarpau- lins, stretched over a frame-work consisting of comer-posts and studs driven into the ground, and plates and rafters. The tarpaulins formed the roof, and old tent-flies were used for curtains to the sides. I like this form of shelter much better for the summer than the regular hospital tent. A good substitute for the tarpaulin in this kind of tents, especially when it is necessary to economize canvas, is to use hospital tent-flies for the purpose. They can be arranged by tacking the side border of a fly upon the ridge-pole of the frame-work ; then drawing it tight over the plate, and fastening the other side-border, by means of its cords, to stakes driven firmly into the ground ; then tack another fly upon the opposite side in a similar manner, and so on with four more flies, and you will have a large and commodious tent, cool in the summer and easily venti- lated.
But the enemy retreated from Corinth without a battle, and when our armies moved on, these large field-hospitals severe ser- were filled with sick and such men as were too feeble ^am^ment to march. No better opportunity could have been before co"^ aflbrded than this for a study of the diseases prevalent ^''*^- in the army at that time. It will be remembered by all who served in the trenches before Corinth, that durinsj the whole time they were constantly on duty, either digging in the trenches or watching on the picket-line, and that their rations consisted of but little more than salt pork and hard bread, or flour, with no means of preparing it. They will remember how grateftd they felt for
50 TYPE OF DISEASE IN THE ARMY BEFORE CORINTH.
any little article of fiiiit or vegetable food that the Sanitary Com- mission were enabled to supply. How could one wonder, then, at the spectral appearance of this army as it marched off !
The following " Observations on Camp Disease in the Field, near Typeofdis- Ooriuth, Miss.," made at the time by myself, and pub- a?^y before lishcd iu the " American Medical Monthly," will give a Corinth. £^jj, ^^^^ ^£ ^^^ ^j^q q£ discasc that prevailed there : —
" In 'our hospital alone there were registered seventeen hundred patients. All of these cases presented the same type of disease, variously expressed by the terms ' Dysentery,' ' Diarrhoea,' ' Febris Typhoides,' ' Scorbutus,' and ' Debilitas.' Subsequent observation of these cases demonstrated the uncertain character of this classi- fication, and that the disease derived its name fi'om the most prominent symptoms present, rather than from ascertained path- ological conditions. It could not easily have been otherwise, as aU surgeons will testify who have found the same person, in the course of a few weeks, upon their register, under treatment for dysentery, diarrhoea, and febris typhoides ; the same attack ac- quiring a new name, in accordance with the development of new symptoms, or the absence of others. In fact, these diseases ex- hibited such a diversity in their behavior, seldom running a reg- ular course, but alternating one with the other, and exhibiting so many symptoms in common, that the nomenclature was necessarily confused.
" The case was termed ' dysentery ' or ' diarrhoea,' in accordance with the presence or absence of tormina, tenesmus, and bloody evacuations. But there was seldom an amount of local pain and constitutional disturbance in the cases exhibiting bloody evacuations sufficient to indicate the presence of active inflammation ; and ul- cerations in the colon, and bloody dejections, frequently occurred, unattended by tormina and tenesmus, and seemed to be more the result of a hasmorrhagic diathesis than of any perceptible organic change. In all the autopsies made, the large intestine was free from ulcerations, but the mucous membrane of the ileum invariably exhibited a softened condition, and was easily removed with the back of the scalpel. This condition also existed in the colon occa- sionally. In no case were there discovered well-defined ulcerations. In a few instances the mucous coat was found absent in patches, but the appearances denoted an abrasion rather than the result of an ulcerative process.
TYPE OF DISEASE IN THE ARMY BEFORE CORINTH. 51
" In cases of fever, the fever present was decidedly of the ady- namic type, and was usually registered as ' febris typhoides.' But this fever differed essentially from the true typhoid or enteric fever in several particulars. There was no tympanites, no rose- colored einiption, and no affection of the Peyerian and solitary glands of the ileum. The visceral complications were trifling. In no case was any disposition to a disorganization of the parenchym- atous organs observed. There was a great tendency to serous effusion, especially in the pericardium. The brain appeared healthy. Death seemed to result from asthenia. Parotid abscesses were frequently developed in the course of the fever. They usually appeared in a late stage; but when they appeared ear- lier in the fever, the system failed rapidly, and death ensued in a majority of cases, though not in all. When life was prolonged, the entire gland suppurated, leaving the whole parotid region cavernous.
" ' Scorbutus ' was applied to cases in which more of the distinct- ive marks of scurvy were present, such as spongy gums, large and flabby tongue, feeble pulse, dusky complexion, and petechise. This disease very seldom appeared in its worst and most characteristic forms.
" ' Dehilitas,^ as used, was a very general term. Sometimes it indicated convalescence ; sometimes it was applied to the merely adynamic condition of the system that resulted from the continued operation of the depressing influence of the past severe winter and spring campaign. In these cases there was no fever, and but httle, if any, diarrhoea, but simply a ' weakness,' attended with emaciation and a loathing of the army ration. Occasionally, cases terminated fatally very suddenly where no cause post mortem could be discovered, save fibrinous coagula in the cavity of the heart.
