'.1/
TPIE
MEDICAL Ai\D SURGICAL HISTORY
OF THE
WAR OF THE REBELLIOX.
PAKT III.
VOLUME I.
MEDICAL HISTORY.
BEING THE
THIRD MEDICAL VOLUME.
Prepared under the direction of the Surgeon General, United States Army.
By CHARLES SMART, Major and Surgeon, United States Army.
WASHIIfGTON:
GOVERNMENT PRINTING OFFICE.
1888.
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WAR DEPARTMENT,
Surgeon General's Office,
Washington, D. C, Januanj 17, 1S88.
Brac.ADiER General JOIIX MOORE.
Surgeon General, U. S. Army.
General:
I liave the honor herewith to submit the Third and concludinsf Part of the Medical
History of the AVar of the RebelHon. The First Part, published in 1870, consisted of a
consolidation by departments and regions of the monthly reports of sick and wounded of the
various regimental organizations, with appended extracts from special reports of medical
officers, giving a view from the medical standpoint, of the movements of our armies and the
manv deadly struggles that took place between the opposed forces. The ^Second Part, pub-
lished in 1879, was devoted to a thorough discussion of the alvine fluxes based on tlie mate-
rials, documentary and anatomical, collected by our medical officers during the war. Sur-
geon J. J. Woodward, its distinguished author, brought to his task a comprehensive knowl-
edge of those records of the past, which form the historical basis of the professional opinions
of the present day, on the nature and causation of these important diseases. Moreover, his
intimate familiarity with the materials which had accumulated in the Army ^Medical Museum,
and the enthusiasm with which he prosecuted their study, peculiarly fitted him for the work
of laying before the j^rofession the results of that study. Unfortunately, failing health and
ultimately death, prevented the further progress of the work by the mind and hand that had
conducted it thus far with sucli consummate ability. In July, 1883, the late Surgeon Gen-
eral Crane expressed to me his desire that I should undertake the Third Part of the work ;
and, in view of my reluctance to assume this heavy responsibility, he gave me to understand
that his wish in this instance was intended to carry the weight of an order. No conditions
were imposed as to the matter or manner of the volume to be written, save that the val-
uable plates which Dr. Woodward had prepared, illustrative of the pathological changes
in the intestinal tunics, should be embodied in the work. Since that time I have given my
best endeavor to the fulfilment of this duty; and in presenting the completed results of
these years of labor, I beg that their shortcomings and errors may be attributed to lack of
judgment rather than to a want of careful and earnest consideration.
I have the honor to be. General,
Very respectfully, your obedient servant,
CHARLES SMART,
Major and Surgeon, U. S. A.
TABLE OF CONTENTS
^OLTJIylE XXT OF FJ^-R^T X
MEDICAL AND SURGICAL HISTORY OF THE REBELLION,
EEIXG THE
THIRD MEDICAL VOLUME.
LIST OF ILLUSTKATIOXS _ ix
LIST OF STATISTICAL TABLES AND TABULATED STATEMENTS xi
CHAPTER I. ON THE MEDICAL STATISTICS OF THE WAR.
SECTION I. Sickness and mortalitj' among the H. S.
forces _ 1-2*
-Mortality, actual and reported 1
Mortality-rates 2
Sickness, absolute and reported S
4
4
6
10
Sick-rates
Rates of fatality in specified diseases
General and annual rates of sickness and mor
tality
Sickness and nrortality as caused byTarious
diseases and classes of disease
Sick and mortality-rates of U. S. white troops,
as compared with those of other bodies of men
of the military age 14
Sickness and mortality as influenced by season,
locality, etc 1"
Discharges on account of disability from disease 24
Transfers to the Veteran Reserve Corps. _- 28
SECTION n. Medical statistics of the Confederate
armies 29-33
Page.
SECTION ni. Prevalence and mortality of disease among
U. S. troops in Confederate prisons 33-15
SECTION IV. Prevalence and mortality of disease
among Confederate troops In U. S.
prisons — - 45-71
Prison-camp and hospital at Camp Douglas,
near Chicago, III 48
Pi'ison and hospital at Alton, 111 50
Prison-barracks and hospital at Rock Island, 111 52
Prison and hospital at Camp Morton, near In-
dianapolis, Ind 5:3
Prison-camp and hospital at Johnson's Island,
Sandusk.v, Ohio 51
Prison and hospital at Camp Chase, Columbus,
Ohio 51
Prison-camp and hospital at Elmira, N. Y 56
Prison-depot at Fort Delaware, Del 57
Prison-camp and hospital atPointLookout.Md 59
Prison-camp near .Springfield, 111 CO
CHAPTER II. INTRODUCTORY TO THE PRESENTATION OF THE CAMP FEVERS.
CHAPTER III. ON THE
SECTION I. The statistics of the malarial fevers 77-111
Malarial fevers among the U. S. forces 77
Prevalence and mortality 77
Annual variations in prevalence and
mortality 82
Relative prevalence and mortality
among the white and colored troops— 84
Seasonal variations in prevalence 89
Seasonal variations in mortality 91
Influence of region on prevalence 94
Malarial fevers among the Confederate
troops 102-ias
Prevalence 102
Mortality — 106
Malarial fevers among the prisoners of war
held by the Rebel authorities 103
ilalarial fevers among the prisoners of war
held by the U. S _"_ l<^
SECTION n. Clinical records of malarial disease 111-119
SECTION III. Symptomatology of malarial disease 119-129
Intermittents and remittents 119
PAROXYSMAL FEVERS.
SECTION III. Sy5iPT0M.\T0L0GV, ETC.— [Continued.]
The pernicious fevers 125
Chronic lualarial poisoning 129
SECTION IV. Post-mortem records and pathology of
malarial disease — 129-1-53
Post-mortem records 129
Pathological anatomy and pathology 144
SECTION V. Causation of malarial disease 153-165
Causation of relaiiscs 164
SECTION VI. Prevention of malarial disease — 165-176
General consitierations 165
Prophylactic use of quinine 166
Prophylactic use of other medicinal agents 175
SECTION vn. Treatment of malarial disease 176-190
General considerations 176
Treatment of interuiittents ISl
Treatment of remittents 182
Treatment of congestive fevers 1S3
Treatment of chronic malarial poisoning l&J
Untoward effects of quinine 183
Use of other remedial agents 184
V
i
TABLE OF CO^'TENTS.
CHAPTER IV. ON THE CONTINUED FEVERS.
Page.
SECTION I. Tlie statistics of tbe continued fevers-— 190-210
In the U. S. armies 100
Prevalence and mortality 190
Prevalenceas related to season and locality- 196
In the Confederate armies 20.3
.\mong Union soldiers, prisoners of war 208
.Vmon):; Rebel soldiers, prisoners of war 209
SECTION II. Clinical records of the continued fevers-210-270
Common continued fever 211
Typho-malarial and typhoid fevers 212
Febrile cases at the Seminary Hospital,
Georgetown, D. C 215
Febrile enses from regimental records 249
Febrile cases from various records 257
Typhus fever. __ 268
SECTION III. Symptomatology of the continued fevers -270-3:34
Comiuon contiuued fever 270
Typhoid fever 27.3
Temperature 279
Pulse 2S1
Epistaxis 283
Condition of the skin 28:3
Sudaniina -- 283
Rose-colored spots 285
Petechia; 287
Bedsores 288
Herpetic spots 288
Peculiar odors 288
Condition of the nervous system 288
Iielirium — 288
Dilatation of the pupils 289
Condition of the digestive systeni 201
Anorexia, thirst and gastric irritability. 2',ll
Appearance of the tongue 292
Sordes 292
Diarrhoea 292
Hemorrhage from the bowels 294
Tenderness, tympanites and gurgling— 295
Pulmonary s.vmptoms 297
Other clinical features 297
^Micturition 297
Parotid swelling 298
Pain in the lower extremities 298
Modified typhoid fever 303
Onset — 301
Pulse 301
Epistaxis 302
Condition of the skin - 302
Rose-colored spots 303
Sudami na 304
Petechial and ecchymotic patches 304
Erysipelas 304
Bedsores - 304
Peculiar odors — 304
Cerebral symptoms 304
Delirium - 304
Contraction of the pupils 305
Prostration and muscular tremors 305
Condition of the digestive system 305
Gastric irritability 305
Jaundice 305
Appearance of the tongue, mouth and
throat 300
Diarrhcea 306
Hemorrhage from the bowels 307
Meteorism, abdominal tenderness and
gurgling 307
Splenic enlargement 307
Chest complications 307
Cough 307
Other clinical features 308
Micturition 308
Pai'otid swelling 30S
VI
Page.
SECTION III. Sy.mptomatology, etc.— [Continued.]
Pain in the joints and muscles 308
Gangrene 308
Relapses 308
Fatality 308
Typhoid, modified and unmodified 309
Sequel* - 309
Relapses 312
Second attacks 312
Extracts from reports of medical officers 312
Typhus fever _ 323
SECTION IV. Post-mortem records of the continued
fevers 331-419
Cases ill which the diagnosis, typhoid, is more
or less sustained by the clinical history 335
Cases entered as typho-malarial with or with-
out a record of symptoms to substantiate the
diagnosis 345
Cases entered as typhoid, but with clinical his-
tories suggestive of malarial complications— .351
Cases reported as typhoid, the clinical history
absent or defective 377
Cases variously registered, but typhoid fever
considered present from the symptoms or
post-mortem appearances JOS
Cases illustrative of complications or sequeUe. 416
Cases reported as typhus 418
SECTION V. Pathological anatomy and pathology of the
continued fevers 419-485
The cases and their analysis 419
The alimentary tract and abdominal viscera— 434
Salivary glands 434
Pharynx and cesophagus 434
Stomach — 435
Duodenum 435
Jejunum 435
Intussusception 4;35
Lumbricoid worms 436
Patches of Peyer ^36
Large intestine ^-il
Solitary glands -i-tS
Erosion of tlie intestinal mucous membrane 450
Hemorrhage, perforation and peritoneal
inflammation 450
Reparation of the intestinal ulcerations— 453
Pigmentation of the Intestinal lining 4.55
Mesenteric glands 4.58
Spleen ^ -159
Liver 460
Emphysema of 461
Gall-bladder 463
Pancreas ^03
Kidneys — 46:5
The organs of respiration and circulation 463
Larynx and trachea 463
Bronchial tubes 464
Lungs 464
Pleura; J65
Pericardium 465
Heart J6&
The blood — 471
The brain and its membranes 478
Age of patient; state of nutrition, etc 481
General conclusions 483-
SECTION VI. Etiology of the continued fevers 48.5-5:31
Common continued fever 485-
Typhoid fever 486
Continued malarial fever — 508
Typlio-malarial fever 508
Typhus fever 526
SECTION VII. Treatment of the continued fevers .531-551
TABLE OF CONTENTS.
CHAPTER V. ON THE DISEASES ALLIED TO OR ASSOCIATED WITH THE PAROXYSMAL
AND CONTINUED FEVERS.
Page.
SECTION I. Cerebro-splnal fever 552-5!i0
Clinical nml posl-inortein records.. 5.12
-Vmonj; tlie colored troops !W(t
Among the Confederato troops 5S7
Amonj; the prisoners 590
Symptomatology and pathological anat-
omy bm-cm
Pathology. _ I'M
Prtpo.
Section I. Cerebko-spinal fever— [Continued.]
Prevention and treatment 610-813
Prevention (jio
Trentnicnt - gn
SECTION II. Pneumonic fever C13-fil5
SECTION III. Diarrhoea and dysentery C15-622
SECTION IV. Scurvy 622-024
CHAPTER VI. ON THE ERUPTIVE FEVERS.
SECTION I. Small-pox. C25-C18
Stiitistics •... 62.5
Clinical and post-mortenx records Oiti
Treatnu-iit («j
rniiiwarcl result.s of attempted vaccination 6.'!1
SECTION II. Measles- ! IH9-661
Prevalence and fatality 649
Clinical records 6.5.5
Post-mortem records (i>s
i| Section II. Measles— [Continued.]
Treatment ._ (^9
SECTION III. Scarlet fever— 662
SECTION IV. Erysipelas - 662-4)7.5
Prevalence and fatality 662
Symptoms 061
Clinical reeoi'ds _ 6(W
Post-mortem I'ccords 669
Treatment 67^)
CHAPTER VII. OTHER MIASMATIC DISEASES.
SECTION I. Mumps-
SECTION II. Yellow fever -. — 675
CHAPTER VIII. ON SCURVY.
Prevalence, etc 683
Clinica; records 696
Postrmortem observations 700
Symptoms .._ 70t
Nyctalopia 706
Morbid anatomy 70S
P:itliiilfi._'y, <>:iM^ntion and treatment 709
CHAPTER IX. ON DISEASES ATTRIBUTED TO NON-MIASMATIC EXPOSURES.
SECTION I. Disease of tlie respiratory organs-. 719-818
faturi-h 725
Kpidemic catarrh 725
-Acute bronchitis 726
Chronic bruncbitis 728
.\sthma -. - 729
ItillaiiiiiiatioD of the hirynx 730
Iiinaiiiiiiatioii of tlie tonsils 732
Diphtheritic iutlaiiiination of the fauces, etc. 73.5
Clinical records 742
Post-mortem records 745
Treatment 749
Pneumonia 751
Clinical records 7.52
Post-mortem observations: 759
with ante-mortem notes 760
in cases complicated with laryngitis 763
in patients affected with delirium tre-
mens 763
in cast's in which cerebral lesions were
not associated with recognized cere-
bral symptoms 763
in cases unmarked hy characteristic
pneumonic symptoms 764
in cases of relapse or recurrence 704
in cases complicated by malarial mani-
festations 765
in cases possibly associated with the
poison of typlioid fever 76(1
in cases showing disease of the solitary
follicles 766
in cases having typhoid symptoms but
no typhoid lesion 767
in cases sliowing the maximum weight
of the consolidated lungs 768
in cases associated with pericarditis 768
in cases complicated with peritonitis... 772
in cases complicated with erysipelas... 773
In cases complicated with inflammation
of the parotids 77-1
SECTION I. Diseases OF RESPIRATORY ORGANS— [Cont'd.]
Post-mortem observations:
in cases fatal by hemorrhage into the
pleural cavity. 774
in cases terminated in abscess or cir-
cumscribed disintegration 774
in caseii ending in gangrene 770
in cases ending in liquefaction of the
lungs 777
in cases with coexisting tubei'cle 777
in cases complicated with cerebral le-
sions. 778
Analysis of the post-mortem appearances
in three hundred lobar cases 779
Post-mortem rccordsof catarrhal cases 783
.\nalysis of the post-mortem appearances
in one himdred and thirty-live catarrhal
cases 798
Pathology of pneumonia 801
Treatment 806
SECTION II. Consumption 818-828
Prevalence 818
Clinical records 819
Post-mortem records 825
Treatment 828
SECTION III. Rheumatic affections s.'9-S44
Acute rlieumatisin H29
Statistics 829
Clinical and post-mortem records 829
Chronic rheumatism 8.32
Statistics SS2
Character of the cases — 832
Treatment 843
SECTION IV. Other diseases attributed to expo3ure-.S44-860
Congestion and indaniinatlon of tlie spinal
membranes 844
Ophthalmia 849
Sunstroke 8-53
VII
TABLE OF CONTENTS.
CHAPTER X. ON CERTAIN LOCAL DISEASES.
r;ig-.
SECTION I, Cardiac diseases - 860
860
863
S66
867
868
Orjjuiiif a fleet ions
Fuurtioiial disturbances.
Idiopatliio pericarclitis —
ICiilitiire of the heart
Aneurism
SECTION II. Morbid conditions attributed to the weight
of the accoutrements S69
HaM»ioi>tysis J^IjB
Page.
SECTION ir. Morbid conditions, etc.— [Continued. ]
Hernia S71
Lumbar pains, etc 872
SECTION III. Constipation, headache and neuralgia 873
SECTION IV. Jaundice ..._ 874
Acute inliaramation of the liver 877
SECTION V. Idiopathic peritonitis 870
SECTION VI. Diseases of the kidneys ssi
CHAPTER XI. ON CERTAIN DISEASES NOT HERETOFORE DISCUSSED.
Nostalgia ..
Army itch .
Poisoning-.
. 884
Alooliolisni SOl)
Venereal diseases S91
Systematized efforts at prevention Si^S
CHAPTER Xil. ON THE GENERAL HOSPITALS.
Extemporized hospitals 899
Barrack-buildings converted to hospital uses.. 90S
Pavilion wards 908
Pavilion hospitals 917
Remarks on construction, personnel and man-
ageuieut 9,50
Li.st of hospitals in active service in December,
1S6J 9G9
Medical and hospital supplies 904
LIST OF MEDICAL OFFICERS CITED OR MENTIONED. — 967
LIST OF MEDICAL AUTHORS AND OTHERS CITED OR MENTIONED 972
INDEX __ 975
VIII
LIST OIP ILXjTJSTK/j^TIOnsrS.
■iO
21
94
100
A comparison of the annual mortality-rates caused Ijy certain speeincd diseases in various bodies of men of tlie military
age,— racing page ■ \[
T^ronthly death-rates among white troops from all diseases and from certain specifled diseases,— feeing page
The prevalence of disease and the mortality caused thereby among the Vt-hito and the colored troops of the U. S. armies during
the years of the war and the year following the war, expressed in monthly rates per thousand of slrengtli present,— faci ng
page - -
Chromo-pUite showing'the prison-barracks and hospital at Rock Island, 111.— facing page - 5'-2
The monthly prevalence of malarial fevers among the wliite troops,— facing page 90
Average annual curves of prevalence of the malarial fevers among the white and the colored troops during the war in monthly
rates per thousand of strength,— facing page
Peasoniil prevalence of malarial fevers in the Atlantic, Central and Pacific regions 00
ilap of the United States, showing the prevalence of malarial fevers in the various military departments during the Rebel
lion,— facing page
Lines indicating the prevalence of tlie continued fevers among the white troops,— facing page - 199
Lines indicating the prevalence and mortality of the continued fevers among the colored troops,— facing page 200
Seasonal variations in the mortality and prevalence of typhoid fever among a U. S. civil population of eight millions 200
Seasonal variations in the mortality and prevaleuco of the continued fevers among tlic white and the colored troops 201
Lines indicating the prevalence of the continued fevers In the Atlantic, Central and Pacific regions,— facing page 202
Perforating ulcers of the ileum,— facing pages 313,382,391
Thickened patches of Peyer and enlarged solitary follicles,— facing pages 380, 410, 112, J36
Sloughing patches of Peyer,— facing p.iges 388, -118
Cicatrices of typhoid ulceratlon.-facing pages 401, '104, 151, 450,458
Ulceration of tlie patches of Peyer,— facing pages 43!',410
Perpendicular section of the ileum showing enlargement, softening and ulceration of the solitary glands,— facing page 444
Perpendicular section of the ileum showing a follicular ulcer which has penetrated nearly to the muscular coat,— facing page 44fi
Section of a typhoid patch ulcerateil superficially ''1'
Section ofa typhoid patch showing the lymphoid elements in the glands and stroma 418
Perpendicular section of the ileum sliowing typhoid thickening ofa Peyer's patch,— facing page 448
Section ofa typhoid patch with the lymphoid elements agg^-egated mainly in the glands 449
Perpendicular section of the ileum through an ulcerated patch from wliich the softened contents of several follicles have
escaped,— facing page ^^^
Microscopic appearance of matter from tlie superficial part ofa typhoid patcli - 450
Jlieroscopic appearance of matter from the dceiicr parts of a typhoid patch 450
Pigmentation of the ileum in continued malarial fever,— facing page 460
Showing the relation between the height of the subsoil water-level and the prevalence of typhoid fever in the State of Michi-
gan during the 5 ear 1882 — - 5*"
Hilliard's temperature chart of typho-malarial fever -— - 518
Town's temperature charts of typho-malarial fever olS,519
Coraegy"s temperature charts of typho-malarial fever — - ^'-O
Hotf's temperature charts of mountain fever ~ — 523,5-1
Showing the monthly rates of prevalence of small-pox and erysipelas among the wiiite and the colored troops,— facing page— 021
Showing the monthly rates of prevalence of measles among the white and the colored troops,— facing page — 050
Showing the prevalence of scurvy among the wliite and the colored troops of the U. S. during the war of the Rebellion, and in
the English and French armies during tlie Crimean war,— facing page -— ""1
Showing that In the civil population of the United States pneumonia has seasonal waves of prevaleucc similar to those of ^
acute bronchial inflammation '"
Showing the monthly rates of prevalence, per thousand men of mean strength among the whites, of catarrh, epidemic catarrh, ^
acute bronchitis, pneumonia and pleurisy,— facing page '_—
Showing the monthly prevalence of tonsillitis and diphtheria among the white and the colored troops,— facing page.-- — 738
Showing the monthlv variations in tlie prevalence of acute and chronic rheumatism and consumption among the wliite and
8''8
the colored troops, — facing page *'**^
Showing the regulation weights carried by the soldier and the belts and braces wliich supported them; also, the method of
carrying them generally adopted by veteran troops,— facing page *'''
Showing the monthly rates of prevalence of constipation, headache and neuralgia among the white and the colored troops,—
facing page ; °^
Showing the variations in the monthly prevalence of jaundice among the white and the colored troops in the Atlantic and
the Central regions,— facing page "'
Lines indicating the monthly prevalence of venereal diseases and of alcoholism among the white and the colored troops,—
X LIST OF ILLUSTRATIONS.
Plans, etc., of hospitals:
Seminary Hospital, Georgetovrn, D. C — 90O
01(1 Hallowell house, Alexandria, Va. - 'J02,SIUS
Broad .and Cherry streets, Philadelphia, Pa 904
Good Samaritan, St. Louis, Mo 00.5. 90(>
Marine Hospital, St. Louis, Mo - 907
Clarysville, Md., pavilions at — 90S
McKim's Mansion, Baltimore, Md — 911
Patterson Park Hospital, Baltimore, Md 912
Campbell Hospital, WashinsTton, U. C — 913
Carver Hospital, Washington, D. C 91-1
Emory Hospital, Washington, D. C 91»
Hilton Head Hospital, S. C - — 91«
Details of wards at Mount Pleasant and Judiciary .Square hospitals, Washington, D. C 917
Judiciary Square Hospital, M'ashington, D. C— ground plan 91S
Judiciary Hospital,— side, front and rear elevations 911*
Chester Hospital, Chester, Pa 921
De Camp Hospital, David's Island, N. Y. Harbor,— facing page - 922
Summit House, Delaware Co., Pa 9J:i
Tilton Hospital, Wilmington, Del 925
Cuyler Hospital, Germantown, Pa -— 927
Satterlee Hospital, West Phil.adelphia, Pa.— ground plan 929
Ventilation of the wards of the Satterlee Hospital 9:n
Mower Hospital, Chestnut Hill, Pa 93S
Stanton Hospital, Wasliington, D. C — — 93G
Armory Square Hospital, Washington, D. C 9o7
Hampton Hospital near Fort Monroe, Va 93*
Lovell Hospital, Portsmouth Grove, R. I 9J0
Harewood Hospital, Washington, D. C 941
Hammond Hospital, Point Lookout, Md.— facing page 9J2
Sections of wards and covered-ways of the Hammond Hospital - 942
Plan of wards as given in orders from the War Department 914
Ventilation and heating of wards as directed by orders from the War Department 9J.>
Sedgwicli Hospital, Greenville, La 946
Kitchen of the Sedgwick Hospital 947
Wards, ventilation and heating of the Sedgwick Hcspital 948
Hick's Hospital, Baltimore, Md 9.50
Cross-ventilation of water-closets of pavilion-wards 951
LIST OF STATISTICAL TABLES AND TABULATED STATEMENTS.
Page.
Mortality of the U. S. Armies from May, ISil, to June 30, ISGC — — - 1
Table I, sliowing the annual movement of sickness and death among the white and the colored troops, expressed in ratios
per thousand of mean strength 6
Statement of the mortality from disease in the German army during the war of 1870-71 7
Rates of mortality from disease in the V. S. Army during the years lS10-'.5i) 8
Rates of mortality from disease among the while troops of the V. S. Army during the years 1S67-"S? !)
Table TI, showing the comparative frequency of, and mortality from, the diseases that prevailed among the wliite troops of
the U. S. .\rmy during the period from Jlay 1, lS(iI, to June 30, ISCfi, and among the colored troops during the period from
July 1, ISIJi, to June 30, 1806 — U
Table III, sliowing, by average annual rates per 1,00*1 of mean strength, the comparative frequency of, and mortality from, liie
diseases that prevailed among tlie wliile and thecolored troops of tlie U. iS. Army 13
Table IV. Average annual sick and death-rates perthousand of mean strength in the V. S. Army before, during and since the
war, and in tlie German and French armies, witli the annual death-rate for males of the military age in the United
.States, as ciilculated from the returns of the census year ISSO 10
Table V, showing the annual prevalenceof sickness and the mortality from disease in the several regions, expressed in rivtios
per tliousand of mean strength 18
T^le VI, showing the annual prevalence of sickness from all diseases in the several military departments, expressed in
ratios per tliousand of strength 19
Table VII. Montiily ratio of sickness per thousand of mean strengtli among the white troops of the U. S. Army, by regions,
for the period from June 30, ISiil, to June 30, 1866 21
Table \'III. Monthly ratio of cases of sickness per thousand of mean strength among the colored troops, by regions, for the
period from June 30, 186:), to June 30, 1866 21
Table IX. Montiily ratio of deatlis from disease per thousand of mean strength among tlie wliite troops of the U. S. Army, bv
regions, for tlie period from June 30, 1861, to June 30, 1866 22
Tabic X. Monthly ratio of deaths from sickness per thousand of mean strength among the colored troops, by regions, for tlie
periotl from June 30, 180:1, to June 30, 1866 — 22
Table XI. Discharges for disabilit.v from disease in the V. H. Army from Maj- 1, 1S61. to June 30, 186<i, with ratio per tliousand
of mean strength in the Held, garrisons and general hospitals, ratio per thousand of total discharges, and mean annual
ratio per thousand of strength 27
Table XII. -Vb.stractof the cases of speciflert diseases with recorded terminations, and of deaths among such cases at the Chi m-
borazo liospit^il, Richmond, Va 30
Statement of the sickness, wounds and mortality in the C. S. army, exclusive of the troops in the Trans-Mississippi Depart-
ment, from tlie beginning of tlie war to December 31, 1862 30
Table XIII. A comparison of the prevalence and fatality of disease in the opposing armies from the commencement of the
Table XIV. Cases of sickness and wounds reported from certain of the Confederate armies during portions of the years I86I,
1862 and 18(>l, with the strength present during tlie periods covered by the statistics, and the calculated annual rates per
thousand of strength in juxtaposition witii the corresponding rates of the U. S. Army for the year ending June 30, 180:1— ;12
Tabic XV, summarizing the records of the hospital at Camp Sumter, Andersonville, Ga 31
Talile XVI, giving a general view of the sick and death-rates from prominent diseases and classes of diseases among the Fed-
eral prisoners at .Vndersonville, Ga., for tlie period extending from Mareli 1 to August 31, 1861. Average present, 19,133
prisoners :t5
Table XVII. summarizing the records of the prison hospital at Panville, Va., November23, 1863, to March 27, 1865-- 41
Table XVIII. showing the number of casesof certitin specified diseases and classesof disease, and of deatlis attributed to tliem,
among the Confederate prisoners of war at tlie principal prison depots, for the period covered by the records of eacli
Table XIX, in which the facts of Table XVIH are consolidated and expressed in average annual rates per thousand of strength,
with the ratio of cases of specified diseases to cases of all diseases, of deaths from specified diseases to deaths from ail dis-
eases, and the percentage of fatal cases of specified disease. Average strength present, 10,81.5 men 47
Table XX, contrasting the mortality rates, per thousand of strength, among the wliite and the colored troops of the V. S.
Army and the Union and tlie Confederate prisoners of war 48
Barrack occujianc.v of the Union troops as compared with that of the Confederate prisoners at Camp Chase, Ohio 5-5
Table XXI, comparing the annual sickness and mortality from certain specified diseases at the principal depots for Rebel
prisoners 61
Tabular statement of the ration in kind allowed to Rebel prisoners of waPf with the full ration of the U. S. troops at the same
dales, and the diflerence in the value of the two rations credited to the prison-fund 69
XII LIST OF STATISTICAL TABLES
PagR
Table XXII. Statement of the frequency and mortality of the several forms of malarial fever, giving the totals reported from
May 1, 1S61, to June 30, 1S66, with the ratio of cases to strength and to cases of all diseases, and the ratio of deaths to
strength, to deaths from all diseases, and to cases of malarial fever: White troops 79
Table XXIII. .Statement of the frequency and mortality of the several forms of malarial fever, giving the totals reported from
July 1, ISCJ, to June 30, ISG6, with the ratios of cases to strength and to cases of all diseases, and the ratios of deaths to
strength, to deaths from all diseases, and to cases of malarial fever: Colored troops ^ SO
Table XXIV. Relative frequency of cases of malarial fevers and deaths caused by them, during the several years of the war
and the year following the war, expressed in annual rates per 1,(XI0 of mean strength : White troops 82
Table XXV. Relative frequency of cases of malarial fevers and of deaths caused by them among the colored troops during two
years of the war and the year following the war, expressed in annual rates per 1,00(J of mean strength 83
Table XXVI. Relative frequency among the white and the colored troops of cases of malarial fevers and of deaths caused liy
them, as shown by the average number annually recorded, reduced to ratios per 1,000 of strength 84
Table XXVII. A comparison of the prevalence of malarial fevers among the wiiite and the colored troops serving in the same
localities during the two years from July 1, 1S63, to June 30, 1865, the figures given being the average annual ratios per
1,000 of strength 86
Tabular statement of the death-rate from malarial fevers among the white and the colored population of certain sections of
the United States 87
Comparison of the death-rate from malarial disease among the white and the colored population of certain cities of the United
States ; : 87
Statement of the prevalence of periodic fevers among the white and colored troops serving, since the war, at certain posts in
the Department of Texas 88
Table XXVIII, showing the seasonal variations in the prevalence of malarial fevers among the white troops in the several
regions during the years of the war and the year following the war, expressed in monthly ratios per l,Ouo of mean
strength 89
Table XXIX. Average monthly number of cases of the several varieties of malarial fever among the white troops from July 1,
1861, to June 30, 1866, expressed as ratios per l.OiW of mean strength 93
Table XXX. Average monthly number of cases of the several varieties of malarial fever among the colored troops from July
1, 1863, to June 30, 1866, expressed in ratios per 1,000 of strength • 91
Table XXXI. Average monthly number of cases of the several forms of malarial fever among the white troops in the several
regions, expressed in ratios per 1.000 of strength, calculated from the cases which occurred from July 1, 1861, to June 30, 1806. 95
Table XXXII, showing the prevalence of malarial fevers in the departmentson the Eastern and Southern coasts of the United
States, and in those of the high and low grounds of the Central Region, expressed in annual ratios per 1,000 of strength,
calculated from the statistics of tlie four years ending June 30, 1865 97
Table XXXIII, showing — 1, the relative prevalence of the malarial fevers among the white troops in the several departments
and regions during the four years ending June 30, 1865, expressed as ratios per 1,000 of strength ; 2, the relative frequency
of the forms of these fevers, expressed in percentages of the total number of cases; and 3, the relative frequency of the
varieties of intermittent fever, expressed as percentages of the total number of intermittent cases 98
Tabular statement of the death-rates from malarial disease in the States and Territories of the United .States from the census
returns of 1870 and 1880 102
Table XXXIV. A comparison of the prevalence of intermittent and remittent fevers in the Confederate and Federal Armies
of the Potomac from July 1, 1861, to March 31, 1862 103
Table XXXV. A comparison of the prevalence of intermittent and remittent fevers In the Confederate and United States
Armies of the Tennessee from June 1, 1862, to May 31, 1863 101
Tabulated comparison of the prevalence of intermittent and remittent fevers in the Confederate Army of the Valley of Vir-
ginia and the U. S. Middle Department of the Atlantic Region from July 1 to October 31, 1862 105
Table XXXVI. A comparison of the prevalence of intermittent and remittent fevers in the Confederate Army of the Valley of
Virginia and the U. S. Department of the Shenandoah from January 1, 1862, to June 30, 1862 106
Table XXXVII, showing— 1, the relative frequency of the forms of malarial fever among the Confederate troops as compared
with their frequency among the troops of the United States, expressed in percentages of the total number of malarial
cases; and 2, the frequency of the varieties of the intermittents expressed in percentages of their totals 107
Tabular statement of the relative frequency of the various types of malarial fever among the U. S. and the C. S. troops, with
an approximative comparison of the mortality occasioned by them _ 108
Table XXXVIII. Cases of malarial fever with resulting mortality, reported from the principal prison depots as having
occurred among the Confederate prisoners of war; with the annual ratios per thousand of strength present 110
Table XXXIX. Statement of the frequency and fatality of the continued fevers, giving the totals reported from Jlay 1, 1861, to
June 30, 1866, among the white troops, and from July 1 , 1863, to June 30, 1866, among the colored troops ; with the ratio of
cases to strength and to cases of all diseases, and the ratio of deaths to strength, to deaths from all diseases, and to cases
of the continued fevers 191
Table XL. Expressing the frequency of and mortality from the reported forms of the continued fevers as percentages of the
total cases and deaths caused by such fevers 192
Table XLI. Relative frequency of cases of the continued fevers, and of deaths occasioned by them, during the several years of
the war and the year following the war, expressed in annual rates per thousand of strength present 193
Table XLII, showing the annual percentages of fatality of the continued fevers 191
Table XLIII. Comparison of the frequency of cases of the continued fevers, and of the deaths occasioned by them, among the
white and the colored troops, as shown by the average numbers annually recorded, reduced to ratios per thousand of
strength ; the figures for the white troops based on the statistics of the period May 1, 1861, to June 30, 1866, and those for
*he colored troops on the statistics of the three years July 1, 186:5, to June :iO, 1866 195
Table XLIV, showing the variations in the prevalence of the continued fevers among white troops in the various regions
during the years of the war and the year following the war, expressed in montiily ratios per thousand of mean strength, 196
Table XLV. Seasonal variations in the prevalence and mortality of the continued fevers among the white troops, expressed
in average monthly rates per thousand of strength, obtained by the consolidation of the figures for the corresponding
month of each of the years covered by the statistics 201
Table XLVI. Seasonal variations in the prevalence and mortality of the continued fevers among the colored troops, expressed
as average monthly rates per thousand of strength, obtained by the consolidation of the figures for the corresponding
mouths of each of the years covered by the statistics 202
Table XLVII, showing the relative frequency of the reported forms of the continued fevers among the "white troops in the
several departments and regions during the four years of war service from July 1, 1861, to June 30, 1865 203
AND TABULATED STATEMENTS. XIII
rage.
Table XLVIII. Xiimbcr of cases of the contiiiuoil fovors in the Confederate and IVilonil Armies of tlie Potomac from July 1,
1>^1, to March 31, IStii, with the ratio per tlioiisanil of mean strength for each monlli 206
Table XLIX. A comparison of the prevalence of the eontiniiccl feveisin the Union and Confederate forces during the nineteen
months, January, 18(32, to July, lSti-3, inclusive, expressed in montlily ratios per Ihousaml of strength 207
Tabular statement of the continued fevers at the hospital at Cainji Sumter, Anderson ville, Ga 20S
Tabular statement of the fatality tif the continued fevers in certain of the Conlederate fj:eneral hospitals 203
Table L. Number of cases of the continued fevers, with the resulting mortality, rep<trtetl from the principal prison depots as
having occurred among Conlederate prisoners of war, with the annual rates per tliousand of strength 209
Percentage of men of various stated ages in tlii' ranks of the army . -181
Table LI, showing the ages of four hundred and thirty-one eases of continued fever, and comparing the frequency of these
fevers at certain ages with the relative number of men of those ages in the ranks of the army 482
Tabular statement of the relations of diarrhaal diseases to the nuilarial fevers as shown by the mortality tables of the Tenth
U.S. Census, ISSO 017
Table LII, showing the prevalence and mortality of the eruptive fevers among the U. S. forces during the yeai'S of the war
and the year following the war 624
Table LIII, showing the numbcrof cases of the eruptive fevers and of deaths caused by them among the Confederate prisoners
t)f war at the principal prison depots for the period covered by the records of each prison C29
Table LIV, showing the annual and average annual rates of sickness and deatli from diseases of the respiratory oi'gans, as
also the percentage of fatality of these diseases among the U. S. troops for stated periods, expressed in ratios per thousand
of strength 719
Table LV, contrasting the mortality irom pneumonia in rates per thousand of strength in certain of the Confederate armies
and the white commands of the Union army 720
Table LVI, showing the prevalence and mortality fi'om certain diseases attributed to atmospheric exposures among the Con-
federate prisonei's held at the principal prison depots in the United States. Average period covered by the observations,
two years; average strength present, I0,S1.~) men 721
Tabular statement of the seasonal prevalence of pneumonia in the .Southern armies 723
Table LVII, showing, by ratios per thousand of strength, the relative freiiucncy of catarrh of the respirator)- inucous mem-
brane and pnemuonia ainong the white troops of the several deiiartments.and regions during the four years of war serv-
ice, July 1, 1S61, to June 30, 1S<)5 _ 724
Table I.VIII. Localization and specification of the morbid conditions found in the lungs in 300 eases of acute lobar pneumonia. 7S0
Tabular statement of the pleuritic complications in 300 cases of lobar pneumonia - 781
Tabulation of the stated conditions of the lungs in 1.35 cases of lobular pneumonia 798
Tabulation of the pleuritic complications in 185 cases of lobular imeumonia 799
Tabulation comparing the death-rates from malarial fevers and consumption in some large cities of the U. S 824
Mean of temperature observations taken during the hot mouths of the years of the war 854
List of general hospitals in active service in December, 1864 060
Quantity of certain medical and hospital supplies, etc., issued by the Medical Purveying Bureau during the war 906
Alphabetical list of medical officers cited or mentioned 967
Al])habetieal list of medical authors and others cited or mentioned 972
Index 975
T II E
MEDICAL AND SURGICAL HISTORY
OF THE
WAi; OF Tin; I!1-p.eli,io> nsiii-Tui.
PAET III, VOLUME I.
BEINO THK XHIRD aiEDICA-L VOLUME.
CHAPTER L— OX THE MEDICAL STATISTICS OF THE WAR.
I— SICKNESS AND MORTALITY AMONG THE U. S. FORCES.
The First Part of this Medical Volume of the History of the War is mainly com-
posed of a series of Tables giving the figures reported by various commands as expressing
the facts connected with the occurrence of sickness and deaths from certain specified
diseases among the troops composing them. To derive any information from tbese Tables
other than that borne upon their face, as for instance, to compare their items one with
another, or with similar statistics from other sources, it is necessary to convert their figures
into others expressive of their relation to some common standard. But before deducing
ratios of sickness and mortality in designated diseases from the figures tabulated, it may
be well to recall some points connected with them that definite ideas may be obtained of
their probable value.
1st. As TO MORTALITY ACTUAL AND EEPOETED. — On page XXXVII of the Introduc-
tion to the First Part, it is shown by a comparison of data drawn from various sources that
the actual mortality of our armies from May, 1861, to June 30, 1866, may be assumed to
be closely approximated by the following figures :
Mortality.
White.
Colored.
Total.
Killed in battle - -
42, 724
47,914
157, 004
23,347
1,514
1,817
29 212
44, 238
Died of wounds, etc
Died of disease
49,731
181), 210
24,184
Total . -
270, 989
33,380
304,369'
1
• According to Dr. JOSEPH JOXES (see Jitchmtmd and LouitvilU Mtd. Jour,, Vol. IX, 1870, p. 259), the deaths in.the Cunfederate armies during
the war did not foil short of 200,000, three-fourths of which number were due to disease and onefounh to the casualties of battle. The data from which
these conclusiims were derived are said to have been critically examined and considered correct by the former Adjutant General of the Confederate States,
S. Cooper, of ,\lexaDdria. Virginia.
Med. Hist. Pt. Ill— 1
2 SICKNESS AND MORTALITY
If the deatlis from unknown causes in this statement be distributed anion" the three
causes specified in tlie proportion which the figures of each bear to their total, the deaths
from disease will be found to amount to 171,806 among the white troops, and to 29,963
among the colored troops, giving a total of 201,769 deaths from disease.
Looking now at Table C,'"' which gives a general summary of the sickness and mor-
tality among the white troops during the war, it will be found that, excluding 37,237
deaths attributed to wounds, accidents and injuries, there were reported 123,937 deaths
from diseases that are specified and 449 from diseases that are not specified, making a total
of 129,386 deaths reported as from disease.
But since the total mortality from disease was 171,806, it is evident that 42,420
deaths, or 24.7 per cent, of the total, were not reported, and that 42,869 deaths, or 24.9
per cent, of the total, were not attributed to their special causes. Hence, if it be desired
to obtain from the Tables in the First Part of this work an approximation to the absolute
mortality from any specified disease, we may assume, in the absence of other and accurate
data, a p?'o rata distribution of the 42,869 deaths from unspecified diseases and multiply
the number in the tables by 1.33, since the number of deaths tabulated and reported as
due to specified causes, to wit, 128,937, is to the whole number of deaths attributed to
disease, 171,806, as 1 : 1.33. Thus, taking acute and chronic diarrhoea and dysentery by
way of illustration, it is found tliat the deaths reported as from these diseases numbered
37,794; but the actual mortality caused by them must have been considerably greater,
to-wit, about 50,226.t
Again, looking at Table CXI, J which gives a general summary of the sickness and
mortality of colored troops during the war, it will be found that in the strength represented,
27,499 deaths were reported from specified diseases. This number is less by 2,464 than
the actual mortality, 29,963, in the strength present and absent. The tables, therefore,
embrace 91.8 per cent, of the mortality statistics of the colored troops. If an approxima-
tion to the actual mortality be desired in the case of any given disease, it may be obtained
from the figures in the statistical tables by the use of the factor 1.09. Thus, in the case
of the alvine fluxes, the tables give a mortality of 6,764, but the actual mortality was
probably about 7,373. ||
2d. As to mortality rates. ^ — Although the figures given in the tables constitute
but 75.3 and 91.8 per cent, of the total mortality among the white and colored troops
respectively, it is to be remembered that the strength in which this tabulated mortality
occurred was only a part of that Avhich furnished the total. The tabulated deaths took
place among the men in the field and garrisons, and among the floating population of the
general hospitals in which the sick from the field and garrisons were treated, when, for
military or medical reasons, it was deemed expedient to send them to a distance from their
commands. The untalndated deaths of white aiid colored soldiers, 42,420 and 2,464,
respectively, occurred firstl}', in commands the reports of wdiich were not received, or if
received were not embodied in the tables on account of some defect which rendered them
valueless for the computation of rates; secondly, among men separated from their com-
mands by the fortune of Avar and held as prisoners by the enemy; and thirdly, among
those not borne as- present numerically in the strength of their commands on account of .
temporary absence on furlough or various special duties.
* Part First, p. Ml. I See Dr. Woouwaud'b calculation, p. 3 of Part II, where the actual mortality in this instance is figured as 49,885.
J Part First, p. 712. || Dr. WooinvAun's calculation puts tlie number at 7,380.
AMONG THE U. S. FORCES. 3
With regard to untabiilatcd deaths due to unrendered or rejected reports, the assump-
tion seems warranted tliat, had these reports been received in a condition to admit of tlieir
incorporation in the tables, it is not likely that the rates calculated from the latter would
have been materially altered, since the numbers tabulated were in themselves so large, and
constituted so large a percentage of the deaths that occurred in the field, garrisons, and
general liospitals. Dr. Woodward estimated that, in a general way, the tables covor<>(l
about nine-tenths of the class of facts which they were intended to embrace.