" These coagula were observed in 33 per cent, of the autopsies nade, and in nearly all the cases of sudden death. They were firm, unmixed with red blood corpuscles, and weighed from one and a half to seven drachms. They were found oftener in the right ventricle ; usually, however, in both ventricles ; generally attached to the chordae tendineae, but sometimes entirely loose. The largest coagulum discovered was in the case of a patient who was admitted on the 28th day of May, 1862, with ' febris typhoides.' At the end of twelve days his symptoms of fever were entirely relieved, and he bid fair for a speedy recovery. He remained in this con- dition, without apparent disease, nourished and stimulated with care, until death came like a gentle sleep on the 22d day of June. The
5'2 MARCH OF THE ARMY OF THE OHIO.
heart was found in all cases pale and flabby, and the blood was very fluid. The gall-bladder was usually found full of dark- colored bile. In several instances it was very much distended ; but there were no icteroid symptoms before death, nor any appar- ent deficiency of bile in the evacuations from the bowels.
" Several instances of intussusception were discovered ; in one of which there were six invaginations of the intestine, ranging from one inch to four inches in extent. Yet the foeces had been passed regularly, without any symptoms of obstruction.
" The deductions from the foregoing observations are, that the causes of all these affections were in the totality of their effects essentially debilitating, and, in the main, may be enumerated : as the long-continued exposure to cold and wet during the "s™ter and spring, the hot sun and cold nights of the later months, excessive labor and loss of ' rest, deficiency of food and bad water ; that, possessing so many elements of similarity, these affections owed their variety to some accidental circumstance in the constitution of the individual; and that no certain classification of these could have been made having for its basis the presence or absence of pathological lesions that could be determined before death. It would seem that the combined operations of all these causes gen- erated a general morbid condition, or dyscrasia, which constituted the true disease ; and that the pathological phenomena that resulted therefrom were but secondary effects, and that these effects or ' diseases ' compensated each other when attacking different indi- viduals, and alternated very often in the course of the same case. Our main reliance in treatment was in rest and nutrition."
Along with the sick above referred to, we received a hundred cases of severe wounds, amputations, etc. Erysipelas appeared in almost every case to a greater or less extent, but gangrene in none.
March of the As I havc already remarked, the army that moved out Ohio after of the trcnchcs in pursuit of Beauregard was but the tionofCor- spcctrc of au army. The men and officers looked sal- improved low and thin, and considered themselves fortunate if they condition. Only had " a little diarrho3a."
After pursuing Beauregard for a short distance into Mississippi, the army of the Ohio (Buell's army) took up its march eastward to Middle Tennessee, and continued marching almost without in- termission for nearly five months ; traversing Northern Mississippi and Alabama up into the mountains bounding Middle Tennessee on
ORGANIZATION OF THE MEDICAL DEPARTMENT. 63
le west ; thence northward through Kentucky to Louisville ; thence retm-ning in pursuit of Bragg, fighting the battle of Perry- ville, on the way back to Nashville, where we finally went into camp and indulged in a short rest before fighting the battle of Stone River. The health of the army began to improve the mo- ment it got into the region of pure water, vegetables, and iruits. Rations of green com did more for the cure of the obstinate diar- rhoea that then prevailed than any or all the theraupeutical meas- ures that had been tried !
When the army arrived at Louisville it was re enforced by re- cruits who came forth in answer to the calls of July, Reenforce- 1862. The personnel of this enhstment was scarcely any ™myfrom* improvement over the former one. New organizations S62Tnoim. were formed, and were officered by inexperienced men. fnXT«"- The government surely committed a great error at this theTroopf time in not filling up the old regiments before creating °^ ■^^^^• new ones. The new recruit would then have been subjected to the inspection of regimental officers already experienced, and would have soon acquired the habits of personal care and comfort that association with drilled and disciplined soldiers alone can teach. But as it was, in a short time these new regiments were reduced in strength below those that were then serving out their second year. On the march from Louisville large numbers fell fi-om the ranks. They had not the encouragement and friendly aid of the old soldier at their side to teach them the folly of carry- ing a heavy knapsack, or to carry their gun for a while, and to re- lieve them of fatigue duty on going into camp at night ; but, ex- hausted and sick, they fell out of line, overloaded the ambulances, and over-peopled every town through which we passed.
But to return to the field hospital at Corinth. After the sick and wounded left behind by the army had been sent North, we were ordered by Surgeon Murray, U. S. A. Medical Director, to bring the tents, etc., to Huntsville, with the view of establishing a similar hospital there, but this intention was not fully carried into effect on account of the retreat of the army into Kentucky.
In the mean time I was assigned to duty as medical director of the 6th (Wood's) Division.
During our march northward we were in constant expectation of an engagement with the enemy, who marched in a par- First attempt
n 1 1 • 1 1 . 1 1 1 • • at an organ-
allel Inie close to our own, and with the same objective izatiouofthe
64 THE LONG REST OF THE ARMY.
medical de- point or points in view. At this time (Sept. 10, 1862) I foTthe field made the first attempt that was made, to my knowledge, wood?D?- toward an efficient organization of the medical department vision. £^^j, ^YiQ field of battle. I do not know what may have
been done in other divisions of the army, and am not disposed to take any especial credit for exclusive originality in the conception, as it appears from Circular No. 4, Surgeon-General's Office, of date March 25th, 1863, that a circular was published by the medical di- rector of the army of the Potomac on this subject the 30th of the following October. The plan that I inaugurated was as follows : I directed that when a battle was imminent the chief surgeon of each brigade of my division should report to me immediately for special orders, and to assist in the selection of a site for the division hos- pital. They were directed to have one regimental medical officer to accompany each regiment upon the field, for giving temporary aid, and to see that the wounded were removed promptly. The remainder of the medical officers were to be held in readiness to rendezvous with their hospital wagons at the point designated for the division hospital. The brigade surgeons were to constitute an operating board, without whose sanction no important operation was to be performed. We had no regular ambulance organization. The season was unfavorable to military movements, and no great Theiongrest danger was felt that the enemy would attack us. The Th?time°^^" mi^ds of the troops were therefore at rest from the con- cuperaSng' staut cxpcctation of orders to march, or apprehensions auTreS^' ^^ ^^^ attack. DuHug this period the army was largely
forcing.