With respect to the deaths that occurred among prisoners of war, they are with pro-
priety excluded from data forming the basis of an inquiry into the mortality rates afl^cting
our armies in the field, since, as is well known, the circumstances surrounding these
unfortunate men were such as predisposed to a higher rate of mortality. Had full returns of
the deaths among them, with a knowledge of the numerical strength present in the iDrisons
during the war, been preserved, they would have served as materials for an interesting
study; but it would not have been advisable to consolidate them witli the mortality
statistics of men under wholly different conditions.
Similarly, it seems proper to exclude from consideration the deaths that occurred
among the large number of men absent from their commands <iu furlough and by reason
of other causes, as this class was for the time being removed from the influence of the
causes and conditions which favored mortality among the men on active service. It is
highly improbable that the deaths among them were relatively as numerous as among men
on field duty. Although many men were furloughed because thcv were sick, and undoubt-
edly many deaths occurred among such cases, the majority of those thus furloughed were
convalescents looking for improvement and return to health during their temporary sojourn
at home. The number of these absent from their commands cannot be obtained; but had
it been possible to have ascertained all the facts, their consolidation with the matter of the
statistical tables of Part First would have introduced an element which would have
recjuircd elimination before the rates affecting the troops on active service could have lieen
deduced.
AVe may therefore accept tlie conclusion that death rates based on the tabulated
figures, notwithstanding the incompleteness of the latter, will furnisli a fair index to the
mortality caused by tlie morbific influences to which tlie army was sulijected during the
years of the war.
3d. As to the cases of sickn'ess, absoja'te akd reported. — Tlie tabulated statis-
tics show the occurrence among white troops of 5,417,360 cases in which the disease is
specified and 7,187 cases of unspecified disease, making a total of 5,424,547 cases of dis-
ease, exclusive of 400,933 cases of wounds, accidents and injuries comprised in Class V
of the ofiicial reports. This number of cases of disease is far from including the whole of
those furnished by the army during the war. The tabulated mortality among the white
troops has been shown to be deficient by 24.7 per cent. The deficiency in the tabulation
of the cases is even greater, as it includes not only cases among prisoners of war and
others absent from their commands as well as those in commands which failed to make the
required reports, but also the many cases that occurred among the floating population of
tiie general hospitals. The strength of these hos2:)itals was reported regularly ; but it was
found impossible, as already explained,'"" to ascertain the number of cases of sickness that
* IntrudiictiuD, Part First, p. XXIV.
SICKNESS AN'D MORTALITY
originated in tliem or the number of cases that were received without having been pre-
viously reported on regimental returns.
The same remarks are applicable to the 605.017 cases of specified diseases which are
reported in the tables as having occurred among the colored troops.
■iTH. As TO SICK BATES. — But altliougli the statistical tables give only an unknown
percentage of the sickness which affected our armies, their application to the calculation
of correct rates is not impaired thereby. They give, we may assume, a fairlv accurate
representation of the attacks of sickness that occurred in those commands in "field and
garrison" from which reports were received. The large number of men, a mean strength
of 431,237 white and 61,132 colored troops, under observation, warrants the belief tliat
the rates deduced from the reports would not be materially altered if to these reports had
been added the mean strength and total cases of sickness of commands which failed to
report, or sent in reports which were valueless in this connection by the omission of needful
data. The remarks already made with regard to mortality rates among prisoners of war
and others absent from their commands are equally applicable here. Supposing the neces-
sary figures for calculating the ratio of cases to strength among them to be available, the
propriety of consolidating these rates with those from trooj-)S in active service would be
subject to question, as tending to complicate the point at issue by the introduction of results
due to other conditions. For similar reasons it would have been proper to have excluded
from the tabulated reports the cases originating in the general hospitals, as the conditions
affecting the inmates of these hospitals were certainly very different from those which
determined attacks of sickness in the field. As it is, those cases were not reported. A
complete medical history of any war necessarily involves the separate presentation of the
facts reported from the various classes of men and their comparison with those gathered
from the men present for duty with tlie flao;; but the difficulties in the way of obtaining
the necessary data are so great that it is doubtful if such a history will ever be written.
While regretting the want of records covering the attacks of sickness in the whole number
of men who were enrolled for service, it suffices at present to point out that this want does
not affect the value of the sick rates deduced from the reports which form the main part
of the First Part of this work.
5th. The kates of fatality in specified diseases. — In comparing the number
of deaths from a given disease with the number of cases of the same disease to ascertain
the percentage of fatal cases caused by it, a point of importance comes up for appreciation.
It has been shown that neither the deaths nor tlie attacks tabulated form the respective
totals of these occurrences, but only an uncertain though comparatively large portion of
them, and it has been argued that this want of absolute figures does not detract from the
value of the death rates and sick rates as deduced respectively from the strength given in
connection with the figures of each, to wit: the strength present in the field and garrison
in connection with the cases, and the strength present in the field, garrisons, and general
hosj^itals in connection with the deaths. But in considering the ratio of deaths to cases
their abnormal relationship, consequent on their derivation from different numbers of men,
must not be forgotten. The cases occurred in the strength present in the field and garri^
sons; the deaths in the strength present in the field, garrisons, and general hospitals.
The strength which furnished the cases, 431,237; in the instance of the white troops,
was smaller than the strength, 468,275, which furnished the deaths. If the cases which
-f—r
AMONG THE U. S. FORCES. O
originated in the hospitals were known, their aJJition to the others would establish a
normal ratio between the cases and deaths. Or, it" the deaths which occurred among
such cases were known, a similar result would be obtainable by deducting them from the
tabulated deaths. But, as it was found impossible to rectify this matter by either of these
methods, there exists this want of relationship between the deaths and cases.
In calculating from the tabulated figures the rate of fatality of a given disease, a
figure of unknown and probably different value for each disease, caused by the unrecorded
cases among the hospital population, tends to increase the percentage of fatal cases.
The fatality of cases originating in the general hospitals was probably greater than
that of those occurring among men in active service, for although the latter had a greater
exposure to many of the causes of disease, they had at the same time a greater power of
resistance against these morbific influences. The exposures of the field may be regarded
also as having tended to multiply cases and to correspondingly lessen the fatality of disease
among the troops as compared with the rates affecting a hospital population. If, therefore,
we assume that the same rates prevailed among the floating population of the hospitals as
in the commands from which their population was derived, we shall ascertain a portion of
the error which is involved in a calculation of rates from the deaths and cases in the tables
already published.
On this assumption the deaths attributable to diseases originating in the hospitals and
those attributable to diseases originating in the field and garrisons would be respectively
proportioned to the number of men present in each; and the factor .921, obtained by
dividing the strength present in the field and garrison by the total strength in the field,
garrison, and general hospitals, when applied to the rates of fatality calculated from the
cases and deaths recorded in the First Part of this work, would reduce these rates by the
elimination of the deaths assumed to have taken place among cases that originated in the-
hospitals. In this way a part of the error is indicated, the true rate of fatality being
lower even than this corrected rate. Thus, in the case of tyj^hoid fever among the white
troops,* where 75,368 cases in the field and garrison are associated with 27,056 deaths in
the field, garrison, and general hospitals a mortality of 35.9 per cent, is obtained; but this,
for the reason given, is certainly higher than the true rate of fatality. Multiplied by the
factor .921 the percentage becomes reduced to 33.0, and this probably expresses the very
highest figure at which we may put the mortality from typhoid fever as deduced from the
tabulated statistics. When we come to consider the continued fevers it will be found that
this corrected percentage is open to question; but the present object is merely an illustra-
tion of an inaccuracy which affects the rates of fatality when deduced from the published
figures.f
The factor .921, based on the mean strength for the whole period of the war, has
necessarily a generic character. The error which it is intended to define varied month by
month and year by year in the same command, and differed in different commands during
the same periods in proportion to the number of men constituting the hospital population.
In the following pages the rates of fatality will be calculated from the figures as reported
in the First Part of this work. Those who desire greater precision in individual cases
• Table C. p. 636, First Part.
tDr. Geokge L. Peabody, in an article on the Trcatmtnt of Tijphoiil Fn-cr. in the Philadelphia Medical Sews, March 29, 1884, tabulates the
typhoid fever cases as reported in llie First I'art of this work, and calculates the fatality among white troops at 33.9 i>er cent, of the cases, without obsen--
ing that the cases and deaths did not occur among the same number of men.
6
SICKNESS AND MORTALITY
may make use of the average factor above stated, or calculate the factor specially appli-
cable to the case in point in accordance with the statement given of the principle involved.
General and annual rates of sickness and mortality. — The number of cases
of disease reported among the vv'hite troops during the period, May 1, 1861, to June 30,
1866, was 5,424,547, and the number among the colored troops during the three years
ending with the latter date was 605,017, making a total of 6,029,564 reported cases of
disease.
During the same period the deaths reported as from disease numbered 129,386 among
the white and 27,499 among the colored troops, making a total of 156,885; but, as has
been already explained, if it be desired to obtain numbers which will express the absolute
mortality from disease in our armies, the factor 1.33 must be used in the case of the white,
and 1.09 in the case of the colored troops, to provide for the addition of 42,420 deaths
among the former and 2,464 deaths among the latter, as the proportion of deaths from
unknown causes which may with propriety be ascribed to disease. There were, therefore,
during the war and the year that followed it 171,806 deaths among the white and 29,963
deaths among the colored troops, making a total in the United States Armies of 201,769
deaths which were attributed to disease.
The cases and deaths available for the calculation of rates of sickness and mortality
are equivalent to 12,579 cases and 276 deaths in every 1,000 of the white troops during
the five and one-sixth years covered by the reports, and 9,897 cases and 430 deaths in
every 1,000 of the coloi'ed troops during the three years similarly covered. Disease among
the latter is thus seen to have been not only of more frequent occurrence but considerably
more fatal than among the former. This may be better seen by presenting the statistics
of the colored troops on a basis of five and one-sixth years of service, when the numbers
are found to be 17,044 cases and 740.6 deaths, equivalent to 135.5 cases and 268.4 deaths
respectively for every 100 cases and every 100 deaths among the white troops. The greater
liability of the colored troops to disease and death is also clearly shown l>y the presentation
of the statistics in the form of annual rates. The average annual numbers among white
soldiers per 1,000 of mean strength were 2,435 cases and 53.4 deaths; in the colored
command the corresponding numbers were 3,299 and 143.4.
Table I.
Shoiclvff tlic Annual Movement of Sickness and Death among the Wliile and the Colored Troops, expressed
in ratios per 1,000 of mean strength.
For the TE.4R ENDISG JUNE 30T1I—
Average
Annual Rate
I'EU 1,000.
1861.
1862.
1863.
1864.
1865.
1866.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
■ Cases.
Deaths.
Cases.
Deaths.
3,82i
10.8
2,983
49.
2, 696
63.
2,210
4,092
• 48.
211.
3,205
56.
140.
2,362
2,797
42.
94.
2,435
3,299
,53. 4
143. 4 1
It may be inquired how these figures compare with the records of other armies. To
institute a satisfactory comparison between the sickness and mortality of armies of difler-
ent nationalities is diificult, especially in dealing with the records of war service.- Besides
differences in nomenclature and in methods of reporting, which interfere with just com-
AMON(i TIIK U. S. KORCES.
parisons in time of peace, tlie war ivcunls are usually more or less inJelinite in certain
items of information, as of strength present, needful tu the calculation of comparative
rates.
There is, however, little to be gained by comparing the statistics of one campaign
with those of others conducted under wholly different conditions. Each may be advan-
tageously studied for the special lessons inculcated, but unless similar general conditions
coincided with particular conditions whirh wre not sinular, there is no [irotit in the com-
parison. The medical histories of the Frt'iich and English armies before Sevastopol present
many fruitful comparisons, but it is of little moment to })lace the 94.9 deaths* per 1,000
of strength which occurred from disease in the English ranks in January, 1855, by the
side of our average annual rate of 53.4, or to note that during that one month diseases of
the stomach and buwi-ls, chiefly diai'rha'a and dysentery, caused among the British troops
as many deaths, 62.7 per 1,000 strength,f as were occasioned by all diseases in our armies
during 1862—3, the year of their liighest mortality, 63 per 1,000. For similar reasons it
is needless to enter into detailed comparisons between the rates above mentioned and the
14.30J deaths per 1,000 of strength, equalling an annual rate of 24.51, which occiu'red
from disease during tiie seven months of war, August, 1870, to Feliruary, 1871, inclusive,
in the Prussian army.
The standard of comparison for each army should be its own average sick and death
rates derived from the records of a series of years during which it was exposed to no
specially unfavorable conditions, or, preferably, the best annual record furnished Ijy its
history, as all deviations from that record indicate, when their causes are investigated, not
only how they may be avoided in the future, but how the standard itself may be improved.
The difference between such a standard and the disastrous experience of the English
dining the first half of the Crimean war was a measure of the virulence of the unusual
morbific agencies to which their array was exposed.
■* MciUcal and Surgical History of the British Arm>/ which served in TurJ.ey and the Crimea during the War agaitist Russia in the years 1P54-G.
Oflicial publicatiun. London. ]SoS, Vol. II, p. 44.
t Op. cit.. last note. Table B.
* Calculated from the figures given by Dr. Enuki. in the ZeUschri/t des Knn J'reussichen Statidesvhen Bureaus Jahrgimg li?, Berlin, ]87,\ p. 250,
The mortality from disease in the German army during the war of 1870-71 was as follows:
Mortality.
Deaths iVoni acute iuternal dl»eases :
Dysentery
Typhus
(lastrie Fever
Sinall-pox
Iiitianimatinn of the air-passugcs ai;d lune;s.
Other diseases ,
Deaths from chronic intenial diseases ;
Consumption
Other internal diseases (chronic)
Sudden death (from disease)
Cnses in which the disease was not given
Cases in which the cause of death was net given
NUlIliEU.
MEAN STKKXGTH.
i.on
...
G, !i:i.')
p. 14
158
0.18
s«
0. Q'J
4IU
0. .->7
515
C. lU
521
0, (il
2-ii;
0. 29
ny
II. HI
53:)
0. i;i
Total.
12, 147
14.30
Tlie strength (^50..">c'.5) fnun which these rates were ealeulated was obtained Iruiu Dr. E.ngkl's statement of the total number cf deatlis (join
disease and injury (40,74:i) and of the rale (47.90) per thousand of mean strcogtli to which this total corresponded.
SICKNESS AND MORTALITY
The difference between the ordinary death rate from disease in the German army,
5.64 in 1868 and 4.76 in 1869/^' and the war rate of 1870, ah'eady instanced, shows
the operation of insanitary causes which might be specified with more or less accuracy by
detailed comparisons. The German record during this war is noteworthy as having pre-
sented a death rate from disease considerably smaller than that resulting from the casualties
of battle. The total death rate, 47.90 per thousand strength, in the seven months of active
operations consisted of 33.60 from violence and 14.30 from disease, the latter being equal
to an annual rate of 24.51 per thou.sand. But when this i-ecord is compared with its
proper standard, the mortality of the German army in time of peace, it will be observed that
a very notable increase took place in the deaths from disease on account of the exposures
incident to the seven months of war. The death rate, in fact, became cjuadrupled.
When our own war statistics, as given above in annual rates per 1,000 of strength, are
compared with similar figures derived from reports covering eighteen years of the history
of the army,"|" it will be found that the morbific influences to which our troops were subjected
were such as to increase the annual deatli rate from disease by 34.50 per 1,000 of mean
strength. The peace rate, 18.98 per 1,000, became nearly tripled by the war influences.
Our war rate does not appear great when viewed in relation to the mortality rates of
previous years and to the English and German figures instanced as expressing the mortality
* These rates were obtained from the Sanitiits Bencht ii. d. Preuss. Jrmee, 1868-69, pp. 40, 142-145, 203, and 298-301. The mean strength during
1868 was 250.376 and the mortality from disease 1,413; the strength durhig 1869 was 248,246 and the mortality 1,183.
tThe records of the .Surgeon General's Olfice show tliat. excluding deaths from wounds, accidents and injuries, and also those from Asiatic cholera
and yellow fever, the annual mortality rate of tlie United States army during eighteen years of peace whicli preceded the outbrealv of the civil war
averaged 18.98 per 1,000 of strengtii, the extremes being 8.4 in 1845 and 39.6 in 1849. The deaths in excess of the minimum were due for the most part
to diarrhcea and dysentery, continued and remittent fevers. Tlie following table has been compiled to show the death rates from disease that prevailed in
the army before the war. The years 1847-48 are not included, as the troops wer^then on active service in Mexico.
YEAR.
Deaths fuoji—
Death Rate fuom—
.Strength.
All Diseases.
Cholera.
Yellow Fever.
All Diseases.
Exclusive of that
from Cholera .and
Yellow Fever.
1840
10,116
9, 748
10, COO
9,863
8,570
8,590
9, 083
9,148
8,970
9, 242
9,203
9,994
8,095
9, 367
14,434
12, 701
14,510
1.3,510
241
367
2S1
156
95
72
175
721
268
280
208
266
224
305
353
107
202
240
10
6
28
12
11
23. 8
37.6
29.1
16.2
11.1
8.4
19.3
78.8
29.9
39.3
22.6
26.6
27.7
33.6
24.7
13.1
13.9
15.5
22. 8
37.0
26.3
14.6
9.8
8.4
19. 3
3X6
22.9
20.5
19.8
16.8
15.2
19.3
20.5
12.0
13.5
10.8
1841
1842
1843
1844
1845
1846
1849
307
60
Ul
26
94
18
104
58
52
3
1850 .
1851
1852
1853
4
83
20
2
14
1854
1855
18.-)6 :....
1857
1858 '.
6
1859
72
10, 3D7
257
24.72
18.98
The figures of this table may be compared, with those fur the years 1866-83, given in note upon page , as well as with those in Table I of
the text.
AMONG THK U. S. FORCES.
9
induced bv war conditions. It is the mortality rate of our army in the years of peace
preceding the war that compares unfavorably with the analogous German rate, and gives
the liigh rate of death from disease when that consequent on the aggregation of our troops
in larsre masses and the exposures incident to field service are superadded. Our army was
scattered at posts in all parts of the countr}^ which afterwards became the theatre of war,
and was exposed to the same miasmatic agencies which subsequently attracted more notice
on account of the large number of men constituting the commands. The peace rate of
IS. 98 shows the insanitary conditions to which our troops were subjected during those
eighteen years. The increase to 53.48 during the war is the measure of the mortality
directly referable to its morbific influences.
But when, instead of tlie average of many years, the best annual record furnished by
the liistorv of our army is accepted as a standard, the influence of the war in giving potency
to the causes of disease becomes very manifest. The rates 8.4 in 1845, 9.8 in 1844, and
10.8 in 1859 are much below the average of the eighteen years. Favorable conditions
conduced to this relatively light mortality. But these favorable conditions were, as will be
shown directly, in great part susceptible of attainment in other years. The average of
these rates, 9.33, may therefore be accepted as indicating the unavoidable mortality frora
disease in a body of men constituted and circumstanced as was our army before the \<ar;
and the large increase of 44.15 deaths per 1,000 of strength annually is necessarily
referred for causation to the war influences.
The war rates assume a larger relative magnitude when the rates which have prevailed
among our troops since the war is made the basis of comparison.* The average annual
*The following table e.vbibits the mortality rates, exclusive cf those from wounds, accijeuts and injuries and also th<;se from Asiatic Cliolera and
Yellow Fever io the army since the war, and may be compared with that given iu the note to page 8, supra.
Table showing the Annual Death Bates aiming the TT7ii7e Troops of the UniUd States Army since the close of the War of the Bebetlion.
Yeak.
Mkan Stkexc.th.
DE.ITIIS FK03I—
DE-ITH R.\TE FR05I—
All Diseases.
CbuletH.
Yellow Fever.
Exclusive of that
All Diseases. fnim Cholera and'
Y'ellow Fever,
16.;6-7
1868-9
1869-70
40, 163
45, 023
37, 197
28, 660
29, 373
24, 116
24, 897
25, 786
21,939
21,718
23, 363
20, 813
21,848
22,096
21, 174
20,723
20,923
1,529
1,168
376
219
355
20-3
247
218
158
169
179
122
162
126
131
141
146
747
139
2
7
437
1
19
46
20
38. 05 19. 29
26.39 ia82
10. 11 10. 03
1
8. 69 ' 8. 03
12. 09 10. 52
10. 91 10. 1'6
9. 93 '.'. 64
8. 45 1 7. 60
:670-!
1872-3
2
1873-4
16
2
30
2
1674-5. .
1875-6-.
7.20
7.78
7.66
5.86
7.41
5.70
7. It
6 40 '
7.57
5. 6i;
6.9i;
5.70
1876-7..
1677-8
1678-9
10
1679-80
1680-1
2
1
C. IJ 6. 0!! 1
1
6.60 1 6.60
6.98 6.83
1681-2
1662-3
3
Annual average
26,462
338.7
517
34.4
12.80 j 9.31
Mku. Hist. Pt. Ill— 2
10 SICKNESS AND MORTALITY
mortality IV.jm disease for the seventeen years, 1866-7 — 1S82-3, was but 9.51 per l.UOU,
although the country occupied by the troops and the unavoidable causes of disease to
Avhicli thev were exposed were the same as in the vears preceding; the war. This rati',
taken as a standard, refers the large annual mortality of 43.9 directly to the exposures
incident to the war. But if the average rate of the ten years, 1873-4 — 1882-3, be made
tl;e basis of comparison, the war influences become correspondingly magnified. This rate,
6.74, is but slightly in excess of the minimum, 5.70. in 1879-80.. The causation of this
great iliminutiou in the death rate of our soldiers of late years is readdy appreciated.