reenforced by the return of men to duty from general hos- pitals, and by new enlistments ; and on the other hand great num- bers of physically disabled men were discharged from the service who had rested as a dead weight on all of its movements.
The first real and successful attempt toward a thorough organ- ization of the medical department of the entire army commenced here under the directions of Surgeon G. Perin, U. S. A. Many practical observations had been made by those medical officers who had labored in the field for a period of eighteen months or two years in all the capacities of regimental surgeon, surgeon-in-charge of field hospitals, and medical director ; — in the camp, on the march, and in battle ; and the new medical director of the depart- ment wisely availed himself of the experience and suggestions of his subordinates, and took them into his counsel. Under his care and direction the army grew in strength like a convalescent, from day to day.
CHAKGE IN METHOD OF COOKING. " 55
If either of the grand armies was ftirther advanced in the com- pleteness of their medical organization than ours was at this time, we would claim in qualification that no other army had done an equal amount of hard and continued service. No other army had less time and opportmiity than ours to inaugurate and carry out reforms. We had long since ceased to look to our common senior for instructions, and any thing of excellence that existed in our administration sprung from our own unaided efforts. We strug- gled without enlightenment from the chief of our bureau, and against the prejudices of a commanding general who felt that every sol- dier detailed from the ranks for the care of the sick and disabled was a permanent loss to his effective force, and that the medical department should be self-sustaining — that the sick should take care of the sick ! Without wishing to dispute his high position among scientific mihtary generals, the commander of the army of the Ohio exhibited in his conduct a great deficiency of sympa- thy for the sick and disabled soldier, and treated the efforts of the medical department to improve itself with an amount of indiffer- ence that showed that he merely tolerated its existence as an un- pleasant necessity.
A different condition of things commenced when General Rosen- crans took command of the army. He and his medical director harmonized in friendship and benevolence of feeling, so that every practicable measure recommended to improve the efficiency of the medical department, and to raise the standard of qualification of its officers, met with his hearty cooperation. Soon after the battle of Stone River an Army Board of Medical Examiners was ap- pointed for the examination of medical officers reported incompe- tent, of assistant surgeons for promotion, and of private physicians applying for contract. I regret to have it to say that we had some medical officers who were found to be grossly incompetent. The effect of these examinations was very apparent in the improvement of the efficiency of the medical staff.
The hygienic condition of the army was greatly improved here by a change in the method of cooking, which was enforced hy orders^ namely, by companies. Heretofore the cooking had been done by squads or messes, notwithstanding the oft-repeated recom- mendation of medical directors in favor of cooking by companies. To insure a good quality of soup for the soldier an order contain- ing a set of most excellent soup receipts was issued on the recom- mendation of the medical director of the department : —
^Q SOUP-ORDER.
GENERAL ORDER No. 76.
Head-quakters Deft, of the Cumberland, Murfreesboi'o, Tenn., April 10th, 1863.
To preserve as far as possible the health of the troops of this Army, the following remilations, in regard to diet, are
Soup-order. mi o o o
prescribed : —
I. When in camp, cooking will be done by companies, instead of squads.
II. Soup, made according to the following recipes, will be served to the men as follows : —
1st. Beef soup, when fresh beef can be procured, twice a week. 2d. Soup made from beans or pease, twice a week, or oftener, if desired by the men.
RECIPE FOR BEEF SOUP.
Beef and Vegetable Soup for fifty men.
Ingredients, — Beef (cut in pieces of 4 or 5 lbs. each) 35 lbs.
Dessicated Vegetables ... 3 "
Rice 4 "
Flour, sugar, and salt, each . . | "
Pepper ^ oz.
Water . . . . . . 8 galls.
Directions. — Soak the dessicated vegetables from reveille until after breakfast. Immediately after breakfast, put all the mgre- dients into kettles at once, except the flour ; set them over the fire, and when beginning to boil diminish the heat, and simmer gently until 11 o'clock ; then add to the soup the flour, which has been first mixed with enough water to form a thin batter ; mix well together and boil until noon. Suflicient hot water may be added, from time to time, to replace that lost by boiling. The soup should be stirred occasionally, to prevent burning or sticking to the sides of the kettle.
Note. — To make good beef soup, it must be borne in mind that the ingredients are put into cold water, and the heat gradually ap- plied until nearly the boiling point ; then simmer for several hours. By brisk boiling the exterior of the meat is hardened, and its juices will not be mixed with the water, but retained. The meat will also be tough and unpalatable. The dessicated vegetables should be well separated when put in water to soak.
|
K SOUP-OKDEK. |
• i |
|
RECIPE FOR BEAN SOUP. |
|
|
Bean Soup for fifty mm. Beans .... Bacon or Pork |
. 4 qts. . 15 lbs. |
|
Onions Pepper Water |
. no. 3 . ioz. . 8 gal] |
Ingredients.