After the war the regular troops were distributed mainly over the undeveloped West to
hold the Indians in check and promote the settlement of the country. The old posts
which had been occupied before the war were in ruins, and the new conditions develojjed
by tl;e advance of civilization westward recjuired the establishment of garrisons in positions
which had formerly been unoccupied. Military policy rather than hygienic considerations
usually dictated the selection of the site, and in many instances the stations were estab-
lished in unhealthy river bottoms for the .sake of being near to a water supplv. The
quarters built b)- tlie troops were of the most primitive character, the materials at com-
mand being only such as the country afforded. Practically, our soldiers during the years
1867 and 1868 were in the field, and hence the high death rate. But in the years that
followed, posts which experience had shown to be unhealthy were abandoned, and monev
was appropriated for the construction of barracks at such stations as appeared likely to
recjuire permanent occupation. The conditions became gradually changed from those
attending a state of war or active field service to those of garrison duty in time of 2:>eace,
although occasional campaigns against hostile Indians kept the mortality rate higher than
a purely peace rate should be. The average rate of the past ten years testifies to the
efforts of the Medical Department on behalf of the soldier, and the earnest and intelligent
co-operative action of mditarv commanders.
The popular idea that our armies suffered severely from disease during the campaigns
of the civil war is thus well sustained by the statistics, in view of the fact that no notable
<?2Didemic of imported ijestilence, as of typhus, cholera, or yellow fever, contributed to their
mortality. Had our camps been unhappily visited by these scourges, our annual mortalitv.
of 53 per 1,000 of strength would have appeared light in comparison with tlie terrible
record which would have formed the text of a medical history of the period.
Sickness and mortality as caused by various diseases and cla.sses of disease. — ■
It has been already stated that among the white troops the cases of disease i-eported during
the five and one-sixth years embraced in the statistical records numbered 12,579 and the
deaths 276 in every 1,000 men of mean strength, these figures being equivalent to the
annual rates of 24.34 and 53.48 respectively. It has also been stated that among the
colored troo])s during three years of service there were recorded 9,897 cases of sickness
and 430 deaths from disease in everv 1,000 men of mean strength, figures ecjual to the
annual rates of 3,299 and 143.4 respectively. The following table is designed to give a
general view of the distribution of these cases and deaths under specific and generic head-
ings. The first two columns of each division of the table rei)resent the sickness and deaths
that occurred during the whole period, the figures being ratios per 1,000 men of mean
strength; the last two columns show to what extent the specified diseases contributed to
the totals of the cases and deaths that were reported as from disease.
Nl
AMONG THE V. S. FORCES.
11
Tablk II.
Sliou-iuff ihc Comparative Frequenci/ of, and }[ortaUtti from, the Diseases that prevailed among the While
Troops of the U. S. Army durinj the period from May 1, 1S61, to June SO, 1SG6, and among the
Colored Troops during the prr/o(? from July 1, 1S63, to June oO, ISGd.
AViUTK Titaoi's.
CoixiKED Troops.
Ciisfs lu.i:l.> t ..>v> jt. r l.)._.t;lts|>er ' Ciiscs ' Deaths I Cnscs per Deaths per
)>crl.lXKlol per l.OiiOof l,000"tl..lal LlHHIof i.,ial per '.l''"' of perl.tHlOof l,(XX)oftolal 1.000. iltulal
tiiean I liienn eases de.ith»froin ^ mean liiean e.l6C8 Ueatlis frum
sTretvj-tli. ' fitreogth. ofdUease. disease. || strength. , strength. ! of disease. , disease.
Coiitiiuied Fevers
Typho-mahiriul Fevers ((t)
Malarial Fevers. .
Diarrhoea and Dysentery
Diphtheria (a)
Eruptive Fevers
Other Miasmatic diseases {h)
Total Miasniatie diseases
-Syphilis, Gonorrluea and Orchitis
Scurvy
Kbeumatism, acute and cbruoic
CunsnmptioQ :.
Itch
Diseases of Nervous System
Diseases of Eye and Ear
Diseases of Circulatory Organs
Acute Bronchitis and Catarrh (b)
loflammation of Lungs and Pleunt . . .
Other diseases of Respiratory Organs.
Total Respiratory Organs
Diseases of the Digestive Organs
I'rino-genital disease
Diseases of Bones and Joints
Boils, .\bscesses and other Integumentarj*
diseases.
Grand Total 12,579.04
as. Ill
11.T.C5
2,(iSa78
3, 673. 93
1G.87
240. 83
404. 60
7, 306. 84
42:!. 8.-.
71.22
590.71
:!I.:i0
74. 39
3.M.33
272.73
.58.22
C01.57
S15.78
235.32
1,352.67
1,306.10
0.28
18.73
440. 17
59.91
P. G7
17.38
80.71
1. .'iS
23.26
5.33
196.79
.29
.82
1.01
ll.-_'.>
9.4!'
a34
2.33
32.73
2. 57
38.23
8.85
. 92 ■
.10
.46
276.30
16.53
9.19
214.55
292.23
1.34
14.85
32.16 I
580. £7
33.69
I
5.66
4G.96
■-•.49 I
3.91
31.34
L'i.i;.<
4.C3
71.67
17. 15
18.71 '
107.53
10a63
&51 j
1.49 j
C4.99 ;
216.82
31.37
6191
292. 10
5. .13
84.19
19.33
712.21
1.05
3.96
3.C7
40.85
12.81 j
9.16 I
118.47 ,
10.74
I3a36|
33.04
132 !
.36
1.67
1,000.00 1,000.00
C8. 98
133. 16
2, 488. 73
2, 51?. 14
12.09
276.86
396.90
5,88*46
23122
205l23
525. 53
21.77
51.63
ail. 53
153.33
23.30
531.91
381.27
131. 03
1,064.22
837.77
43.34
15.54
192.37
37.36
20.33 I
33. CS
103.81
.95
53. C8
8.93
338.62
.50
6.07
aer
13.94
12. 75
.03
7.31
4.07
86.62
6.35
S7.04
15.19
2.05
.23
.43
6.97
12.44
231:47
VA. 43
1.58
•10. 13
5.!4. C8
3.5.56
26.80
53.10
2.20 ^
5.22 :.
39.56
16. CO I
2.58 1
5a 73
38.53
15.36
107.53
60. 7J
4.<:s
1.57
19.44
6C.84
47.31
C9.r.3
I
24.-). S7
2.23
138. C4
20.88
C01.19
1.16
14.11
8. .-)3
41. 1 '4
39.C4
.c; I
16. 98 I
9.46
201.33
14.73
235.57
3.'.. 31
4.76
I
"CO. CO 1,000.00
(a) Cases were reported under this heading only during the period from June 30, 1362.
(h) In the composition of thi.s table the fifrures reported under llie heailing Epidemic Catarrh have been dropped from the class of miiismatie diseases
and consolidated with the diseases of the respir.itorj- organs, as there seems good reason for believing that intluenza was at no time prevalent atiionir the
troops. .See infra, page 725.
Among the white troops diarrhoea and dysentery occurred with great frec^uency and
occasioned a laro-e mortality. These intestinal affections were the cause of more than one-
fourth of all the entries upon the sick reports ; and it is a singular coincidence that their
reported cases bear to the reported cases of all diseases the same ratio, 292 per thousand,
that the deaths occasioned by them bear to the total deaths from disease. Malarial fevers
^followed in order of frequency, haying constituted, if typho-malarial cases are included,
about one-fourth of the whole number of cases of disease. These caused nearly one-tenth
of the total deaths, a mortality almost reached by the eruptiye fevers, which, howfever,
occasioned only 14.8 of every thousand of the cases. But in order of gravity the continued
fevers, consisting mainly of typhoid cases, took the second place, having caused 216 deaths
in every thousand from disease, although contributing only 16.5 cases fo -v ry thousand
12 SICKNESS AXD MORTALITY
cases of all diseases. To the miasmatic diseases as a class were attributed considerably
more than one-half, 581 cases per thousand of all diseases, of the entries on sick reports, and
nearly three-fourths of the mortality, 712 deaths in every thousand. The only other classes
of disease which furnished high rates of prevalence, diseases of the digestive and of the
respiratory organs, agreed closely in their number of cases, 103.8 of the former and lUT.o
of the latter, contributed to every thousand of all diseases ; but the deaths caused by the
diseases of the respiratory organs assumed a higher jiroportion, 138.4 per thousand, on
account of the gravity of the pneumonic cases. Scurvy as an individualized disease caused
less than 6 in every thousand of the cases and less than 3 in every thousand of the deaths.
The second part of the table presents the parallel facts deduced from the medical
statistics o£ the colored troops. Among the colored, as among the white troops, diarrhoea
and dysentery occurred with great frequency and fatality. The ratio of cases of these
intestinal aflfections to the total number of cases of disease was 254:. 4, and of deaths caused
by them to the deaths caused liy all diseases, 245.97 in every thousand of each respectively.
Malarial fevers constituted one-fourth of the whole number of cases of disease, and caused,
if typho-malarial fevers are included, somewhat more than one-tenth of the deaths. But
inflaraniation of the lungs occupied the second place in the order of gravity, the deaths
from this cause having formed 201.3 of every thousand from all diseases. The eruptive
fevers occasioned 128 of every thousand deaths. The continued fevers did not occupy so
prominent a place in the medical, records of the colored troops as in those of the white
regiments ; the cases formed only 6.97 of every thousand cases of all diseases, and the
deaths 86.84 of every thousand deaths from disease, as compared with 16.55 and 216.82,
the corresponding numbers from the records of the white troops. Miasmatic diseases as
a class caused 594.68 of every thousand cases and 601.19 of every thousand deaths.
Scurvy attained a decided prominence among the colored troops as compared with its
prevalence among the whites. It was nearly as frequent as the eruptive fevers, 26.80
cases having been recorded in every thousand cases of disease ; and a comparatively large
number of deaths were attributed to it, 14.11 of every thousand from all cases, as asrainst
2.96 among the white troops.
Incidentally a comparison may be instituted between the sickness and mortality of
the white and the colored troops by noting the figures in the third and fourth columns of
Table II, in connection with the corresponding figures in its seventh and eighth columns.
The first two columns of each division of this table are insusceptible of comparison, as they
do not refer to equal periods of time, but in the following table the average annual rates
of sickness and death in the white and the colored commands are strictly comparable.
From this table the greater sickness and the very much larger death rate among the
colored troops may be appreciated and referred to tlie disease or classes of disease that
occasioned them. There occurred on the average annually in every thousand of the colored
men 143.4 deaths from disease as compared with 53.48 among the white troops ; and as
the sickness of the former, althougli large, was not proportionally increased, the greater
fatality of disease among them is manifested.
Malarial diseases caused 829.58 cases as against 522.34 anaong the white troops, and
10.03 deaths as against 3.36, whilst at the same time cases reported as typho-malarial
were more numerous and very much more fatal among the colored commands. Evidently,
from these figures, the latter did not possess that insusceptibility to the malarial influence that
AMONU THK U. S. FORCES.
13
has been sometimes claimed for them.* Indeed, an insusceptibility to the typhoid poison
rather than to the malarial influence appears suggested, for the average annual number of
Taklk III.
Showing by Average Annual Rales per 1,000 of mean strength the Comparative Frecjuency of, and
Mortality from, the Disea.ses that prevailed among the While and Colored Troops of the r\ .S'. Ainm.
WnnE Troops.
C^*l.^-M:tll i i:"
Diseased
Cases.
Deaths. I Cases. I Deaths.
Average uuniia) mie fur all diseasi-
2,434.04
53. 43 3, 59?. %
14^4
_L
I
Continued Fevers
Tj-pho-malarial Fevers
Malarial Fevers
Diarrhoea and Dysentery
Diphtheria
Eruptive Fevers
Other Miasmatic diseases
Total Miasmatic diseases
Syphilis, Gonorrhcea ami Orchitis .
Seur\'y
Rheumatism, acute and chrunic . . .
ConsuinptioD
Itch
Diseases of Xervoos System -.
Diseases of Eye andEar
Diseases of Circulation
Acute Broacbitis
Inflammation of Lungs and Pleura
Other diseases of Respiratorj' Organs
Total diseases of Respiratory Organs
Diseases of Digestive System
I'rino-^nital diseases
Diseases of Bones and Joints
Boils, .Abscesses and other Integumentary diseases .
40.29 I
22.3?
532. 34
711. 4C
3. sa
4i;. Gi
7S.31
1,414.22
M. 04
13.78
114.33
cot)
11. 40
71). 31
Si 7.1
1 1. i7
174.43
41. 7i;
45. 55
2til.80
252.70
i:i. 41
3.G3
8.5. 19
11.60 1
l.f?
3. 3i;
15.62
.34
4.50
1.03
38.09 |,
.01)
.It) '
.20
2.18
1.84 !
.OtH
. ("9
.4;i
.:. :i4
. !;7
7.40
1.71
. 1.-
.02 ^
.09 i
2a 99
41.05
829. o-
639.38
4.23
92.29
132.30
1,9()1.82
77.74
88.43
178.54
7.26
17.21
130.51 '
52. 7^i
8. .".0
177. :tn
li7. 09
CO. 34
354.74
295. 93 '
1.;. 4.-.
5. 18
C4. 12 '
12. 45
6.7? '
10. 03
35.27
.32
18.36
2.99
86.21
.17
2.02
1.2:)
6.31
4.25
.01
2.44
1. 311
2. 12
32.35
5.96
.i;8
.14
'5^,
cases of the continued fevers was only 22.99 amoncj the colored men, yv\m\; it reached 40.29
among the white troops. Nevertheless, the annual death rate from these fevers, typhoid
mainly, was somewhat larger among the colored men, 12.45, than the white commands,
11.60; thiS indicating the unlikely coincidence of a diminished prevalence and a largely
augrnented virulence. This anomaly is probably due to the aggregation of a larger propor-
tion of true tyjihoid cases in the 41.05 cases reported as typho-raalarial from the colored
commands than in the 22.38 cases similarly reported from the white regiments. Diarrhoea
and dysentery, the eruptive fevers, diseases of the lungs — in fact, with the partial exception
of the continued fevers, all the diseases that were specially i^revalent in our camps occasioned
more sickness and more deaths among the colored troops than among corresponding numbers
of the white troops. Miasmatic diseases as a class caused 1,961.82 cases and 86.21 deaths,
as compared with 1,414.22 cases and 38.09 deaths among the whites. Even those, such as
' See in/ra, page S4, in continuation of this subject.
14 SICKNESS AND MOPITALITY
sypliilisi, gonorrhoea and orchitis, consumption, diseases of the eye and ear, diseases of the
circulation and acute bronchitic attacks, which were not of more frequent occurrence
among the colored troops were, nevertheless, attended with a higher mortality than among
the whites.*
Sick- and mortality-hates of U. S. white troops during the war as compared
WITH THOSE OF OTHER BODIES OF MEN OF THE MILITARY AGE. — Table IV and the plate which
faces this page have been designed to illustrate the A^arious points that appear of interest
under this heading. Special attention may be invited to some of the more prominent of these.
Five of the red lines representing annual mortality rates among our white troops
during the war are projected into the closed-up divisions of the plate. Evidently the dis-
eases indicated by them caused the main portion of the total mortality. The length of
these lines as comjaared with that of the correlated lines of other colors, gives expression
to the influences whicli the conditions of war impressed on the mortality from these affec-
tions. The diseases thus prominently brought into notice are those already recognized
in Table II as having occasioned so many of the deaths among our soldiers. Of the 53.48
deaths that occurred annually in every thousand men of the average strength present,
diarrhoea and dvsenterv caused 15.62; the continued fevers, not includino- those reported
as typho-malarial, 11.60; diseases of the respiration, jjneumonia chiefly, 7.40; the erup-
tive fevers, 4.50; and the malarial fevers, 3. 36. The only other lines that are projected
into the denser portion of the plate are the black line indicating the mortality, 5.32, from
diarrhcea and dysentery among our troops before tlie war, and the green line representing
that from the continued fevers, 3.39, among the French troops. The former was due to
that want of sanitary supervision and care for the health of "the troops which permitted
scurvy to show as a well-defined cause of death among them, while it scarcely appears
among the other bodies of men tabulated, except in our own armies during the war, when
the unusual nature of the conditions suffice to explain, and in a measure to condone, its
appearance. The latter was due to the influence of local epidemics during the years taken
for comj^arison, and especially to the prevalence of continued fevers among the troops in
Algeria.
The increased mortality during the war from what has been called typho-malarial
fever is well marked by comparison with the death rate from tlie same disease since the
war; but, as will be shown hereafter, febrile cases presenting essential differences were
aggregated under this heading.
The large death rate, 11.60 per thousand of sti-ength, from the continued fevers during
the war period, when compared with their relatively insignificant mortality in our army
since the war, 0.61, in the German array, 0.98, or among our civil population of the
military age, 0.49, implies of necessity a vastly increased prevalence as well as fatality.
Both of these facts may be verified from the data in Table IV. A precisely analogous
series of facts delineated under the heading of the eruptive fevers is suggestive of one of
the probable causes of the increased prevalence and fatality of the continued fevers. The
main factor in the development of an epidemic of the eruptive fevers is not so much the
introduction of the contagion, although this of course is essential, but the accumulation in
the population of a sufficient number of susceptible individuals to afford material for the
' This tendency of the colored troops to succumb to morbific iniiuences was brought forcibly to the notice of the writer in ISfA by Assistant .Surgeon
J. T. Calhoun, U. S. Army, then in charge of a field hospital fur their treatment at City Point, Virginia. " I do not know what to do with these colored
men,'' lie said, **I cannot keep them up. They do not have tlie stamica of our wliite men. They just go to their beds and die."'
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AMONG THK U. S. FORCES. 15
operation of tlie morbid agency. This is well recognized by the recurrence of the epidemic
visitation after a certain lapse of time has permitted the conmumity to accumulate a large
proportion of jiersons hitherto unafleeted ; and in the case of small-pox, by the institution
of effective preventive measures based on the destruction of the susceptibility rather than
on the exclusion of the contagion. Keginients recruited in country districts that had been
unvisited by these fevers for a nunib(>r of years, presented material for their rapid spread
on the introduction of the contagious princi[)le. Similarly, regiments from localities that
had lieen free from typlund. were liable to sntlVr severely iVom this disease on account of
the susceptibility of the men composing them.
The mortality lines of our armies during the war period are exceeiKxl by tlioso of other
bodies of men in the two instances, consumption and scurvy. The males of our civil
population have a higlier death rate from the first-mentioned disease as a result of the
selection for service and discharges for disability that tended to free the army from such
cases. Our own troops, before the war, had a higher rate from scurvv, owing to deficient
supplies and their isolation at stations at and beyond tlie frontier of civilization.
Diseases of the digestive system gave a larger mortality among our troops during the
war than among other bodies of men. The records show this to have been mainl\' due fo
the fatality of cholera morbus and dropsy from hepatic disease.
Diseases of the nervous system had also a comparatively large mortality, wiiich, huw-
ever, was equalled in our own army before the war.
Active service during the war slightly increased the mortality from diseases of the
circulatory system; but the records of the French army ascribe to these diseases a nearly
similar death rate.
Rheumatism contributed but little to the mortality in our camps, scarcely more than
was the result of the conditions existing at the military jiosts ol' earlier times.
From Table IV, on the next page, may be gathered sonie interesting points regarding
prevalence not shown by tlie mortality lines.
Thus, according to the figures, the number of cases of sickness among our troops was
relatively greater before the war than during its progress. Certainly, in its early service
in the Indian country, our small army was exposed to many of the influences that subse-
quently contributed to the war rates of sickness. It will be observed, however, that the
number of serious cases, i. e., of diseases yielding a high mortality, was invariably greater
during the war than before it; hence the smaller figures of which our war rates consists,
2,434.64 cases annually per thousand of strength as against 2,886.01 in earlier years,
must be attributed to the failure of our medical officers during the active progress of a
campaign to record cases of trivial ailments rather than to an actuid diminution in tlieir
number.
Again, the frequency of cases of disease in our army since the war appears to have
been more than double that of the German army during corresponding years of peace,
1.474.26 per thousand of strength as compared with 660.78. Here the gravity of the
affection recorded as a case of sickness forms an element of difference. In our service
every man excused from military duty on account of sickness, however trivial, counts as
one case upon the record; but since the mortality rate of the German army is not decreased
in jJroportiou to its sickness, as compared with our rates, it may be inferred that in their
service the trivial cases are not recorded.
1
16
SICKNESS AKD MOBTALITY
Table IV.
Avemffe Annual Sick end Death Rates per thousa7id of mean strength in the U. S. Army before, during
and since the tear, and in the German and French a)-mies, loith the Annual Death Rate for males
of the military age in the United States, as calculated from the returns of the census year 1S80.
o_ be"
^ =^ "3 "a"
= -^ x ^
£ a 3 ■£
" ^.= x
= "!! t.%
Strength represented : 'l, 906, 276
U. S. Array,
White Troops
fur 5J years of
War.
,8,987,358 431,237
Deaths. Deaths.
Average annual rate for all diseases .
C. 97 ! 6.87
Cases. ' Deaths.
a, 434. 64 53. 48
Continued Fevers .'1'.' .54 , 40.29
Typho-malarial Fevers 23.38
Malarial Fevers
Diarrho?a and Dysentery-
Diphtheria
Eruptive Fevers
Other Miasmatic Diseases
Total Miasmatic Diseases
Syphilis. Gonorrhtea and Orchitis
Scurvy
rheumatism, acute and chronic
Consumption ;
Itch
Diseases of Nervous System
(^Diseases of Eye and Ear
Diseases of Circulation
Acute Bronchitis
Inflammation of Luoijs and Pleura
Other Diseases of Respiratory Organs
Total Diseases of Respiratory Organs
Diseases of Digestive System
Uriuo-genital Diseases
Diseases of Bones and Joints
Boils, Abscesses and other Integ-umeutary
Diseases.
.19
.04
.09
.02
.04
■J. 94
.46
.08
.77
.13
.98
.35
.33
.04
.04
.26
.05
.06
.04
2.33
.56
.33
.05
.97
.12
1.14
.33
.18
.03
.05
522. 34'
711.461
3.921
46. 61
78.31
l,414.Sa
82.04
13.78
114.33
1
6.06
14. 40]
76. 31
52.79
11. 27
174. 49
41.76
45. .=55
261. 80
252. 79
13.41
3.63
83.191
11.60
1.68
3.30
15.62
.34
4.50
1.03
38.09
.06
.16
.20
2.18
U. S. Army,
White Troops
for 18 years be-
fore the War (c)
r. S. Army,
White Troo"ps
for 10 years since
the War.