Directions. — Soak the beans over night ; at reveille in the morning, put them into vessels, carefully cleaned, and boil steadily until done ; then mash them with a spoon, or masher made for the pui'pose, and strain through a colander if practicable.
Immediately after breakfast, put the bacon (or pork), cut in pieces of from three to five pounds each, into another kettle with water, and boil for an hour ; pour off the water, add the bacon to the soup, with onions (chopped fine) and pepper, and boil until noon. Remove the bacon and cut into smaller pieces, suitable for serving with the soup.
Note. — In the preparation of this soup, soft or rain water should be used, when practicable ; and if a less quantity than that directed be put into the vessel, or if it become necessary, from long boiling, to add more, it should be boiling and not cold water. The bacon, after parboiling, can be placed near the fire if the beans are not sufficiently soft to mash well. The reason for direct- ing that the bacon be added after the beans are done is, that grease of any kind hardens them.
When pease are issued in lieu of beans, they should be treated in the same manner.
III. All commanding officers are charged to see that these or- ders are strictly enforced, and that there may be no neghgence on the part of company cooks. Company officers will inspect the cooking every day, to see that it is properly done.
IV. The especial attention of the officers of the Inspector-Gen- eral's Department will be given to this matter, and they are di- rected to report the execution or neglect of these orders, by every regiment in the Department, in their semi-monthly Inspection Reports.
V. The senior medical officer on duty with each regiment \vill make a "written report, on Monday of each week, to the Medical Director of the Department, tlirough the intermediate medical officers, stating the number of times soup has been served to the men during the week, the kind, and the quality of the cooking.
58 CAMP POLICE.
The importance of wholesome food cannot be over-estimated, and the General Commanding enjoins upon the commanding officer of every regiment the necessity of enforcing these orders. Im- proper and badly cooked food, eaten at unseasonable hours, is the cause of much of the sickness which thins our ranks and fills our hospitals.
By command of
MAJOR-GENERAL ROSECRANS,
C. GODDARD, A. A. Gr.
There appeared but very few cases of scurvy here, applying this name to cases in which wer-e present the diagnostic symp- toms usually given for it ; yet a dyscrasia evidently existed with the troops, as many cases of death occurred, some of them sud- den, in which a similar post-mortem condition was discovered to that described as having existed at Corinth. For the period of many months the men had received no fresh vegetables regularly through the commissariat ; though the necessity and importance of the issue had been very frequently reported to the head-quarters of the army. Relief finally came, not through the commissary, but through the agency of the Sanitary Commission, to whom General Rosecrans gave unlimited orders for transportation for this purpose. It seemed that the U. S. Sanitary Commission could succeed in furnishing potatoes, etc., where the commissary could not. This has been accounted for by the fact that the government let con- tracts for their supply in such large amounts, that no one dared to undertake to fill them properly, whilst the Sanitary Commission purchased in lots of any size, and forwarded them to the field im- mediately.
A few cases of Cerehro-Spinal Meningitis occurred here, though it Cerebro-spi- did uot prevail as an epidemic. I cannot give the treat-
nal Menin- n ^ i t ^
gitis. ment ot these cases, or the success, as i became an m-
valid myself about this time, for a period of two or three weeks, with an attack presenting some of the prominent symptoms of that disease.
Camp police was a subject that received special attention during the army's long; rest here. As a principle, habits of order.
Camp police. iit .i • I ii
and cleanlmess m the regimental encampment, extended their influence to the soldier in the care of his person and accoutre- ments, and greatly contributed to his health and happiness. Our camps became models of neatness and order, and received the most flattering encomiums from the U. S. Army medical inspectors who visited us. The latrines and kitchen sinks were constructed very
MARCH OF THE ARMY TO CHATTANOOGA. 59
[generally upon the same plan ; by digging pits, corresponding in [size to the purpose, being larger for the former, and smaller for the flatter ; then covering them over with platforms made of clapboards, excepting a place small enough merely to give a sure support to a half-barrel or cracker box, in the top of which was made a hole for the convenience, as the case might be, of a seat, or of pouring in slops. Any day the most fastidious person might have gone through the encampment of the 21st Army Corps without per- ceiving an unpleasant odor. These measures of personal and camp police, including the improved method of cooking, had a remark- ably good effect upon the health of the soldiers, which was demon- strated by their subsequent endurance of fatigue and wounds.
The subject of an ambulance organization also engaged our at- tention here. Up to this time no regular ambulance sys- Ambulance tem existed in this army. Regiments were unequally organization, supplied with ambulances, and as regimental quartermasters were responsible for them, their use was by no means restricted to legiti- mate purposes, and were not usually kept in serviceable condition. For instance, in a report made by myself on the subject, Dec. 7th, 1862, out of one hundred and one (101) ambulances reported in my corps, only thirty-nine (39) were reported as serviceable ; and it was with this number that we transported our wounded from the battle-field ! The division quartermasters reported that they had made frequent demands for ambulances ever since the army left Louisville, the preceding August, but failed to get any. On recommendation of the Medical Director, an " Ambulance Order " was issued, March 6th, 1863, which, in the hands of the medical directors proved very efficient during the long march to Chatta- nooga, and in the battles of Chickamauga, Lookout Mountain, and Mission Ridge.
Thus was the army of the Cumberland, on the 20th of June, when it broke camp, to commence the summer march March of the of 1863, that led to the battle-field of Chickamauga. Chattanooga. The 14th Corps had a short engagement with the enemy before reaching Tullahoma, but my own corps being a few miles distant, I knew nothing of this engagement that would be of interest in this history.
During the march to Chattanooga there was nothing occurred worth recording beyond the incidents common to a continuous march of weeks, and the occasional rests that intervened. The hygienic condition continued good ; all the conditions were favor- able. The season summer ; the country mountainous and abound-
60 SIEGE OF CHATTANOOGA.
ing in springs and running streams of pure water; the marches easy; and suppHes of blackberries, peaches, and green com in abundance. But few fell sick on the way. Chattanooga was evacuated on our approach. We here found a large number of pavilions that had been used by the rebels for hospitals, which we immediately prepared for our own use. They were well arranged for the pur2)ose, but were not nearly as elaborate in all their appoint- ments as our own general hospitals. One striking feature of their general arrangement was, having a large receiving hospital near by the principal railroad depot, where the sick and disabled could be received at all hours, and not have to suffer ambulance transporta- tion before being fed and dressed.
Our army remained in Chattanooga, in this state of siege, for a pe- siege of riod of five weeks. Owing to the fall rains the roads soon nooga. became almost impassable. The troops were regularly on
half rations, and sometimes failed to get any for a day at a time. Sometimes, in lieu of rations, they were favored, over the horses, with a few small ears of corn, which they parched and ate with a rehsh.
Soon all the forest trees within the works, and as far beyond as it was safe to venture, were felled and used for firewood ; and when this supply was exhausted, the stumps thereof disappeared for the same purpose ; and w^hen these failed, the roots and rootlets of the trees were dug from the ground, and husbanded with care. There had been no issue of clothing made since in the summer. The men had left their knapsacks and overcoats at Murfreesboro, according to orders, and now were protected only by their thread- bare and tattered summer clothes ; none had overcoats, and but a portion had blankets.
The transportation of the army had become fearfully reduced. For want of forage many of the officers were compelled to turn their horses out to roam at large, and perhaps die, or else see them starved to death at the picket-stake. Thousands of mules died from starvation. The road to Bridgeport was corduroyed with their carcasses. In every mud-hole they might have been seen struggling with feeble and fast-waning strength in fruitless eiforts to extricate themselves. Whole wagons became worthless under their ravenous attack. They died in such numbers in the encamp- ment that the hving scarcely sufficed to drag their dead away. All the ambulance-horses that could be spared, and almost all the artillery-horses, were sent away to the rear. Finally the situation demanded, as the only hope of our army, that we should fight
BATTLE OF MISSION RIDGE. 61
again. And although no very apparent increase of sickness had been produced by the destitution of food and clothing, yet it may be readily conceived with what forebodings for our wounded we contemplated the necessity for another battle. We knew that their hygienic state must be unfavorable to recovery from wounds, and the means at our control were almost totally inadequate for their prpper care and subsistence. When the enemy evacuated the place, they cleared the hospitals of every thing that could be of use to us, even to household utensils. Not a bunk was left in the buildings used for hospitals. Truly, " we were compelled to make brick without straw." A part of the pa\dlions that the enemy had used for hospitals came Avithin the range of the guns, when our defensive lines around the city were established, and were de- stroyed by fire ; and for hospital purposes we were driven to the necessity of using hotels, churches, and deep and badly ventilated warehouses, the walls of which had become so many square yards of fomites^ in consequence of the poisonous emanations from the large number of Confederate sick and wounded who were treated here. For bedsteads, we manufactured bunks from fencing-boards and the sidings of old frame houses, which were careftilly removed that the nails might be saved for special purposes. A few bales of cotton frirnished us material for mattresses, and for cooking purposes we gathered odd pieces of cooking utensils and broken ranges which, at any other time, would have been considered worthless, but which to us now were invaluable.
The battles of Lookout Mountain and Mission Ridge were fought on Nov. 23d, 24th, and 25th, 1863, and opened up Battles of the old line of communications to Bridgeport. Our fore- RWge and bodings for the sufferers in these battles were too w^ell Mountain, verified. Under the best nursing and treatment that we were enabled to give them, the mortality was very considerable. Na- ture seemed to arouse all her enero-ies in one effort to cure ; but hospital gangrene and its congeners bliglited with their poisonous venom her laudable efforts, and again we were compelled to stand by and see case after case that had excited our most lively interest falter in the reparative processes and perish. We lived in con- stant fear and trembling for our most promising cases ; not until the last particle of pus had ceased, and the cuticular epithelium had interposed itself as a final protection, pronouncing the amputation or wound healed, did we rest secure in our triumph with nature's remedial forces. Too often, at night, we left our " good fellow " with promises that he should soon go home to his friends, and in
62 IMPROVEMEKT IN THE MEDICAL DEPARTMENT.
the morning met the nurse with the deportment so ominous of evil tidings, and with the report that our patient " had had a chill ; " and, on inspection, found, instead of laudable pus, a sanious dis- charge upon the dressings, with perhaps gas bubbles issuing from the wound, and granulations of a hue of greenish gray. Our pa- tient would then be singularly unconscious of any danger, taking his quinine as if he had only a chill, and, loth to see inevitable death in the case, for a few hours, or a day perhaps, we, too, hoped it would prove " only a chill." But it was well for him that, as he must die, his death came from a simultaneous poisoning of his system with his wound, rather than from the slow exhaustion of gangrene and repeated secondary hemorrhages.