Cases.
2, 886. 01
Deaths. Cases.
18.98 1,474.26
596. 63
4S7. 34
1.29
1.76
5.32
6.74
German Army
for four years,
]874-'3 to
1877- 8. (<2)
? >•
334, 193 1459, 420
Cases. I Deaths.
660. 78 -4. 38
7.48j
1,112.74
67.86
26.37
114.33
3.53
1.84
.004
.69
.49
6.34
.57
7.40
1.71
.18
.02
.09
.19
(/)..
8.56
.08
.£8
.18
1.84
82.26
1.77
."ig.Ol
.01
3.04
.23
299. 59
.19
27.28
1.36
326. 8'
1(8. 46
1.55
.04
129. 91
3.23
2.38
226. 68
S24. 56
.55
2.61
'/)8.48
468.89
87.62
.42
116.54
4.08
.29
lll.S
34.42
7.70
208.83
10.54
11. 42
230.
191. 20
15.44
3.92
118. 09
.61
.34
.32
.47
.02
.06
(/). 13
1.96
.05
.005
.06
.72
.98
24.79
21.88
1.18
4.S6
.009
.10
.04
.07
C7.07 1
41.36
.10
26.21
3.77
1.20
.006
.009
.03
.74
.38
.26
.05
.39 !
.79
4.17
.005
41.08
.67
2.10
.06
43.64
.84
17.61
^n
i.'io
61.25
.69
30.82
.24
6.34'
.21
.03
.06
.03
7.13
43. 78
.75
.009
.08
.06
.006
4.48
.004
I
.004
.09
.48
.004
.18
.18
1.02
.33
1.51
.29
.04
.09
(a) The mortality returns of the Tenth U. S. Census. 1880, were not published at the time this table was calculated; but by the courtesy of the
f5uperintendent the writer was furnished with page proofs of Table XI, Statistics c^f ilortalitij, giving the deaths in certain grand groups by age and sex,
with distinction of color and specification of cause, from which he calculated the rates for his comparative table of annual rates in men of the military age.
The grand groups, Nos. 2, 8 and 11 of tlie topographic.il divisions made by the Census Office, have a population of 1,906.276 white males between and
including the ages of 20 and 44 years. They are: 2, the Middle Atlantic Coast, comprising the District of Columbia, the State of Delaware, and part of
Kew York, >'ew Jersey, jMaryland and \'irginia; 8. tlie Interior Plateau, embracing parts of New Yorl;, Pennsylvania, Virginia and North Carolina;
and 11, the Soutliern Interior Plateau, including parts of South Carolina, Georgia, .\labama, Mississippi and Tennessee.
(I) The figures in this column were calculated from page proofs of Table VII of the Statistics of Mortality of the Tenth Census, which gives the
mortality of the United States from each specified disease and class of diseases, with distiuction of age and sex but not of color.
(c) The average rates in this column are from the statistics of the years 1840 to 1859 inclusive, hut not including the years 1847 and 1 848, during which
•the troops were on active service in Mexico. YeUow fever and cholera prevailed during certain of these years, but the influence of these epidemics
has been excluded in calculating the rates. There were 317 deaths from yellow fever and 764 from cholera, which, if included, would raise the average
annual death rate from 18.98 to 24.73.
((i) These rates were calculated from the Statistischen Sanitiitsbericht iibcr die Kmifflich rrfussische Jrmre. Care was taken in the computation to
so aggregate tl>e figures given under specified diseases as to render thera strictly comparable with the l'nite<i States statistics.
(c) As the French Statistijues Medicales rfe r.-lrmie do not report the number of men excused from duty and treated in quarters, their recorded cases
are not susceptible of comparison with those of the I'nited States or German army. (/) Not including yellow fever.
AMONG THE X'. P. FORCES. 17
Notwithstanding tlie great frequency of malarial attacks during the war, 522.3-4 eases
annually per thousand of strength, it will be observed that these were even of greater
frequency among our troops during the years that preceded it, 596.63 jx-r thousand. TIk'
material reduction of late years in malarial sickness, 226.68 jter thousand, is due to the
abandonment of unhealthy stations."^"
Venereal diseases and those affecting the uriuo-genital organs were nearly as frequent
in our army during the war as in earlier years.
Scurvy during the war gave annually per Ihousand of strength 13.78 cases, or only
about one-lialf of the number, 26.37, recorded by our medical officers before the war.
Tlio war records, co!n{>ared with those of our array before and since the war, do not
show an increased jirevalence of rheumatism, nor of diseases of the nervous svstem, nor of
bronchitic attacks; pneumonic cases, however, were more frequent and liv far more fatal.
Diseases of the circulation were somewhat increased, and those of tlic digestive system
considerably augmented iu number during the period of the war.
Sickness and mortality as influenced by season, locality, etc. — The regimental
monthly reports, compiled from the morning reports of the medical officers on duty, arc the
ultimate elements of which the statistics of sickness and death in our armies were composed;
but these lost their individuality when they were converted into departmental returns. The
data in these departmental tables were intended to show, when converted into comparative
figures, the influence of season, locality and military operations as affecting the prevalence
and fatality of the diseases specified. The influence of season can be determined with
accuracy, but that exercised by locality and military operations is not so well defined.
A series of regimental histories giving in parallel sentences an account of the condi-
tions affecting the health of the men during the progress of their service, and the preva-
lence of disease and death among them, would have been a desirable addition to the
materials for a medical history of the war. The want of these has been in part replaced
by the special reports rendered by medical officers, although generally in these more atten-
tion was given to the details of hostile movements, battle scenes and surgical service, than
to the less exciting contests with the more deadly enemy, disease. By the consolidation
of the regimental into departmental returns the numerical statements lost a great part of
their value. Certain sections of the departments were healthy, others unhealthy, and the
consolidation of the regimental reports obliterated the records of special localities and gave
results for each department depending on the character of that section of it in which the
majority of the regiments were concentrated. Besides this, even the boundary lines of
departments were subject to constant variation consequent on changes in the military policy,
the assignment of new commanders, etc. Departmental reports must therefore be consid-
ered in connection with the localities which were the theatre of military operations, rather
than as figures applying generally to the section of country included in the department.
This renders it difficult to attain to an accurate estimate of the relative value of region as
influencing disease and mortality.
Moreover, military operations carried the troops from one part of a department to
another, and frequently to some other department. They entailed upon the soldier fatigues,
exposures and privations which tended to sickness and death. The pernicious influences of
service in one department came thus in many instances to be credited to a wholly different
locality. A synopsis of the history of the operations in each department precedes the annual
* See svpra, p. 10,
Med. Hist. Pt. 111—3
18
SICKNESS AND MORTALITY
statistical tables in the First Part of this work, and many of the movements and the influ-
ences exercised by them have already been given in free extracts from the reports of the
medical officers who served with the commands. Nevertheless, it will readily be appreciated
that the ratios of disease and death calculated from the figures in the departmental tables
express only in a general way the conjoint influence of locality and military o2)erations.
The following table presents a general view of the annual movement of sickness and
death among the white and the colored troops in the several regions:
Table V.
Showing the Anmud Prevaletux of Sickness and the MortaHty from Disease in the several- Regions,
expressed in ratios per 1,000 of mean strength.
Foe the teab esding Juse SOth-
-
1861.
1862.
1863.
1864.
1865.
1866.
Cases. Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
White Troops,
Atlantic Region
3,930
3,432
11.4
7.2
2,719
3,495
2,171
32
81
10
2,553
2,841
2,133
42
85
9
2,137
2,262
1,816
33
58
11
2,221
2,328
1,864
53
61
12
2,292
2,549
1,749
42
48
14
3,822
10.8
2,983
49
2,696
63
2i210
48
2,273
56
2,362
42
Colored Troops,
3,461
4,373
83
269
3,122
3,248
HI
156
3,574
2,842
1(H)
93
Total colored
4 092
211
3,205
140
3,797
94
The commencement of service was in all instances characterized by the highest ratio
of sickness.
Among the white troops the first year gave a mortality rate as low as 10.8 per thou-
sand of strength; but this rate is calculated on observations covering only the months of
May and June, as the troops were being hastily called into service. The third year, ending
June 30, 1863, gave the highest death rate, 63 per 1,000. The rate fell to 48 in the fourth
year, and rose to 56 in the fifth year. In the year following the war the sick rate pre-
served its war height, but the mortality fell to 42.
Among the colored troops the sick rate fell from 4,092 during the first year of tlieir
service to 2,797 during the last, and the death rate from 211 to 94.
The rates in the Pacific region corresponded with those in tlie army as a whole since
the war. The troojis in that region were, in fact, during the war exposed to no greater
fatigues or jirivations than the army encountered when at the close of the war it was
distributed over the west.
The high death rate of the troops in the Central region is one of the chief points
developed by this table. In this region during the year of greatest prevalence the deaths
were to the cases as 1 : 43, and during the year of least prevalence as 1 : 39. In the Atlantic
region, omitting the figures for 1861 as representing only a lydrt of a year, the correspond-
ing jorojiortions were 1 : 85 and 1 : 65. The fatality rates or the deaths in a given number
of cases, as well as the mortality rates or the deaths in a given number of men, were
greater in the Central than in the Atlantic region. Unfortunately it is impossible to learn
precisely in which of the departments of the Central region this large excess of deaths
AMONG THE U.
FORCES.
19
took place. The statistical tables in tlio First i'ail of this work record the deaths which
occurred among the troops serving in each department; but the deaths that occurred in the
general hospitals among soldiers of one department are consolidated with those of mei)
belonging to other departments in a series of tables giving the deaths in the general
hospitals of the region. A\'^e must, therefore, endeavor to appreciate the influence of
locality on the mortality by an examination of its influence on the prevalence of disease.
Tlie following table was constructed to facilitate this examination:
Table VI.
Shotcing the Annual Prevalence of Sicknei^s from all Dmases in the several Military Departments,
expressed in ratios of 1,000 strength.
WiiiiK Troops.
Middle Department
DepHrlinent of the .Shenandoah....
Army of tlie Potomac
Departineut of tlic Uappabannock .
Department of Vii^inia
Department of North Carolina
Dei^rtment of Die South
Department of the East
DejtHrtment of AVa.«hing1on
Middle Division
Atlantic Kef^on
Total in Atlantic Jitgion..
I>ei>artinent of We.*.tern Virginia --.-.
Department of the Cumberland
Department of Tennessee
Dei*artment of tlie tliilf
Dei>artinent of the Norlliwe-st
Dei>ar1ment of .Missouri
Northern De(>artnn'iit
Department of the Ohio
Department of Arkansas
Military DiTision of the Mississippi, Part 1 .
Military Division of the Mississippi. Part II
Central ResT'on
jy^al in t.'tntral Retjimi.
l>e|«rtmentof New Mexico .
Dei>artnient of the Pacific. . .
Pa*:ilic Ke^itn
ToUit in racific Region -
Army tif the ITnittd Stales
For the visak knding Ji'nk 30th—
166-2.
Cases.
3,930
3,930
3,83S
3,099
2,aol
2,844
2,204
a, 432
2,410
3,09.'>
2,719
2,802
3,415
3,991
3,85.1
2,889
3,301
3,495
1,738
2,575
2,171
18fi3.
Cases.
■2,609
2,583
2,985
2,249
2,335
2, .'>24
2,002
1,563
2,823
4,012
2,796
2, 217
2.401
.137
2,005
2,936
2,8.')8
3, 996
2,394
2,296
3,383
2,202
2,218
2, 076
2,133
i696
1,293
1,747
2,614
2,923
2,035
2,249
3,029
1,931
2,829
1,693
1,900
1,816
2,210
186.5.
1,363
2,729
3,110
2,395
2, 219
2,273
1,788
2 221
2, 7I>3
2,109
2,494
2,508
3,428
2, 361
1,688
],li58
1,9I>4
1866.
2,292
2,292
2,549
1,749
2^362
20 SICKNESS AND MORTALITY
Perhaps the first point that will attract attention in this table is the gradual diminu-
tion in the sick rates as the war progressed. The years of the war, tliough nominally five,
were in reality but four, that ending June 30, 1861, having embraced only two months of
service. In a general way, as may be seen by the regionic or army totals, the rate of sick-
ness decreased during the first three years and became somewhat increased during the fourth
year. Locality had nothing to do with this except in so far as in some instances to occasion
an exception to the general rule, as in the Departments of Virginia and North Carolina,
where the sickness increased progressively during the three years on account of continued
exposures in malarious sections. The diminished sick rate must be attributed to the
weeding out by death and discharge for disability of the inferior material necessarily present
in all new levies. The term of service of many of the regiments expired during the third
year of the war, when the hardy veterans composing them were in many instances replaced
by raw troops who, in becoming inured to active service, swelled the sick rates during the
fourth year.
The lowest rate, 1,293, was furnished during the third year by the high grounds of
Western Virginia. The low rate of 1 ,563 was given during the same year by the veterans
of the Army of the Potomac. The battle of Gettysburg began the year, and the desperate
struggle that led from the Wilderness to Petersburg during May and June, 1864, ended it;
but the greater portion of this period was spent in what was regarded by the troops as a
picnic in sumiBer quarters on the Rapidan, or hutted during the succeeding winter and
spring in a healthy locality. All the conditions were favorable to a light sick report.
Many of the men were anticipating a sojourn at home on the expiration of their term of
service. Even the exhausting movements which closed the year, the constant skirmishing,
and the battles fought in quick succession at the Wilderness, Spottsylvania, the North
Anna, Cold Arbor and Petersburg, while undoubtedly the cause of much sickness, tended
to reduce the sick rate as preserved on the records which medical officers made up at
intervals from memory or pencilled notes, overlooking the slighter ailments that would
have been recorded in quieter times and noting only those more serious cases that had been
despatched with the wounded to the general hospitals.
The highest rate, 4,012, was furnished during the third year by the continued exposure
of the troops in the malarious regions of the Department of North Carolina.
The high mortality rates in the Central region corresponded with high sick rates which
are jDarticularly displayed in the reports from the Departments of the Tennessee and the
Gulf. The j^revalence as well as the virulence of the morbific influences was greater in the
Central than in the Atlantic region. The influence of locality on the prevalence of
particular diseases will be discussed in the chapters relating to the diseases in question.
To express the relation of season to sickness and mortality in the various regions, and in
the army as a whole, Tables VII, VIII, IX and X have been constructed ; but, as it is a work
of some labor to gather from such tables the relative value of the figures contained in them,
the diagram facing page 24 has been j^repared, and to it accordingly attention is invited.
The sickness is expressed in monthly rates per thousand of strength on the left side of the
jalate and the mortality on the right; but the scales have been so proportioned that the sick
rate may be read as well on the right by appending a cipher to the printed numbers. The
narrow red line represents the sick rate among the white troops of the army, the broader line
the death rate, wliile the yellow lines indicate the correlated figures for the colored troojjs.
Oloi
b
CJt
c
o
5 CJl
b
01
C i OT 1 O
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ui o oi
to t>;
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b
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02
o
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i
Ally.
Sep
Od.
Nov.
Dec.
Jail
Feb.
Mar.
Apr.
Afar
June
1
i
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hdy
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Sep.
Oct..
.Vov.
Ilec.
Jon.
Feb.
Mar.
Apr
May
June
-
r 1 , :
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1 1
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k,
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Mar
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July
Aiii/.
Sep.
Oct.
Nov.
Dec.
Jan.
Feb.
Mar.
Apr
Miiy
8
1
r ; 1
1
1
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llUI
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m
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July
Aliq.
Sep
Oct.
Nov.
Dec.
■Jan.
feh.
Mar
Apr
May
Jwu
1
^
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- 1 ; 1 1
1
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id.
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r
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1
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■vy.
July
Aug.
Sep.
Oct.
Nov.
Dec.
Jan.
Feb.
Mar
Apr.
May
i
;
1
T
- ;■ -, -j
1
1
i 1
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i
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far
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1
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1
1
1 ol'-'i'- '1
— -"1 C) ^"1 "
o
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to to
9\'-
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to
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to
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01
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^
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'5
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amoxg t5ik t'. s. forces.
Table YIT.
21
Monthly ratio of Skhiess per 1,000 of nuan strem/th umoiuj the White Troops, C. S. Aniu/, by regionn,
for the period from June SO, 1S61, to June 30, 1SG6.
Vkak exi'Im;—
Kegion.
>
c
b:
i
o
i
>
O
s
9
June3n,18fi2
Atlantic
385
157
370
389
193
2il7
346
200
306
239
263
215
250
268
326
197
285
283
270
172
275
2.17
303
230
271
240
263
181
~251
Central
315
154
Total
324
3li4
257
June 30,1863
311
245
186
235
220
256
238
Central - . . ...
"14
I^'ific . . ...
159
Total
2T9
228
244
268
161
2:15
164
238
178
234
222
175
197
192
186
176
169
190
151
143
158
Central
Pncifio
217
257
226
235
230
145
194
212
195
150
172
189
160
154
Atlautio
269
258
132
260
276
263
143
168
Central
174
Pacifii*
144
265
214
253
160
230
201
172
171
Juii^3l), litK
199
232
149
227
246
166
ffi3
224
183
177
IRi
154
150
Centnil ....
144
Pacific
149
Total
215
233
232
219
177
147
V.
348
128
2:»
222
256
172
238
148
1,1..
153
138
140
113
151
137
1
3
:
2
^
=
X
:••
S
<:
184
167
206
253
261
294
205
194
141
203
195
245
181
180
149
236
240
210
146
152
169
158
165
160
162
113
1,-M
140
146
153
144
124
134
96
113
- — . t
123 I 123
169
142
164
141
179
159
142
154
136
168
138
136
176
183
149
137
141
lye
209
226
192
154
179
147
190
134
174
170
183
162
187 I
--I
239 ;
"iss'i
219 I
181
291
181
213
237
178
206
227
124
218
181
190
166
188
170
155
185
207 I
224
146
199 I
178
188
151
184
183
194
155
191
212
146
Table VIII.
Monthly ratio of cases of Sickness per 1,000 of mean strenf/th amowj the Colored Troops, by regions,
for the period from June SO, 1863, to June 30, 1S66.
1 »
Vkak KNidNi:—
REfilON.
iS
a
«
^
i
a
c
<
517
w
569
403
%
'A
294
S
>
<
y.
a:
<
s
1
1
>
1?
-
June 30. Ism
-Mhiiilic
292
fVntra!
4-M
441
410
430
3B8
342
333
:tOl
3lA
Ti'tul
:;j;
M ■
J.'il
422
361
333
309
283
328
■ n-
KT
341
Aihinrl.'
Jnoe30. ]8e.>
p
Cfntml . - -
Total
351
359
328
287
.'.>2
311
224
216
267 1
271
262
Juii»* 3(1 iHt;fi
Al!;.i,i;.-
i.".rt
231
264
asi
1 -
1
152
161
122
92
1.'.4
i 215
Central- ... -..
:ii 1
30U
298
282
2T5
2te
lei
.<«
158
137
141
145
.27
i-M
157
237
1 ="
Total
22
SICKNESS AND MORTALITY
Table IX.
Monthly ratio of Deaths from disease j^er J ,000 of mean strength among the White Troops, U. 8. Army,
by regions, for the period from June 30, 1861, to June 30, 1866.
Ykar ending—
Region.
<
i
§
O
>
o
-A
i
i
n
i
2
<
"-3
i
<
a.
I
X
<
<
><
<
o
P
a
§2
1.93
.97
1.33
2.04
2.82
.89
.1.78
3.49
1.26
2.01
4.55
1.21
2.66
6.20
1.60
3.23
6.58
1.00
2.90
8.84
.19
2.40
8.82
.41
2.52
10.24
.88
3.12
6.37
.49
2.85
7.18
.51
3.00
6.42
.77
2.67
6.76
.88
Total
1.49
2.15
2.21
2.82
3.79
4.2r
4.52
4.11
4.79
4.58
4.93
1.44
.5. 17
.70
4.61
1.65
4.79
1.03
4.11
a 47
7.07
.76
5.27
June 30. 1863
3.80
6.63
.72
.5.19
5.55
.55
4.06
5.36
.56
4.52
5.60
.79
4.76
7.48
1.02
4.69
8.00
.81
3.88
8.09
.49
3.08
9.67
1.02
2.74
9.35
.32
2.04
7.09
1.15
Centi-al .
Pacific
4.96
5.25
4. .58
5.01
6.09
6.21
5.93
6.39
6.11
4.76
3.52
3.56
a 45
6.67
.33
2.74
7.53
.65
2.63
5.84
.63
3.02
4.18
.94
2.51
4.06
1.00
2.46
a50
1.28
3.03
3.94
1.25
2.63
4. 25
1.28
a 51
5.51
1.01
2.95
4.98
1.08
1.87
3.92
.71
2.93
4.41
.81
2.73
4.87
.93
Central
Pacific
Total
4.97
5.60
4.51
3.71
3.44
3.10
3.58
3.61
4.71
4.13
3.12
3.82
4.02
5.54
G.8S
.65
6.75
6. 10
.65
5.16
6.05
.53
5.76
5.35
1.08
3.87
3.96
.58
4.90
4.41
1.41
3.80
5.00
.88
3.51
4.75
1.30
4.38
5.89
1.11
3.33
.5. 04
1.63
3.08
3.48
1.17
3.95
3.28
.91
4.44
5.06
.99
Ceutral
Pacific .".
Total
6.17
6.25
5 58
5.46
3.86
4.57
4.41
4.11
5.11
4.15
a 24
1.05
1.06
.77
3.53
4.71
a 52
4.01
1.13
JuneaO, 1866
Atlflntir
5.06
5.07
.98
3.62
4.72
.99
4.26
5.42
1.39
4.42
4.46
1.09
3.05
3.44
1.98
1.84
2.66
1.49
1.24
1.79
.93
1.06
1.38
1.11
1.84
1.66
.83
1.14
1.31
.95
.90
.82
.70
Pacific
Total
4.92
4.10
4.62
4.07
3.07
a. 15
1.43
1.22
1.54
1.19
.99
.82
a 51
T.-VELE X.