The behavior of all classes of wounds was very much modified by the character of the buildings or shelter in which they were treated. It was best in tents, next in pavilions or modern build- ings, and least well in the brick buildings. A row of deep ware- houses was used for our purposes, a part of which were constructed of brick, and a part of wood, and it was observed by all who went from ward to ward that there was a decided improvement in the appearance of the patients in the wooden over those in the brick portion of the buildings.
Immediately after the battle of Mission Ridge, two divisions March to the of the 4th Corps marclicd to the relief of Knoxville, and Kuoxviiie. remained in that vicinity until the army was concentrated health not- for thc Spring campaign. It is a fact worthy of note that
withstanding ^ ^ -i i ,. . . ,,1 , .
destitution although thcsc two divisious were compelled to subsist on
of all kinds . '^ . . , mi i i i •
of supplies, the very shortest rations, and were still almost naked in the midst of winter, and without tents, yet their health was un- precedented, many of the regiments not reporting a single case of sickness on their monthly reports of sick and wounded ; while the remaining division that was in camp near Chattanooga, which was much more liberally supplied, was constantly reporting quite a large sick list, and the appearance of scorbutic indications. Short rations alone do not cause bad health so much as a more abun- dant ration less careftilly prepared, and, usually, the more abundant the ration, the less carefrilly it is prepared for food.
The long rest that ensued after the battle of Mission Ridge was Further im- spcut ill Still further improving the efficiency of the fn*themedi- medical department, by reducing its transportation and ment.^^'^ coiisolidatlng its forces. The transportation allowed to a regiment for medical purposes was one serviceable pack-mule for the purpose of carrying a medicine pannier. Regimental hospitals
IMPROVEMENT IN THE MEDICAL DEPARTMENT. 63
^B were abolished, and a system of brigade hospitals was established, equipped in accordance with the following allowance, namely : one wall tent, one common tent, and hospital tents in the proportion of one for every 350 men present ; camp kettles, etc., as many as are absolutely necessary; and one medicine wagon and two army wagons for transporting medical stores and camp and garrison equipage for the brigade hospital — all of which were to be under the direction and charge of the brigade surgeon. A field supply- table was determined upon, and published for the guidance of medical officers in a circular dated "Head-quarters, Department of the Cumberland, January 1st, 1864," specifying the allowance for a brigade. This obviated the necessity of continuing the trains of corps reserve supplies which had proved so advantageous in pre- vious campaigns.
The ambulance corps was more thoroughly organized, in accord- ance with General Orders No. 2, Head-quarters, Department of the Cumberland, January 2d, 1864.
CHAPTER THIRD.
ARMY ALIMENTATION IN RELATION TO THE CAUSATION AND PREVENTION OF DISEASE.
BY SANFORD B. HUNT, M. D.,
ILATE SURGEOX AND BREVET LIEUT.-COL. U. S. VOLUNTEERS; FORMERLY PROFESSOR OF ANATOMY IN THE MEDICAL DEPARTMENT OF THE UNIVERSITY OF BUFFALO.
Public Opinion respecting the Wants of the Army prior to the Rebellion. — Experience of the British and French Annies 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 different Nations. — Rations of the United States Array 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 Convalescent 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; Coffee, Tea, and Whisky. — Summarj'. — Professor Horsford's Plans to diminish the Weight and Bulk of the Army Ration.l
Prior to the Great Rebellion the public mind had rested in quiet Public opin- satisfaction as to the physical wants of its small regular ingth?^^* army. The few who had opportunities for observation wants of the^ g^^^ ^j^jy ^ wcU-fcd, wcll-dressed, and well-" set-up " looking man in uniform, who had no complaints to make ; and, therefore, they ran easily to the conclusion that gov-
1 The endurance and health of the soldier are obviously affected, favorably or unfavor- ably, to a greater or less extent, by alimentation; inadequate nutritious supplies must, of course, lessen his ability to sustain the hardships of army life, and impair the power of resisting disease. The regulation of army rations, so as to secure to each soldier a proper relative proportion of the different alimentar}' principles, avoiding, on the one hand, defi- ciency, and on the other hand, excess, and the preparation of food with regard alike to wholesomeness, convenience, and economy, are objects of the greatest importance with a view to promote the largest amount of efficienc}', and to afford the fullest protection against morbific causes other than those which are directly or exclusively dietetic. Army alimentation, therefore, belongs properly among the topics embraced in section first of this volume ; and, in consideration of its importance, a distinct chapter is devoted to it. The next chapter contains testimony of medical officers respecting certain points connected with alimentation. Dietetic causes, standing in direct relation to the production of certain indi- vidual diseases, especially scurvy, diarrhoea, and dysentery, will enter into the consideration of these diseases in section second of this volume. — Editor.
army prior the Rebellion.