Monthly ratio of Deaths from sickness per 1,000 of mean strength among the Colored Troops, by regions,
for the period from June 30, 1803, to June 30, 1866.
Year ending—
Region.
"-a
H
QQ
-<
s
t
w
O
S
>
O
<
•A
i-s
a:
b;
X
<
S
X
<
a
< «
¥
6.90
22.44
2.22
29.19
4.58
31. 40
7.40
31.02
7.08
32.63
4,48
16.84
7.31
15.40
7. .54
18.48
9.03
20.24
9.41
22. 16
6. 33
25.52
5.77
21.38
5.77
20. 75
Central
Total .
24.15
25.31
7.38
18.50
14.79
24.91
8.89
16. 87
14.14
8.59
7. (Ill
25.06
8.62
ia'39
ia22
iai2
15.09
16.41
18.07
19.25
16.54
15.40
17.60
Jiine:tO, 18H5
8.60
20. 7U
16.71
6.67
10. 01
6.76
10.93
9.08
15.24
11.73
12.14
10.35
12. 11
11.45
7.45
8.07
8.36
10.33
11.23
10.70
13.31
9.01
10.04
9.23
12.99
11.66
8.30
7.72
7.82
Total
11.63
12. 09
7. 9l»
8.81
9.33
5.18
7.26
b. 96
12.77
8. 16
6.74
6.91
11.99
6.73
6.62
9.55
4.64
7.57
10.89
Atlantic
11.11
!i. r.ii
7.24
7.15
11. II-..'
4.21
a 00
2.91
a 51
Total
...-,
"■"'
6.63
7.97
6.99
a 18
a 41
AMONG THE U. S. FORCES. 23
The largest monthly ratio of cases among the white troops occurred in August, 1S61,
shortly after the enlargement of the army to meet the military necessities of the time.
This ratio amounted to 364 cases per thousand of strength. The exposures, fatigues, altered
diet and other changes in the conditions afl'ecting the men incident to their new mode of
life as soldiers, coincided at this time with the period of greatest annual prevalence of
malarial disease, and the large amount of sickness indicated by this ratio was the result.
A reference to the diagram showing the prevalence of diarrhoea and dysentery* will mani-
fest the great influence that this class of camp diseases exercised on the general sick rate of
the array at this time. Their extensive prevalence in the Atlantic and Central regions, in
which most of the troops were massed, contributed much to the height of the general sick
wave as shown' on the diagram under present consideration, or more especially on Table
VII, which it illustrates.
The irregular prominence of the line in April, July and October, 1862, appears due
to excess of diarrhoeal cases, — in the Central region during the first-mentioned month, and in
the Atlantic region during the others. As diarrhoea, dysentery and the malarial fevers
occasioned more than one-half of all the cases of disease, 507 of every thousand cases^ that
were reported from the white commands, the concurrence of their periods of maximum
prevalence gives prominence in the autumnal months of subsequent years to the line
indicating the prevalence of disease in general. But in none of these years did the
monthly ratio at all app>roach the height reached during the autumn of the year 1861 : thus
the highest ratio recorded in 1862 was that of July, 279, while August, in the three follow-
ing years, gave the highest monthly rates, respectively 256, 265 and 233 per thousand of
strength.
The minimum as well as the maximum of prevalence in the year ending June 30,
1862, was higher than in the subsequent years. This is attributable mainly to the
frequency of diseases of the respiratory organs and to diarrhoeas, which continued to affect
tlie troops in the Central region, and but little to the malarial influence which in this year,
as will be seen hereafter.^ was at its minimum. The minima of the several years were as
follows: 195 in March of 1862, 179 in May of 1863, and 137, 144 and 123 respectively
in February of the three following years.
Speaking generally, the amount of sickness among the white troops was much less in
the last year than in the first, the average monthly rate of the latter, 249, being greater
than the highest monthly rate of the former, 233 per thousand. A glance at the diagram
will, however, show these variations in the level of the rates more satisfactorily than a
lengthened description. It may be added that the narrow red line, the subject of the fore-
going remarks, corresponds closely in its course with that indicating the prevalence of
disease among the white troops in the Atlantic region. The rates of the Central region,
when plotted diagrammatically, give a line which runs parallel to the red line but on a
somewhat hicrher level. The rates of the Pacific region, wlien delineated in this manner,
occupy a lower level, and fail to manifest in their irregularities the existence of the marked
autumnal elevations which form so striking a feature of the lines for the other regions.
The mortality from all diseases among the wliito troops, represented on the diagram
by the thicker red line, increased from a low rate during the first month to its maximum,
6.39, in February, 1863. After this it fell during March and April to 3.5 in May and
- - _ — . _ _
* Facing pa*fe 22 of the Second Part of this work. t See Table II, supra. X See diagram facing page 90, infra.
24 SICKNESS AND MORTALITY.
June. The line is very irregular in the remainder of its course; but in each of the subse-
quent years there may be distinguished a large autumnal and a smaller spring elevation,
the latter usually occurring during the month of March. Tlie plate facing page 20 affords
a satisfactory explanation of most of these irregularities in the level of the mortality line.
The sudden rise in the rate during the autumn of 1861 was due almost wholly to typhoid
fever, but in November and December of that year and January, 1862, pneumonia and the
eruptive fe\-ers aided considerably in its elevation. The mortality from typhoid fever
continued to augment and uphold the general death rate, although the former allies of this
disease declined in virulence as the spring advanced. Meanwhile diarrhoea, and a little
later the malarial fevers, began to contribute materially to the rate. During the period
from November, 1862, to March, 1863, when the monthly death rate amounted to about 6
per thousand of strength, all the diseases delineated formed notable percentages of the total.
In the subsequent years the autumnal increase corresponded with larger rates from diarrhoea,
typhoid and malarial fevers, while the smaller prominences in the spring months were
caused by a maximum rate among the pneumonic cases and eruptive fevers, with a large
minimum rate among the diarrhoeal diseases and typhoid fever.
But to return to the diagram on the opposite page: The sick rate of the colored troops,
indicated by the thin yellow line, was highest immediately after their enrollment in 1863,
when nearly one-half of the command was reported as having been taken sick during each
of the months July, August and September. Autumnal exacerbations were encountered
dui'ing each of the subsequent years; but on the whole the health of these troops improved
so remarkably that during the last quarter of the year ending June 30, 1866, tlieir sick
rates were somewhat lower than those of the white troops.
Their death rates, indicated b}^ the heavier yellow line, followed a generallv parallel
course — high at first, about 25 per thousand of strength monthlv during the first four munths
of service, and afterwards declining to the minimum of 3.18 per thousand in Mav, 1866;
but at no period of their service did the death rate of these troops fall Itrdow that of the
white commands.
Discharges on account of disability froji disease. — The sick and mortality rates
by no means express the whole of the loss to the armv occasioned, by disease. Large
numbers of men were discharged as unfit for military service on account of disease that in
a majority of instances originated in the line of duty.
The records of the Adjutant General's Office are understood to embrace certificates of
disabilitv on which 275,738 white soldiers of the regular and volunteer armv were dis-
charged, but the Surgeon General's Office has reports of only 215,312 sflch cases. Of these.
48,374 were based on wounds, accidents and injuries; 4,439 on deformities, immaturity
and senility, disabilities which existed prior to enlistment; and 25,915 on causes that were
not specified. Dropping these, there remain 136,584 certificates in which the disease is
stated. But if the cases in which the disease was not stated and those reported to the
Adjutant General, but not to the Surgeon General of the Army, were distributed pro rata
among the discharges occasioned by wounds, by conditions which should have prevented
enlistment, and by disease, the number referred to the last cause would be increased to
198,849, equal to an annual loss of 82.2 men in every thousand of sti-ength.
Tlie files of the Adjutant Generals Office include certificates pertaining to 9,807
colored men, while those in the Surgeon General's Oflice number only 8,223; and of these
s
iiile
AMONG THK U. S. FORCES. 25
1,479 are based on wounrls, 687 on causes which should have rejected the recruit, and
1,226 on unspecified causes. Dropping these, there remain 4,831 certificates iu which the
disease is specified. But if these figures were treatcil as in tlie case of the white troops,
the number of discharges due to disease would be augmented to 6,771. erpud to an annual
h)ss of 35.3 men in every thousand of strength.
These heavy losses were not wholly due to the diseases incident to military service.
Many of the disabilities existed prior to enlistment; for instance, not all of the men dis-
charged for consumption contracted the disease in the service, nor did all of those discharged
for hernia become ruptured in the performance of military duty. Ignorance, carelessness
and intentional iVaud at the recruiting depots were at first responsible for the enrollment
of this worse than valueless material; afterwards liberal bounties induced men to conceal
infirmities in order to secure acceptance. In garrison or winter quarters their disabilities
were in many instances not manifested; but when exposed to the hardships of a campaign
they swelled the sick list, crowded the hospitals, andvvere eventually discharged. L)r.
Tripi.er reported that of 3,939 discharges for disability from the Army of the Potomac
during the last quarter of the year 1861, 2,881 were for disabilities tliat existed at the
time the men were enlisted.* . Medical officers serving in the field had their duties
materially increased by the presence of cases of this character. Some adverted to the fact
apparently to explain the large number of discharges reported from their commands; others
entered a vigorous protest against the gross negligence of the recruiting authorities. A few
extracts are herewith submitted, and as these are by no means exceptional cases, it will I
appreciated that a considerable percentage of the disabilities were not fairlv attribut
to the service of the soldier :
I con.sidpi- the careful iiispeetiou of the voluuteers before acceptance a matter of the greatest importance.
The great uuniUer of discharges for disqualifying defects among the three-months men that have come under my own
notice, convinces me either that the men were not inspected at all, or else that the duty must have been performed
by inexperienced ofiicers. The incumbrance and dead weight of the men of this description with our columns has
been a serious and con.stantly accumulating impediment to its motions. — Surgi'on Chaules S. Triplek, U. S. Armti,
Mi (lira} Dhictoi; Department of Pennsijlruniu, Charhstown, T'a., Jul;) 18, 18GI.
The number of men discharged from service within the last month or two is very large, owing chiefly to the
fact that a great many were .sent here without undergoing a proper physi<'al exaniinatiim al the time of their enlist-
ment. For example, some thirty or forty cases of hernia have lieen sent away, and in ahuost every instance the
disability existed previous to enlistment. I observe, al.so, that a large number of boys may be found among llie
troops who are [diysiially incajiable of enduring the hardships of a soldier's life in tlie fii-ld. — S'kiv/toh .1. M.Crvi.EH,
r. S. Army, Medical llireclor, Portress Monroe, 1'a., August 3, 1861.
In regard to the condition of the companies, they are, with one or two e.v.ic pliuns, conii)osed chielly of men
who hold respectable positions at home as farmers, nu>chanic.s, &c., and who possess some degree of pride concerning
cleanliness and )ir(ii)er behavior. It is to be regretted, however, that in the haste of preparation and departure,
i|uite a number were enlisted whose physical conilition was such that they ought to have lieen rejected. A large
pri>)iortion were examined in the country towns by ]diysicians not regularly ap])oiuted, and .some were not examined
at all. This may liel]) to account for the fact that, while the number of sick in the hospital is not very great, the
list of those in quarters is larger than it should be, — Axuixlnnl .Surgeon J. Foster II.wex, .jr., i'. .S". I'uh., Camp
l-ml.r, roolesrillr. Mil., September 'SO, 1801.
The 28th Pennsylvania ^■olunteers, numbering ten companies, left Philadeliihia July 26, 18til, with orders to
proceed to Harper's Ferry. They had never been regularly examined by .1 surgeon, and a number of disea.sed men
had been enrolled. These have constantly nuide the sick list larger than it otherwise would have been. Eleven
of these men have been discharged, and certificates of disability made out for fifteen others. — Surgeon H. F.ahnest
(iKoi.MAX, 28(/i Pa. 1'oh., Xorrniber 14,18G1.
I joined the regiment after it was mustered into service and found over one hundred enlisted men that should
have been rejected by the Meilical Inspector before their enlistment. As a cousei|Uenre of this I have been com-
pelled to recommend a large number of nu-n for discharge on certificate of disability. There yet remain a few cases
that I doubt not before long will be decided unfit for the duties of a soldier. — Surgeon \Vm. K. Thkai.i., 27(/( Ohio
Foh., December 31, 1861.
* See patfe 47. Ai>i>eii<lix Iu the First Fart of tliis work.
Mei>. Hist. Pt. Ill— 1
2g SICKNESS AND MORTALITY
A. BRADLEY, jr., U. S. A., Cami> Dupoul, Va., December 31, 1861.
''n";r!rofirst ™"2n;:;rr:»^^ ...» .... or . *..». .—.■«... «■«' <-• •-
require no formal expression. ,„ti,oritie8 of vour State be iuvite.l to tl.is matter, aavising that
„e.ic^^^i:S^t t::::^TTZ:'^^X:rZ a .««. in t.e ...ce o. tUe meaiea. o.cer ot the
^^^"^:;z.i";:rr:::r;:c;^I'itS-ionof tueei,utrec^^^^^ .
Z^ e ana tistnia in ano of Ion. etan.in.. . -^f ---^-tl ' es'a "^ .tS Zt^
.ernia!- 5. Mo.^meut of right ^<>^^- l^^^'^^'^l^Z ^T^: ^^^^^^^n^''^^^^^^
siae. 6. Total blinaness of right eye ^-^^^^fj^^Zi general configuratiou iauperfeet. To ,he«. are aaaea
8. Syphilis ana pulmonary trouble; chest baa Ij f"™^';"'' ^'°^^,_^^i„„ ^ 1. Louis Loeb, the butcher, who
the iL nu-n aisapprovea, but retainea tor the ^^^^ ^^^^^^^^^, f,ou. au oUl ana severe injury of the
is too fat ana heavy for a Soulier; 1^- *-* -<\' f;/;^;"*^^^ f " "^"Lt motion of the left elbow, resulting frou. a
2^:;^Uu!:-"rs:^irn:tse^^^^
commanding 1st BrUjadc Xno Jersey Vols., near Alexan,h;u, T a.
of every IhoBswul discharges for disease. Typhoid a„d mala, al 1, ^« •'■''*■■ £^.u,^^(^j
„„, i.^; fo» d-scbarges; Urt ,l,e disaU.Uy „. a ^^^ ^^;,:'J^j^'X^«.
aad the 2,224 dropsical me,, was „u doubt due to tl,e»o u.mb.ho iS*"""-
heart d,sease.d,ich together caused scarcely o,,e deatl, 1- —^ ^ f ™= '.
auuually, coutributed largely ,„ dimm.shiug J" *;'-^,^- It ^i^^uut of
having constituted 8b. 2 and the lattei ,i.^oie\eiy
o
disease
^e relations between death and discharge, as the result of disease, n.ay be ascer-
ihe lelations De w eonnection with that now under consid-
tained by an examination ot tables li and lii ui co
.ration. The white troops lost, annually by death Irom disease 5..4S, ^1- -'-- P
143.4 in every thousand men; but these rates, while correctly expressing the tacts ot
AMONG THR V. S. FORCES.
Table XL
27
Discharges for Disabiliiy from Disease in the United States Arm i/ from May i, ISGI^io June. 30, 1860^
with ratio per IfiOO of mean strength in Field, Gaii^lson, and General Hospitals , ratio per J flOO
of total discharges and niean annual ratio per 1,000 of sirengUu
Specifietl diseases ouly . .
Typhoid Fever
Mularial Fevers
Diarrbuea and Dysentery
Eruptive Fevers
Debility
Syphilis
Rheumatism
Drtii»S3'
CuDSumptiou .
Scrofula
Epilepsy
Instioity
Piimlysis
Ophthalmia
Deafness
Heart disea^se
Varicose Veins
Varicocele
Asthma .,
Bruiichitis
Intlainmatiiiii ut' Lungs . . .
Inrtummatiou uf Pleura. . .
Hsemorrhage from Lung's
Hernia
TnHammation of Liver
Pil.-s
InOammation of Kidneys .
Anehyli'sis
Diseases of Spine
White Titoors.
198, 849
336, 584
2«),
8 = 2
8t
991.7
1.9
1.8
:!7. 1
.9
:ti.o
.1.8
Sf). 1
4.7
4:i.fi
i.n
C.3
1.7
(i. 1
;i. 1
SJ. 7
4.2
3.0
a.fi
8.0
2.3
1. I
1.3
19.9
a. 9
3.3
2.3
3.9
3. '.'.
■I I
B.7
fi.2
127.3
3.1
10i;.2
l:t.o
8C.2
1C.3
149.4
6.fi
28.3
CO
20.8
10.7
8.5
77.9
14.4
10.2
8.9
27.3
8.0
3.6
4.11
65.9
9.9
11.4
7.8
13. .-.
82.2
0OI.ORK11
TliOOl-S.
i
g§
ii,
•o
fM
It
s °
5-s'i-
■~S
-% ?
= s.
•5 QJ
C!«-=
.= £■3
is
s
'A
0,771
IS
K
1 . HOO.
10.1. 9
4,831
. 'C
.35
7.19
.18
5.99
.74
4.87
.92
8.43
.37
1.60
.34
1.17
.60
.48
4. 4U
..'1
.57
.50
1.54
.45
.20
.26
3.72
.56
. >il
.44
.■;fi
In
30
.5
3.59
3
:•. 6
540
8.4
86
1.3
874
13.7
109
1.7
592
9.3
147
2.3
174
IJ.7
34
.5
69
1. 1
25
.4
3H
.6
u;i
2.5
69
I. 1
25
.4
42
.7
96
1.5
25
.4
18
.3
4
.1
:i58
.5.6
29
.4
1,1
27
105
;u
46 I
.4
1.6
.5
.7
l>. 2
74.3
.G
111.8
17.8
1KU.9
22.6
122.5
30.4
:i6. 1)
7.0
14.3
5.2
7.9
33. 3
14.3
5.2
8.7
19.9
5.2
3.7
74. 1
6.0
8.9
.5.6
21.7
6.4
. 05
.16
1.87
.02
2.82
.45
4. .50
..57
3. 09
.91
.18
.36
.13
.20
.84
.36
.13
.50
.13
.09
.112
1.87
.13
.22
.14
.55
.16
-•,'4
official records, do not convey with accuracy tlie relations of death to disease. In view of
I he iuniil)er of men discharged for diarrhoea and dysentery it is evident that the mortality
rates for these intestinal affections would have been greatly increased had the undoubtedly
Z8 SICKNESS AND MORTALITY AMONG THE V. S. FORCES.
serious cases that led to tlie issue of these certificates been followed up to their termination.
In view also of the disjiroportiou between the discharges from the white and the colored
commands, the mortality from disease, as above expressed, requires modification. Among
the former 82.2, among the latter only 35.3 men were discharged annually from everv
thousand present. No doubt many of these went liome to die. If it be assumed that
more deaths occurred among tlie 82.2 discharged'white men than among the 35.3 colored
men, the difference between the mortality rates of the two will be lessened. But even if
the whole number of cases in each instance died ultimately of the disease which occasioned
the disability, the greater mortality among the colored troops would still be evident, for the
sum of the deaths and discharges among them numbers 178.7 annually per thousand of
strength as against 135.68 among the white troops.
The infrequency of discharge among the colored troops may be attributed chiefly to
their jieculiar condition at that disturbed period of their history, and to the more rapidly
fatal course Avliich disease certainly ran when these men became its subjects. While 7.19
whites were annually discharged on account of diarrhoea and dysentery, 5.99 on account of
debility and 8.43 on account of consumption from every thousand- men, in the hoj^e that
the change of climate, scene and surroundings consequent on a return to their northern
homes Avould tend to prolong existence, the corresponding figures for the colored troops
were onlv 1.87, 2.82 and 3.09. The cases represented by the difference between these
figures were retained in hospital until the occurrence of ths fatal event, in some instances
because of the imminence of that event, in others because of the homeless condition of the
colored soldier.
Transfers to the veteran reserve corps. — The list of men discharged for disa-
bility would liave been considerably larger but for the establishment of thi^ Veteran
Reserve Corps. This command absorbed a large number of men who would otherwise
have been discharged. From certain tables appended to a report of Surgeon J. H. Baxter,
U. S. Volunteers, Chief Medical Officer, Provost Marshal General's Bureau, dated April
28, 18G4, it is found that among officers the principal disabling cause was wounds received
ill Ijattle. Of 636 officers transferred, 426, or two-thirds of the whole number, were the
subjects of gunshot wounds which prevented their participation in active or field service.
Among the enlisted men, however, disablement by disease was more extensive than by
wounds. Of a total of 25,031 transferred in 1863, 6,067, or 242.3 per thousand, were
occasioned bv gunshot wounds, and 2,037, or 81.4 per thousand, by injuries mainly also,
perhaps, caused by gunshot. Deducting these cases from the total it is found that 16,927
were transferred on account of disease. Chronic diarrhoea and general debility were thf
chief causes of disablement in these cases, the former havina; occasioned the transfer of
2,292 men, or 135.4 per thousand of the total from disease, and the latter 1,916, or.115.0
per tliousand. Consumption, whicli figured so largely in discharges, was found iii (Hil^y
217 of the transfers, or in 12.8 per thousand of those for disease. But disease ol' the
heart, rlieumatism and hernia contributed as largely to the constitution of tlie Tn\'alid
Corps as to the list of discharges. Heart disease occasioned 1,735 transfers, or 102.5 per
thousand of the total from disease, rheumatism 1,363, and lumbago 427, a total of 1,790
cases, or 105.7 per thousand, and hernia 1,017, or 60.1 per thousand.
I .1
29
n.— MEDICAL STATISTICS OF THE CONFEDEUATE ARMIES.