FAULTY ALIME:N^TATI0N IN THE AKMIES. Q^
ernment took ample care of its soldiers, and, of course, would do so in the then impending crisis. Even in the Mexican War, when the element of undisciplined volunteers, under inexperienced offi- cers, had been largely introduced, the distance of the field of operations was so great, and their results so satisfactory to our pride, that little attention was drawn to the disastrous mortahty from diseases of assimilation that attended those briUiant campaigns. Fortunately for the American people, this self-contented apathy was broken by the revelations of the sufferings of the Experience British and French armies in the Crimea. The results and French
. . . IP armies in thfe
01 parliamentary mvestigations and or newspaper reports Crimea, revealed the fact, that, afler an experience of many centuries of foreign wars and wars of invasion, the British commissariat was totally inefficient. The science of the alimentation of armies had been neglected to an extent that involved all the errors of a diet which, when abundant, was unsuited to the wants of the system ; and which was so often deficient as to produce actual starvation. The publicity so sensibly given to these important truths seems to have been the direct cause of the inquiries made into the constitu- tion of the United States army ration at the outset of the rebellion, and the considerable reform, by enlargement and increase of flexi- bility, made by Congress in the summer of 1861.
But notwithstanding this, and without having been subjected to such calamities as attended the Crimean War, the armies Faulty au- of the United States doubtless endured much that might the armies of have been avoided. The ration was sufficient (judi- states, ciously issued) in weight of nutriment, except in the more pressing exigencies of hard marches and distant bases of supply ; yet it can- not be denied that a fault existed, which we may expect to find, — 1st. In the arrangement or equalization of the different nutri- ments ; or,
2d. In their lack of adaptability to vicissitudes of climate or the accidents of campaigns.
The proof of the existence of the fault asserted needs little argu- ment. It is found in the great mortality from diseases of assimi- lation which began with the war and increased in fatality up to its close ; and in the evil results which attended gunshot injuries and operative surgery from the impoverished condition of the blood of the sufferers. Thousands of such men were borne from the field, apparently hardy and strong, Avho within a few days developed some cachexia, seriously comphcating the otherwise simple nature of their injuries. In the establishment of the present ration, only
GQ IMPORTANCE OF THE LAW OF ALIMENTATION.
tradition was consulted. So far as is now known, it was arranged by men without pretense to skill as experts, and without any exhaustive study of the laws of alimentation.
In the discussion of the food of armies it is not our intention to Occasional hsise our argument on those occasional interruptions of tKro/sup- s^Ppty which sometimes subjected our troops to the evil ^^^' of short rations. They were the almost unavoidable
incidents of a sudden and gigantic war, conducted by inexperi- enced officers, and of the magnitude of which only a few foresaw enough to urge the needed preparations. These misfortunes, as they occurred in camp, in hospital, or on battle-fields, it was the work of the Sanitary Commission to relieve. In all wars this sup- plementary labor will be necessary. Some agency must exist in alliance with, but independent of, the government, which, with an easy book-keeping and a broad charity, can be present with help in emergencies and remedy the deficiencies of the government and the improvidence of the soldiers themselves.
On the other hand, we have been led to the conviction that, The ration throwiug out of vicw thcsc occasioual disturbances of pk)ymenra ^upply, and making the broadest allowance for all other B^urce of causes of disease in the army, one, and the most fruitful, disease. ^£ j^g sourccs is to be fouud in the ration and its unscien- tific employment. We reach this conclusion from the almost uniform observation of army surgeons, — that veteranship conferred no immunity from diseases of assimilation ; that chronic diarrhoea and scurvy increased with the term of service ; that the longer a soldier had been subjected to the ration (as he got it), the more liable was he to develop some form of cachexia when wounded. Thus, hospital gangrene was hardly known during the first few months of the war, but steadily increased in frequency of occur- rence up to its close.
To insure a proper comprehension of this subject in the pubhc Importance T^^^^^ it is neccssary to revert briefly to some of the more ofaUmS- obvious of the laws of alimentation; to endeavor to ^°^- establish some standard of diet, which, in average cir-
cumstances, shall be sufficient to maintain the body in health ; to note the variations in that diet which may be required by way of adapting it to the peculiar life of the soldier ; and, finally, in the suggestion of any changes, to see that they possess the requisites of sufficient cheapness and ease of transportation. Without the latter essential the best of rations would be unavailable. It must be in some form that can accompany the march of a column, without overburdenino; the train or the haversack.
AVERAGE DIURNAL LOSS AND GAIN IN WEIGHT. 67
A STANDARD OF ALIMENTATION.
The average weight of seventeen hundred soldiers of the army of the Potomac was 147^ pounds. The average weight Average of seven hundred and five French mounted chasseurs soldiers in was 142^ pounds. The average weight of twenty-seven mies. thousand eight hundred and fifty-three recruits to the British army at home, in 1860, was 128 pounds ; and the average weight of twelve thousand one hundred and ninety-one British recruits for 1861 was 131 pounds. These recruits were all over twenty- one years of age. Thus, the average French weight was 5^ pounds less than the American, and the average Enghsh weight was about 18 pounds less than the American ; a fact brought out by investigations made under the direction of the Sanitary Com- mission. It is an emphatic contradiction of the prevalent idea that the physical manhood of the Americans has deteriorated fi'om the European standard.
Physiologists have fixed upon one hundred and forty pounds as the average weight of the human male. Supposing that Average to be the weight of a person in perfect health, the diet ^^e^h^nan he needs is one that will keep him at that weight by °'*^®' equalizing the receipts and disbursements, the food and the waste of the system. The gain acquired by the assimilation of food, should exactly counterbalance the loss by exertion. Yet there is a further consideration. In what material, in muscle, in fat, or in bone, shall this one hundred and forty pounds of original capital be invested? A soldier's diet must be adapted to a soldier's needs and vicissitudes, to his capacity for enduring heat and cold, to long marches and heavy burdens. He demands an athletism not called for in the ordinary walks of civil life. The diet, therefore, most favorable for the counting-room or the shop, is not that required in the field.