The sources ot" the Httlo inloriiiatinii we posisess coiK-crning the i>rev:ilence and fatuhty
of disease in the Confederate armies have ah-eady been noted in connection witli the subject
of diarrhoea and dysentery.* They consist of the monthly returns of sick and wounded of
tlie Army of the I'otomac for the nine montlis from July, 1861, to ^larch, 1862, the re]>orts
of certain general hosjiitals in Virginia for the four months, September to December, 1862,
the original registers of the Chimborazo Hospitiil, Richmond, Va., extending from October
17, 1861, to March 31, 1865, and the figures published l)y Pr. JosKPH Jones, of New
Orleans, La., as compiled from the records of the Surgeon General of the Confederate
States Army.
The Returns of the Army of the Potomac give 151,237 as the nmnlier taken sick
and wounded during the nine months in an average strength of 49,394 men. The cases
of sickness numbered 148,149, equivalent to three entries per man, 3,019 per thousand,
during the nine months, or to four entries per man, 4,025 per thousand, for the year. The
United States Army of the Potomac during the same nine months had 2,136 cases per
thousand of strength, equivalent to an annual rate of 2,848 cases. The deaths on the
Confederate returns number 2,016, but they arc given only as the total number that
occurred among the sick and wounded; their distribution among the specified diseases and
wounds is not known.
The hospital reports shovu 48,544 admissions, of which 34,890 were for specified
diseases; but the deaths, 1,899, are not distributed.
The registers of the Cliimborazo Hospital, Richmond, Va.,t which have been carefully
examined and freed from duplication of cases originating in transfers from ward to ward,
show a total of 77,889 admissions; 14,661 of these are recorded under the headings of
Class V of the U. S. sick reports, comprising wounds, accidents and injuries, 12,057 have
no entry in the column of diagnosis, 50 are reported as malingerers and 771 as conva-
lescents, without specification of the disease or injury. There remain 50,350 cases of
specified sickness, but the result in 26,501 of these cases is unknown, as 14,464 were
transferred to other hospitals, 5,537 were furloughed, while in 6,500 no disposition is
recorded. Of tlie cases with known results, 23,849 in number, 19,457 were returned to
duty, and to these may be added 998 terminated by desertion; 2,717 died and 677 were
discharged. The mortality was therefore 11.39 per cent., equivalent to one death in every
8.8 terminated cases. An abstract of the cases in this hospital is given on the following
[.age.
Some interesting data bearing on the mortality of disease in general, and of some
specified diseases, may be gathered from the various publications of Dr. Joseph Jones. J
* PaR^afi, Part .Second of this work.
t Rrfi'rence was made in a foot-note on pape 28 of the .Second Part of this work lo a partial statement of tlie statistics of ttiis hospital liy r»r.
J(»Krn JONty {Richmond and Louisville Mai. Jour., June, 1870. p. (i50), and reiustms were assigned for preferring to tliein tlie more complete statistics
oimpiled from the ho.spital registers. Another |>artial statement of the statistics of this hospital w:is published by .S. K. IIabkI{8HA.^I— Ob.^. on Vie
statistic* of Chimborazo Hospital, with remarks upon the treatment of rarioii.-; diseases during the recent ciril war. — Xashcille Jour, of Med. and
Surg., N. .S., Vol. I. l&W,, p, 41t> — but Dr. H.\uei!Sfl.\.M's tabic covers only the periiKl from Octolier. 18t;l. to November. 186;J. while the registers include
the facts np to March 31. 186.'>. The former foots up only 3G.8-1T admissions for all diseases, with 2.96:1 deaths, while the latter give 77,889 ea.M-s and
3.'.M4 deaths.
t JONKS — Obserrations on the losses of the Confederate armies from ttattU, tC-c. — Richmond and Louisville Med. Jour., Oct*>ber and N'oveiiiber,
1869, and March and June. 1870. Essay on tlie prevalence of Pneumonia and Typhoid Fever in the Con feAerate. forces, and on The diseases of the Federal
prisoners confined at Andersonville, published iu the Medical Volmne of the Memoirs of the United States Sanitary Commission, New Vork, 18(i7. Flteu-
mania in the Confederate Army, in Vol. I of bis Medical and Suryical Memoirs, New (Orleans, 1876.
30
SICKNESS AND MORTALITY
Table XII.
All Abstract of the cases of Specified Diseases, with recorded terminations, and of the Deaths among such
cases at the Chimborazo Hospital, Richmond, Va.
Specified Diseases.
Cos
= ? «
■Si %
go c3
■= s-a
Conlinneri Fevers
Malarial Fevers
Eruptive Fevers
Diarrhiea and Dysentery.
Debility and Anemia
Consumption
Rheumatism
Scurvy
Bronchitis and Catarrh
rneurnonia and Pleurisy. .
Otlier specified di.seases. ..
2,15a
1,988
760
4,644
5,780
189
1,!)84
119
1,099
1,568
3,565
885
125
166
455
117
52
80
8
89
583
157
41.11
6.29
21.84
9.80
2.02
27.51
4.03
0.72
8.10
37.18
4.40
325.7
46.0
61.1
167.5
43.1
19.1
29.4
2.9
32.8
214.6
OT.8
Total specified diseases 23,849
11.39
1,000
He states tliat the reports of sick and wounded filed in the Office of the Surgeon General
of the C. S. A., exclusive of those from the Trans-Mississippi department, gave the follow-
ing figures up to December 31, 1862:
On Field Eeturss.
On hospital Reports.
Total
Deaths.
Cases.
Deaths.
Cases.
Deaths.
848, .555
29,569
16,220
1,623
441, 689
47,724
19,359
2,618
35, 579
4,341
Gunshot wounds
818, 986
14,597
393,965
16,741
31,:a8
Dr. Jones has, however, pointed out that, on account of the repeated transfers of
patients from one ho.^pital to another, the number of cases shown by the hospital reports
as admitted for treatment bears no ascertainable relation to the actual number of patients
admitted from the field. This will readily be acknowledged, in view of the fact that
while a total of only 108,068 cases were sent from the field to general hospitals, no less
than 441,689 cases were reported as admitted on the hospital registers.
But since the system of reports in the Confederate army was similar to that employed
in our own service, and since the hospital cases in both services were derived from'" similar
sources, consisting of those from the field, those originating in the liospital population, and
an indefinite number from men and commands on detached or special duties, the number
of cases borne on the field reports of each service may be compared with the corresponding
number of deaths in field and hospital, with the view of contrasting the relative mortality
from disease in the two armies. In accordance with Dr. Jones' figures, 31,338* deaths in
* These numbers should probably be 31,238 and 819,286; see the totals in Table XIII of th"! text. Dr. JONES' statistics are full of inaccnracies,
the result apparently of careless preparation and proof-reading.
AMONG THE CONFEDERATE TROOPS.
51
s coiislifiitini; 2 Der
field and hospital corresponded with 818,986 cases oi' disease and injury other than gunshot
wounds. The deaths constituted 3.82 per cent, of the cases, or in other words, were to the
cases as 1 : 26. In recasting our statistics''" to coni'onn to the classification addph.'d liy i)r.
JoNKS in his statenient tabulated above, it is i'ound that from the coniiuencenuMil ni the
war to December 31, 1862, the total number taken on siek rejiort for all causes except
giuishot wounds was 1,709,416 cases, of which 31,326 died, llie death.'
cent, of the cases, or being to them in the proportion of 1 : 50.
The following table contrasts the ratios calculated from J)r. Jones' figures with those
obtained from the statistics of our army for the same jieriod:
Table XIII.
A Comparison of ihe Prevalence and FataUty of Dheasc in the Opposinr/ Armies from the Commencemetit
of the War to December .?/, /Sf]?.
Continued Fevers
Malarial Fevers
Eruptive Fevere
Diarrhcea and Dysentery
Pulmonary affections . ..
Rheumatism
All other diseases
Total diseases and injuries exclusive only of gun-
shot wounds.
Confederate Fohckb.
36,746
115,415
44,438
226,888
42,204
29,334
324, 321
819,286
12,225
1,333
2,274
3,354
7,972
4,080
■5 -'■■a
45
141
.M
277
51
36
396
1,000
eg
391
43
73
107
255
131
1,000
ft
33.27
1.15
5.12
1.48
18.89
U. S. FOKCES.
3.81
51,923
274,053
38,888
482, 764
196, 567
88, 475
.Wfi, 746
, 7ii'i, III
11, .571
2, 603
2,050
6,040
4, 607
122
7,333
34,326
.So ■
30
160
23
283
115
52
337
1,000
337
76
00
176
131
3
214
1,000
22.88
.95
5.27
1. 2.i
2.34
.14
1.32
2.01
It is greatly to be regretted that Dr. Jones has not published the mean strength for
the period corresponding to his sick reports. He has given, it is true, the mean strength
represented by the field reports of the Confederate Army for each month of 1862 and for
the first six months of 1863,f but as no mean strength for 1861 is tabulated, and as there
is no way of ascertaining what portion of the figures given in his text belongs to that year
and what portion to 1862, it is impossible to compute trustworthy ratios of cases to strength
for either year.J Nevertheless, by making use of the sick report of the Confederate Army
* Published in Tables III, XXIV and XLVII, Part First of this work. t Richmond and Louisville Medical Journal, Vol. VIII, 1869, p. 351.
; Nor can any assistance be obtained in this connection from an inlerestinp article published orif^iimlly in the Xcw York Tribune, and subsc«iuently
reprinted m Xhe Hislnrical Magazinr ' VusUrrolU of Ihe Confederate Army for WW, 18fi3aKrf 1864. The Uislnrical >laga:ine atid Notes ami Queries con-
cerning Ihe Aniiiittilies. llislo-, nnd Iliography of America. Morrisania, .New York, Vol. II, N. S.. 1867, page 1(13. Mr. llENIiY B. DAWSON, Iho editor ol
this magazine, invt'- ..n- attention of Ihe Surgeon General to the article cited, as likely to prove useful in eonneclion with the data collected by Dr. .JoNEb.
I"nf.— ,-iy ine statements in this lu-ticle referring to Ihe year 1861 are too fragmentary to be used in computing ratios. Indeed tliey could not be safely
so \ised were they as complete as the figures for 1862, contained in the same article. This will be readily understood on comparing the strengths reported
for 1862 with those given by Dr. JoNi:..;, Thus, the article in question contains a table jnirporting to give "approximately and in nnuid munbers Ihe
strength and disposition of the different t'onfederate armies at several irn]virtaTit periods during the war." Two of these periods fall withici Ihe year IMlia.
The first, for .July 2(1, 1862, does not include the Trans-Mississippi department, and gives the total strength of the "Armies of East and West" at 289,0011
pivsent, of whom 217.0(.)() are reported " ftir duty," Now the tat)le of Dr. JoNKti, referred to at the commencement of this note, which als<) does not include
Ihe Trans-Mississippi department, gives the " mean strength, officers and men," for July, 1862, at 79,999, The second period for which the total strength of
Ihe "Armies of East and West" are given in Ihe Ilislorical Magazine is Septemljer, 1862; this includes the Trans-Mississippi deparhnent. Deducting
the force reported for that department there still remains, according to the magazine article, a force of 228,000 present, of whom rj.'i.lXtU are reported for
duly. But Dr, Jo.VKS gives (he "mean sln-ngtli, officers and men, ' for September, 18(;2, at 12,5.408. Nor does this eiii>rmous rliscrepancy indicate any
unfailliliilness on the part of eitluT anihority. The magazine writer altemiited to give a correct notion of the whole Confedenite force ; Dr, JONES neccs.
sarily intended only to give Ihe actual mean sirenglh of that part of the Confederate force represented by the sick reports to which ho had access. Ratios
computed fnim Ihe eases and deallis derived from the latter, and the strengths derived from the former source, would understate the sickness and mortality
of the Confederate armies to an indefinite extent.
32
SICKNESS AND MORTALITY
of the Potomac, preserved by Dv Williams, and of certain figures puLlished by Dr. Jones,*
it is possible to calculate sick rates for a part of the Confederate forces during certain periods .
prior to July, 1863, the aggregate monthly strength represented being 123,257 men. In
Table XIV the information gathered concerning these forces is presented and calculated into
ratios pi'r thousand strength, wliirh an- placed for comparison in juxtaposition with the rates
furnished by the white troops of the United States Army during the year 1863.
Table XIV.
CdfiOi of Sickneas and Wounds reported from certain of the Confederate Armies during portions of the
years ISlJl. 1862 and lS6o, tvifh the strength present during the periods covered bij the statistics,
and the calculated annual rates per thoasand of strength, in ju.vtaposition ivith the correspjonding
rates of the United States Arrny for the year ending June 30, 1863_^.
X
6 ^n
» >*
oT
i-B
i S 1
S2S
is =
Srf
> ^
ll
<
^(?;
S2 ■
ss
s -
1-d-?
Sg
c jj.
S-x
g s
l«
.?§2
*s
^s
"cS '1
- <
li
s
til
lb
g<:2
««5
o
-a
li
a) COD
O - Q
cSbO
6
r
ho
S S =
« >* H
^ o '^
< ta
3 a K
'^ y- e*
<
Q
o
n
<:
<
<
9
19
19
12
10
Confeder-
ate Army.
U.S.
Army.
49, 394
25,732
6, 7.^2
40,282
15, 582
123, 257
15] , 237
157, 113
^
58, 453
226, 721
53, 198
646, 722
4,563
159 (o)
2,861
93
4,404
2,768
10, 197
«
10, 197
275
123('0
Malarial Kevers
16, 781
41, .536
13,940
36, 665
3,876
112, 788
796
460
Diarihcea and Dysentery
M, 572
'
987
T>-a{l)
Pneumonia
3,233
2,220
l,l(il-
6, 974
1,0.14
14, 622
103
34
734
231
445
373
135
43
1, 1158
821
211
101
2,683
971
19
7
17
10
Laryngitis ,
Phthisis .
315
1,312
19,455
184
1,428
18, 8ti2
191
408
3,500
902
8,')8
11, 575
85
514
5, 408
1,677
4,520
58,800
12
32
415'
9
30.
192
AtMite BnincIiitisaiHK'atarrh.incliuliiipcHsesiepinted as epidemic
373
251
1,953
176
111
1,189
855
290
4,732
235
36
1,518
1,639
688
9, 392
Ifi
7
90
16
6
76
Artite Rheumiitisni
2,047
854
.5, 195
1,0^0
1
9,136
87
76
(a) See the text tor the derivation i>f this rate.
(fc) To effect an allowable ennipiirisnn between the Union and Confederate fij^nres indicatinfj; pievalenee, this annual rate is based on
the Union .\rniy of the Votoinac for the nine nnmths, July, IStil, to March, 1862, inclusive.
The imperfection of the data here presented is obvious; only in the figure
Confederate Army of the Potomac are the cases of disease separated from those of
received in l.iattle. But as tlie gunshot casualties in tliis army during the nine
covered by the records do not fairly represent tlie frequency ot these injuries,
derived from them cannot with propriety be applied to tlie consolidated figures t
the reports i>f
s of the
wouinls
months
the rate
"rom the
*See pages 571-589 of the Medical Volume of the U. S. Sanitary Commission Memoirs, New York, 1867.
AJIONG THE CONFEDERATE TROOPS. 33
other departments. Fortunately, Dr. Jones has put on record figures which show the rela-
tion of gunshot wounds to cases ot" disease in the greater part of the Confederate forces
during the first year and a half of the war. The total number of cases of wounds and
tlisease reported hy him was 848,555, of gunshot wounds 29,569. These figures authorize
the statement that the tabulated annual rate of disease and wounds, 4,563 per thousand
strength, included about 159 injuries received in battle. The annual rate for disease alone
is thus seen to have been 4,404, which may be compared with the corresponding rate of
2,768 among the Union forces. Continued and malarial fevers, diarrhoea and dysentery,
bronchitis and pneumonia, were apparently the chief causes of the increased rate among
the southern troops. An expression of the mortality rate per thousand of strength cannot
be directly obtained from the data presented. But since the sick rate has been found to
number 1,404 cases annually [ler thousand of .strength, while the fatality rate was 3.8 per
cent., the annual munber ol deaths per thou.'-and strength must luwe been 167.3, a rate
larger even than the average annual mortality among oui- coloi-ed ti'oops. I'^xception may
be taken to this calculation as the sick and fatality rates used are derived from different
sources, but it serves to indicate in a general way the greater relative mortality among the
smaller number of combatants on the southern side.
In brief, so far as coiujiarison can be made with the statistics at command, disease was
nut only more fatal among the Confederate forces, but the number of cases, in proportion
to the strength present was considerably greater among them than among the United States
t roops.
in.— PREVALENCE AND MORTALITY OF DISEASE AMONG THE ONION TROOPS IN
CONFEDERATE PRISONS.
The fragmentary character of the evidence relating to the diseases of the Federal
lirisdner^ in the hands <•{' the Confederates has already been indicated.* The statistics at
command are derived from the original registers of the hospitals attached to the Anderson-
ville and Danville prisons and certain tables prepared by Dr. Joseph Jones from official
records, and publislu'd in ins article nn the diseases o[' the Andersonville prisoners."}" The
records ol' the Atljulaiil (Teneral's ( )fliee, U. S. Army, according to a communication from
that office dat.ed June 22, 187i^, includi' the: cases of 30,564 Federal soldiers who died
whili.' prisoners o( war.
The Andersonville register. e.Ktending from February 21, 18()4, to April 17, 1865,
inclusive, shows the number uf admissions tVom the stockaded prison to have been 17,875,
but as 45cS ot these are re[iorted as having been cases of wounds and injuries, and 1,430
have iiu diagnosis entered against their names, the cases of specified diseases number only
15.'.)>S/. The result in V)46 of these cases is not recorded, so that the number of cases of
specified disease that may be traced to their termination is reduced to 15,(141. Of these
1 1.(1S6 died, or 73.7 per cent, of the whole number. This enormous mortality is an index
*.See jWMje 31. .Seoniid Part of this wcik.
i Ther^ are also in the Otlii;o of the Adjutant Gnneral a list of ] 4"..* deaths that oi-eiiri-ed amuii^ j«irk and woun'Ied prisonerB at Cahawba, Ala., atid ttvo
hospital rejriKtei^;, one from Hospital Xo. 13, and the other from ji ward of Hospital No. "21, Kiehtnond. \'a. But Wwsp. registers are valueless for statistical
puriHtses, as so many of the i^iitients received were speedily sent elsewhere; and in the ease of the register of Hospital No. 21, the disjtoshion of so many
of the eases is unrecorded. The register of Hospital No. 13 extends fnnu June 2, 1863, to February 14, ISti-l. and contains a record of tiS.") admissions
disposed of by tninsfer in tii] eases, by death in (i7, and by desertion, etc., in 7 cases. The register of Hospital ','1 extends from November, 1663, to
F*ebniarj-. 18fi.'i. f>f 1,3."»8 admissions it is not stated what became of the patients in jt»8 instances: 23(1 were transferred, 2i6 paroled. 173 retunied to
•lUarten* and 3 detailetl ; one is siiid to have ewaped and 217 to have died.
Mf.p. Hi.st. I't. III—.-.
34
SICKNESS AND MORTALITY
of the condition to which tlie unfortunate men became reduced before they were admitted
to this so called hospital. The professional mind is shocked in endeavoring to realize the
scenes presented in an establishment the wards of which formed the ])ortals of the grave to
three out of every four soldiers who had the misfortune to enter them. Indeed, it appears
that large numbers died uncared for in the prison and were removed to hospital simply for
record and interment. Sometimes the deaths in the prison outnumbered those in the hos-
pital. The reports for the week ending September 20, 1864, show the occurrence of 336
deaths in the former and 334 in the latter establishment. At this particular time one-half
of the fatal cases were already terminated when taken up on the hospital register. The
average number of deaths that occurred daily during the occupation of the depot was
thirty; but as many as a hundred deaths were recorded in a single day. Certainly the
most fatal field of the war was that enclosed within the stockade at Andersonville, Georgia.
Ratios calculated from the hospital register have a melancholy interest as indicating
the manner in which these men were cut down in the flower of their manhood. They
have no bearing on the fatality of the specified diseases as the number of those sick within
the stockade is not known; but the information yielded concerning the relative prevalence
of certain grave diseases is as definite as if complete records of the sickness were at com-
mand. The accompanying table gives a summary of the facts gathered from the register:
Table XV.
Summarizing the Records of the Hospital at' Camp Sumter, Andersonville, Georgia.
All diseases and injuries.
Wounds and injuries .
Not specified
Specified diseases .
Continued Fevers
Malarial Fevers
Eruptive Fevers
Diarrliwa and Dysentery .
Dobility
Dropsy
Consumption
Khenmatism
Scurvy
BronchHis
Pneumonia and Pleurisy .
Other diseases
Total specified diseases 15, 987
458
1,430
15, 987
883
254
lli4
', 35-1
333
498
35
202
i, 6fia
205
.553
446
47
8
941!
376
3i;
19
30
377
4
64
S3
946
~ CO
'Eg
•3 '2
16, 874
4U
1,422
15,041
281
241
162
6,976
897
479
35
173
5,S85
201
489
423
15, 041
12,541
163
1,292
241
163
82
5,605
193
3B3
26
83
3,614
141
322
234
11,086
11^
17.
15.
10.
4.19.
20.1
31.;
12.1
3.54. 1
12.1
34.1
27.!
S3 ^ -^
t: t; ■«
.2" E $
21.7
14.7
7.4
505. 6
17.3
34.5
2.3
7.5
336. n
13.7
29.0
21.0
li
73.7
1,000
85.8
67.6
50.6
80.3
64.6
80.0
74.3
48.2
68.4
70. 1
65.8
55. 3
73.7
Diarrhoea and dysentery caused somewhat less than one-half, and scurvy somewhat
more than one-third of the total number of cases. Under these two headings were entered
AMOiS'G UNIOK TROOPS IN lOKl-KDEK.\rE PRISONS.
35
814.1 of every thousand cases, leaving only 185.9 cases in the thousand tor distribution
among all other diseases. These cases also occasioned the greater part of the mortality.