Physiological experiment has arrived at a close approximation to the average diurnal s^ain and loss in the man of one hun- Average
J , J p 1 • 1 mi 1 •^ . . 1 dJ"™a,l loss
area and forty pounds weight. The daily gam is stated and gain in as follows : —
Inorganic gain lbs. 6.301
Organic gain . lbs. 2.250
lbs. 8.551
|
Water . |
lbs. 4.109 |
|
Oxygen |
. « 2.192 |
|
Dry vegetable food |
. « 1.687 |
|
" animal " |
. " .563 |
|
Total daily gain . |
, |
68 FOODS EITHER NITROGENETIC OR CALORIFACIENT.
The total daily loss, in a healthy body, will be exactly equal to the gain. The rapidity of this interchange is an important ele- ment in the argument. It may be augmented by severe exer- cise or decreased by idleness ; and there are articles of diet that may compensate for a short alloAvance of food by restraining the waste of the system. This waste, however, may be largely in- creased without impairing the health, provided the food is equalized to it. The waste is from interstitial death of organic atoms in the system ; and that atomic death depends largely on the activity of ex- ercise— the wear and tear to which the system is subjected. And if we have other new-born organic atoms ready to fill the places of those destroyed, the weight of the body will remain unchanged.
In the above table we may at once dispense with three fourths of the weight of the ingesta named, as not in any army ration. Water and oxygen are provided by another Commissary ; but it should not be forgotten that they are nevertheless foods, and that the official act or neglect that deprives the soldier of any part of his six and three tenths pounds of water and oxygen, robs him of so much actual food to which he is entitled. Beyond that, it remains only to consider what we have called the " organic gain " ; the actual food, vegetable and animal, assumed to be necessary to the maintenance of the body, under usual conditions, in a station- ary condition of serviceability.
CLASSIFICATION OF FOODS. The division of foods into vegetable and animal is unsatisfactory, Foods either insomuch as it docs uot spccify, except very roughly, the S*caforifa-° chemical or physiological office of either class. Reject- cient. jj^g ^^^ division, we find another in the physiological
office of food, which is either nitrogenetic or calorifacient, — flesh-forming or heat-producing. To this it is objected that it is not yet proven that the production of animal heat is a proc- ess of combustion ; yet it is so plain that animal heat is main- tained by some kind of chemical process carried out under phy- siological control ; so plain that the class of nitrogenetics cannot produce heat except at a gTeat waste ; so plain that the so-called calorifacients cannot, under any circumstances, become converted into plastic compounds, that the objection loses all practical force. We know that the nitrogenetics are the only source of muscular flesh. We know, also, that the calorifacients contain the elements of animal heat ; and whether those elements are actually burned, or in some other manner applied to the same pur-
SALTS OF LliME, SQDA, ETC. 69
f'V
pose, is a question which is neveu practically employed in our studies of alimentation.
All foods may be expressed in one chemical triad, namely. Al- buminoids, Starch and its products, and Fats. Of these, Aibumin- the first are nitrogenetic, flesh-forming. Starches and andfat^^ '
ts are calorifacient, — heat-producing, — and do not contain the elements of muscle. They cannot, therefore, perform the office of albuminoids ; but albuminoids may, and doubtless do, in the proc- ess of their excretion from the system, become calorifacient. Thus we reach at once the safe conclusion that nitrogenetic food may imperfectly perform all the offices required ; that a man will avoid starvation much longer on albuminoids alone, than he will on starches or fats only.
Allied to foods — in the better sense of the word, actual foods — are the various salts of lime, soda, potash, iron, mag- saitsofiime nesia, and phosphorus, which are all essential to the ^°^^>^*'^- proper assimilation of food. In all good diet-scales they are, with the exception of common salt, found provided by Nature in suffi- cient quantities, and beyond that they do not need to be sought after. As artificial substitutes for food, the cerebral stimulants, alcohol, coffee, and tea, may be mentioned. And as all foods find their final expression in the constitution of healthy blood, we here introduce Le Ganu's analysis of that fluid.
ANALYSIS OF HEALTHY BLOOD.
First Anah'sis. Second Analysis.
Water 780.145 786.590
Fibrin 2.100 3.565
Albumen 65.690 69.415
Coloring matter 133.000 119.626
Crystallizable fatty matter .... 2.430 4.300
Oily matter 1.310 2.270
Extractive matter soluble in water and alco- hol 1.790 1.920
Albumen combined with soda . . . 1.265 2.010 Chloruret of sodium and potassium and alka- line phosphates, sulphates, and sub-car- bonates 8.370 7.304
Sub-carbonate of lime and magnesia, phos- phates of lime, magnesia, and iron, and
peroxide of iron 2.100 1.414
Loss 2.400 2.586
1000.000 1000.000
To this proximate analysis we here append the ultimate analysis
70 CARBON AND HYDROGEN.
of Prof. Playfair, of the blood and flesh of the ox, showing their ahnost absolute identity.
ANALYSIS OF THE BLOOD AND FLESH OF THE OX.
Ox Blood. Beef Muscle.
Carbon . . . 51.95 . . . 51.83 Hydrogen . .