Diarrhoea and dysentery caused 505.6 and scurvy 326.0 deaths in every thousand deaths from
all diseases, leaving only 168.4 in the thousand for distribution among other fatal diseases.
l>r. .foNKS has fortunately j)r('served a monthly return of the cases and deaths in the
t^tockade and hospital for the si.x; months from March 1 to August 31, 1864, giving also
the mean monthly stiengih dui-ing the j)eriod.* From this paper annual rates of sickness
and mortality per thousand of strength ma}' be calculated. Some idea of the relative
prevalence of specified diseases and of the mortality caused by them may likewise be
obtained from the information thus preserved. In the following table the facts gathered
from the paper in question are so arranged as to admit of comparison with the analogous
facts from the records of our troops in the field, the Confederate forces and other bodies of
men already submitted in Tables II, III, IV, XIII and XIV.
T.Vl^LE XVI.
Giring a (jeneral view of the Sick and Death Rates from prominent disecises and classes of diseases anwng
the Federal prisoners at AndersonviUc for the period extending from March 1 to August 31, 186 i.
Average present 19,j^53 prisoners.
'
c
1
*
1
1:5
11
Anriuul rates of deaths
per 1,00() strength.
il
■s- «
iij
(- = •3
Hi
nil
11
1
42,686
7,718
4,388.6
792.8
1
238
■174
21
.565
24.4
48.8
9.2
sao
Not si>etn(it*(l
; Specifiwl diseases
■1 , '.'74
T.V!
a,!(66
236
16,772
955
1,556
114
iJ66
9,501
2,eo«
97!)
7,126
4,315.4
732.6
1,000
i.noo
17.2
■
199
11''
til
4, .>2!(
170
319
33
20
999
90
266
302
77.4
■mr-,.
1,724.4
98.9
160.0
11.8
89.0
976.8
988.6
100.6
4.59. 4
90.5
12.2
8.2
465.6
17.5
39.8
3.4
2.0
102.8
9.9
27.4
31.0
17.9
70.7
5.6
399.6
22. 8
37.1
2.7
9a6
996.4
66.9
93.3
106.4
27.9
16.7
11.2
635.6
23.9
44.8
• 4.6
2.8
140.2
19.6
37.3
42.4
26.4
4.0
3a9
27.0
17.8
20.5
28.9
2.3
las
a2
27. a
6.8
Debility .
Dropsv ...
I
Consumption
Rheumatism
Scurvy
Pneumonia and Pleurisy _
4, :■: ;
7, I'JN
■1. :il5. 4
732.6
1,000
1,000
17.9
The annual sick rate per thousand ot* prisoners was 4:,o6t:>.5, or nearly double that oF
our white troops. Nevertheless, it was not so high as the rate which, according to Table
* Memoirt «/" VniUd StaUs Saniuxry CtnnmUtion, p. 5-34. Dr. JOXES. «;>. cit., \\. 5fi7, speetfies the strength fur each nf the six months and gives
the average >trengih iis "^1,120 men. There is an error either in the items nr in ihe rulculate*! average. ISut as the items art- expressed by the same
numbers in another part of his article, p. 502, it seems probable that the error is in the oaleiilation, the correct strenKlh for the six moDtfas being 19.453.
36 SIOKNE!<S ANJI MORTALITY
XIV, prevailed in certain purtioiis (if the L'ont'ederate forces. Tliis demoiistrates merely
that the methods adopted in reporting sick men in the Confederate ranks was not observed
m the case of the Andersonvdle prisoners. The number of sick was certainly vastly in
excess of the number of recorded cases. AVhen Dr. Jonks inspected the stockade in Sep-
tember, 18(34, he found two thousand sick exclusive of those admitted into the prison
hospital, and as there was but one medical officer to attend to this enormous number of
patients/'' and to the cases brought dady to his iK^ice among the mass uf the prisoners, the
impossibility of preserving an accurate record of the cases is manifest. Large numbei's of
the prisoners who had never been entered on the sick list were sufi'ering from severe and
incurable diarrlujea, dysentery and scurvy, f^lighter ailments, such as dictated the relief
of a soldier on active service from military duty and his entry on sick re[)ort, were of
necessity unnoticed. Hence the annual ratio of sick per thousand persons present, and
the ratio of deaths to cases, as represented in the table, are certainly far from accurate,
and are not admissible for comparison with the records of the Confederate troops on active
service. Nevertheless Dr. Jones instituted the comparison and concluded that the diseases
referable to exposure without jn'oper clothing and shelter were as prevalent among the
Confederate troops as among the Federal prisoners. The following by Dr. J. C. B.\TEs,
who was on duty at the prisun hospital from April 22, LS64, to March 26, 1865, is of
interest in this connection:
"I it-fjit-t to say tliat the sTiiiplj' of wood was uot sufficieut to keep the prisouers from what we term freezing
to death. They would not, perhaps, actually freeze to death, hut a patient wliose lilood is thin, and hi.s system worn
down, is very susceptible to the intlueuce of cold. In the aliseuce uf sufWcieut food, sutticieut stimulus, and especially
in the absence of fuel, numy of the patients (I speak now of what I saw in my own ward) would, duriu;; the iiiglit,
become so chilled that in the morning, passing round, I would remark to my steward, ' Last night did the work for
(hat poor fellow — he will die:' or 'This one will die; I cannot resuscitate him with the means iu my hands, his s.vs-
tem is so reduced.' Lying upon the ground during tho.se chilly nights (the weather was not freezing, but sufficient
to thoroughly chill the whole system), the jiatient would reach a conditiiui in which resuscitation was a matter of
iuLpossibility after he commenced going down hill from this (exposure. I have seen a number die in that way." —
]\iport OH tin: Trail incut «/' I'rimmrx of fViir hij thi- llihrl Juthoritiis, 2d St-n/i., iOth ('oiiij., p. IIX.
The Hgures expressing the relations of individual diseases to the total cases of specified
diseases are modihed by the exclusion of the inanv cases of slight ailments which were
unnoted, and by the errors iu diagnosis consequent on the disposition of so many cases by
one medical officer. On September 18, 1864, y(J6 new cases were reported as taken on
sick rejiort; but as none were so reported on the two following days, it may be assumed
that these three days were spent in the transfer of the men in question to the sick report.
Ten hours daily of uninterrupted labor on the part of the medical officer would have
afforded about two minutes for the diagnosis and treatment of each case; but this officer
was not at liberty to allow so much time to the new cases, for the 1,1U2 cases carried
forward from the previous day claimed some share of his attention. Naturally, under such
conditions, the diagnosis and management of a. majority of the cases devolved upon the
intelligence (jf the probably unskilled men who, having gi\'en their parole, were granted
the freedom of the post and tilled subordinate offices in its domestic economy.
Overlooking the influeiice of inaccurate diagnosis, the annual death rate tabulated
may be accepted as a close approximation to the actual mortality. In this consists the
chief value of the extracts made li\' Dr. Jo^'KS from the records. During the six months
7,712 deaths occurred in the average strength of 19,453 prisoners present, equaling an
* "Al till!, time uuly uii« tneiiital ofticer was in atlfmlaDct', wliereas at least twenty iiitUital ullicers should liHvi.- been einliloyed."'— JO.NliS, op. cit., i«. JlL'.
AMONC, UNION TROOPS IN OONFKDEUATK PRISONS. A,
annual rate of 792.8 por thou.sainl, or tlh' I'Xtiuftion ul' ili.' whole I9,45;> in about litU'cii
months. By comparing thost- colnnms ol' Tahlfs X\' an<l X\'I wliu-li iriv.' ixprcssinn 1r.
th<' total nunilier ot deaths, it will he found that tln' nioitalitv was much i;rcat('i- iluiinu
tht^ first six months than dtn-im^ the last eight months, 7.712 deaths haviuif heen recorded
during the former ]>eriod. which number was increased (k Imt 12,")41 by ihc addiliou o|'
those tiiat occurreil later. This might indicate that ilisea<e became less prevalent or less
fatal as time progressed, or that the number of men in confinement became consideral)ly
reduced. In the absence of a knowledge of the strength present this point cannot be
.settled: but it is of interest to observe that while the greater number of the specified
diseases |iarticipated in this diminished mortalitv thei-e was one verv marked exception.
Tlius: deaths from continued fevers, numbering 199 in ihe first six months. l)ecarae
increased to 2-H during the whole period, an addition of only 42 fatal cases for the last
eight months, ^falarial fevers, numbering 119. boM^imi- correspondingly increased by 44.
Onlv 2 deaths tVom the eruptive fevers occurred in the last eight months, as against 80 in
tl arlier period. l)iarrh(ea and dysentery ended fatally in 4.529 cases during the first
six months, and in 5, 605 cases during the whole period, an addition of only 1.07<) deaths
for the last I'ight months. And so of most of the diseases specified. But scurvy, which
occasioned 999 deaths in the first period, had bv the end of the second period increased
the number of its victims to 3,614 bv an addition of 2,01.3 cases.
The aggravation of the scorbutic element, as time progressed, is manifested by these
figures. Of the 7.712 deaths that took place in the first jieriod, diarrluea and dysentery
caused 4.529, or fi36 of every thousand, and scurvy 999, or 140 of every thou.sand. Of
the 4.S29 deaths that occurred during the second period, diarrhrea and dysentery caused
1.07(). or 223 in every thousand, while scurvy caused 2,(U3, or 541 in i/very tli<iusand.
At first more than one4ialf of the victims tell before the causes of diarrhoea and dysentery,
but later scurvy assumed the" role of chief (-xecutioner. Together thev occasioned more
than three-fourtiis of the total mortalitv.
Dr. .Ii«\ES says: Tlif effect of scurvy was manifest iiii every liainl, ami in all its variiins stages, fioni the
nuiildy (lalf riini]ilexion. pale uunis. feelile. languid, iiiiiscular motions, lowness of spirits, ami fetid lireatli, to the
dusky, dirty. leaden complexion. sw<dleu features, sponj^y, purple, liviil. fungoid, bleeding gums, loose teeth, o'de-
niatous liiulis. covered with liviil vihices and petechia-, spasmodically llexed. ]>aiuful and hardened extremities,
sjionlaneoiis li.emorrliages from mucous lauirls, and large, ill-conditioue(t, spreading nlceis covered with a dark
piirpUsli fungons growth.
Ill souM- of the cases of .scurvy the parotid glands were greatly swollen, and iu some instances to such an
extent as to preclude entirely the power of articulation. In several cases of dropsy of the abdomen and lower
extremities supervening n|ion .siurvy. the patients affirmed that previous to the a])pearauce of the dropsy they had
sntlered with jirofuse and obstinate diarrlxea: and that when this was checked by a change of diet from Indian-corn
bread, cooked with the husk, to rice, the <lro))sy appeared. The .severe pains and livid patches were freiiuentlv
associated with swellings in various parts, ami I'specially in the lower extremities, accompanied with stiffness ami
contractions of the knee-joints and ankles, and often with a brawny feel of the parts, as if lymph had lieeu effused
between the integuments and aponeurosis. |)reventiug the motiiui of the skin <iver the swollen parts. • » •
The scorbutic ulcers iiresented a ilark. ]iur))le. fungoid. I'levated surface, with livid, swollen edges, and exuded
a thin, fetid, sanimis tiuid instead of ])us. Many ulcers which originated from the scorbutic' condition of the system
a)ipeared to liecome truly gangn-nous. a.ssuming all the characteristics of hospital gangrene.
Frinu ihi- crowdi'd condition, lilthy habits, bad diet. dejecte<l and depres.sed condition of the prisoners, their
systems had becoiue so disordered that Ihe smallest abrasii>n of the skin, from the rubbing of a shoe, or from the
effects of the li«t sun. <ir frtmi the prick of a sjdinter. or fr»uu scratching a mosipiito's bite, in some cases took on a
rapid and frightful nlceralion and gaugreue.
Dr. JoNfJs was surprised at the comparative absence of typhoid and typhus fevers,
notwithstanding the prevalence of the conditions that are suppo.sed to -produce them, and
attributes this to the immunity derived from a previous attack, or to an insusceptibility
<3»
38 SICKNESS AND MORTALITY
resulting from continued exposure. According to the records continued fevers constituted
only 17.9 of every thousand cases. They were thus comparatively rare, but this arose
from the increased prevalence of diarrhoeal and scorbutic cases rather than from the actual
infrequency of typhoid. An annual rate of 77.4 cases of the continued fevers per thousand
of strength was recorded; and, as has been already shown, the figures representing the
prevalence of disease within the stockade greatly understate the facts. This rate is con-
siderably higher than the average annual rate among our white or colored troops ; although,
as might be expected, it falls below that shown on Table XIV, as prevailing in the camps
of the Federal and Confederate Armies of the Potomac when typhoid was epidemic in
many of the new regiments. Continued fevers caused 26.4 deaths annually in every
thousand prisoners, as compared with 11.6 deaths among our white troops.
Malarial fevers were infrequent among the prisoners; but as their percentage of fatal
cases was much larger than among the United States or Confederate troops, 4 per cent, as
against 1.15 and .95 respectively,* it is probable that numbers of intermittent and remittent
attacks were not recoi'ded.f
The other diseases specified were presumably of more common occurrence among the
prisoners than among our troops in active service; certainly they were more fatal.
Bronchitis, which in the field gave an annual death rate of .49 per thousand of
strength, caused a rate of 9.2 among the prisoners, while the corresponding rates for inflanr-
mation of the lungs and pleura were 6.3 and 27.4.
This extensive prevalence and terrible fatality of disease among the Andersonville
prisoners creates no surprise when the unsanitary conditions aflfecting them are taken into
consideration. These were officially investigated by Dr. Jones, and are fully developed in
the report of tlie Committee of the House of Representatives on the treatment of prisoners
of war by the rebel authorities during the War of the Rebellion. J
The Andersonville stockade and prison hospital were established on a naturally healthy
site in the highlands of Sumter County, Ga. The former enclosed twenty-seven acres,
consisting of the northern and southern exposures of two rising grounds, between which lay
some swampy bottom and a stream running from west to east. In August, 1864, nearly
33,000 prisoners, were crowded together on this area, wliich afforded but little more than
35 square feet for each. But even this limited space was not wholly available, as six acres
of the bottom land had by this time become unfit for occupation. Each prisoner had there-
fore scarcely 28 square feet of surface on which to conduct all the operations of nature.
The Confederate guard occupied the fortified exterior of tlie stockade.
No shelter from the sun, wind or rain, the dews of night or the frosts of winter, was
furnished by the Confederate government. Fresh arrivals of prisoners were driven into the
stockade and left to find so many feet of foul surface for their occupancy among the army
of ragged, vermin-covered, emaciated and dying men already there. The pines and other
small trees that had originally sparsely covered the enclosure had been cut down. Frag-
ments of tent-canvas, blankets, oil-cloth and clothing were stretched upon sticks as a
protection from the hot sun. Some of the men burrowed in the ground and others built
huts of the mud removed from these burrows.
The sinks were built over the lower portion of the stream, but the volume and flow of
the water was insufficient to carry off the excreta. Heavy rainfalls causing the stream to
* See Table XIII sM^ra p. ,31. t See in/ra, note *, page 109.
ISeport Nt>. 4.'), IJousf of Rfprfsmtaiivfs, 3d Sfss., 40th Conr/ress, fVnvernment Printing Otfire. Washington, D. C, 1869.
AMONG UNION TROOPS IN CONFEDERATE PRISONS. 39
overflow spread the foul accumulations over the adjoining bottom lands, converting them
into a quagmire of fermenting filth the stench from which has been represented as horrible,
sickening and indescribable. Speaking of the stream as it issued from the stockade, Jones
says :
As tliesf wati'is, UiuiIimI witli tillli :uh1 liiuiian fXiTi'incnt , How slnj;^islily tlHciiij;li I lie swani]) liclinv, filled with
trees and reeds routed with a tiltliy deposit, they emit an iiitoleialde and most sickeninfj; stench. Standing as I did
over these waters in the middle of a hot day in Septemlier, as they rolled slugf^ishly forth from the stockade, after
having received the filth and excrement of twenty thousand men, the stench was disgusting and overpowering: and
if it was surpassed in unpleasantness by anything, it was only in the disgusting appearance of the filthy, almost
stagnant, waters UM)ving slowly between the stum))s and roots and fallen trunks of trees aud thick branches of reeds,
with inuunu-rable long-tailed, large white maggots, sw dlen peas, and termenting excrement, and fragments of
bread and meat .
But the pollution of the soil was not confined to the bottom-lands. Many of the men
were so prostrated by diarrhoea and scurvy that they were unable to reach the low-grounds
on every call of nature, and the general surface of the enclosure became covered with their
morbid dejections. Tlie ground was honey-combed with small pits a foot or two in depth,
which were used as latrines and emitted an intolerable stench. Later, the tattered clothes
of these men became the receptacle for their involuntary discharges; and ultimately the
foul and wasted forms were carried out for burial. In the vicious atmosphere of this
prison-pen myriads of flies and mosquitoes were developed, which would have made life a
misery even to healthy men.
There is one form of disease which is almost too horrible to l)e witnessed, yet we cannot understand the wretch-
edness rf the prison without looking upon it. This is not a solitary case, but we shall find numerous ones before we
leave this living charnel-house. We instinctively pause as we reach the awful sight before us, holding our breath
lest we inhale the terrible stench that arises from it. Here is a living being who has become so exhausted froiu
exposure that he is unable to rise from the ground, suffering from diarrhoea in its last form. He is covered with his
own fteces: the vermin crawl and riot upon his flesh, tuml)ling undisturbed into his eyes and ears and open mouth;
the worms are feeding beneath his skiu, burying themselves where his limbs, swollen with scurvy, have burst open
in running sores: they have even found their way into his intestines and form a living, writhing mass within him.
His case has been represented to the surgeons, but they have pronounced him incurable, and he is left here in his
misery, in which he will linger for three or four days more.*
But all the sick in the stockade were not left thus to die when their strength had
failed them. The 1 ,292 fatal cases in which no diagnosis was made may be supposed to
represent those exceptional cases in which the medical officers on duty became first aware
of the sickness by a knowledge of the death. It will be observed that such exceptions
constituted one-tenth of the total mortality.")"
In fact, an eflPort was made to aggregate the sick of the stockade, nearly 2,000 in
number at the period of Jones' visit, in four long sheds open on all sides and situated at
the north end of the enclosure. Here the haggard, helpless, hopeless miserables lay side
by side on the boards or upon such ragged and vermin-covered blankets as they possessed,
witliout bedding — without even straw — while foul emanations and swarms of flies consti-
tuted their atmosphere.
The Confederate Congress in May, 1861, passed a bill providing that the rations
furnished to prisoners of war should be the same in quantity and qnlity as those issued
to the enlisted men in the Army of the Confederacy. The daily ration per man officially
consisted of one pound of beef or three-quarters of a pound of bacon, and one and one-
* Op. cit,. last note, page 40.
t It appears that Andereonville, Ga., was not the only prisun iii which the sick were left to die in quarters without the care or knowledge of the
surgeon. A letter to this olfiee from the Adjutant General's Office, dated June 2:2, 1878, states that for the month of December, 1864, alone, the Confed-
erate " burial rei»ort" at Salisbury, N. C, shows that out of 1,115 deaths, 223 or 20 per cent, died in prison quarters and were not accounted for in the
report of the surgeon.
40 SICKNESS AND MORTALITY
quarter pounds of corn-meal, with an occasional issue of beans, rice, raolasses and vinegar.
Although this may have been the issue at first, there is no doubt that it was diminished at a
later period. Isaiah H. White, chief surgeon of the prison, in a re|iort dated August 6,
1864, speaks thus of the diet of the prisoners :
The ration consists of one-third pound of bacon and one and a quarter pounds of meal. The meal is unbolted,
and when baked the bread is coarse and irritating, producing diseases of the organs of the digestive system [diar
rhoea and dysentery]. The absence of vegetable diet has produced scurvy to an alarming extent, especially among
the old prisoners.
It is also well established that this miserable diet was generally not onlv of an inferior
but of a dangerous quality.. The beef was often tainted, the bacon decomposing, and tlie
meal musty, innutritions and irritant, the cob having been ground up with the grains.
Moreover, the ration was frequently issued to the prisoners imperfectly cooked. Nearly
three months after the establishment of the prison the surgeon in charge reported to the
commanding officer that —
The bakery and other culinary arrangements have just been completed, up to which time there had been an
inadequate supply of cooking utensils, and in consequence thereof the articles of 4liet have been insntticiently cooked.
Frequently the food was issued in the raw state. Those of the prisoners who had
the strength and energy to cook their allowance, lacked the necessary fuel and kitchen
utensils, while many were incapable of the effort had all the facilities been afltirded. The
issue had, therefore, to be devoured in this condition, if tlie pangs of hunger were acute
and the individual had not as yet reached the stage of apathy that preceded deatli. Many
also were incapable of eating the ration even if properly cooked, on account of tlie condi-
tion of their teeth and gums. Lieutenant-Colonel D. T. Chandler, Assistant Adjutant
and Inspector General, in his report of an inspection of the prison on August 5, 1864, says
of the rations and their preparation:
The sanitary condition of the prisoners is as wretched as can be, the principal cause of mortality being scurvy
and chronic diarrhcea, the percentage of the former being disproportionately large among those brought from Belle
Isle. Nothing seems to have been done, and but little if any effort made, to arrest it by procuring proper food. The
ration is k pound of bacon and If pounds of unbolted corn-meal, with beef at rare intervals, and occasionally rice.
When to be obtained — very seldom — a small quantity of molasses is substituted for the meat ration. A little weak
vinegar, unfit for use, has sometimes been issued. The arrangements for cooking and baking have been wholly
inadequate, and though additions are now being completed, it will still be impossible to cook for the whole number
of jirisoners. Raw rations have to be issued to a very large proportion, who are entirely unprovideil with proper
utensils, and furnished so limited a supply of fuel they are compelled to dig with their haiuis in the filthy marsh
before mentioned for roots, &e.
But as this monotonous diet, inferior in equality, insufficient m quantity, and having
its intrinsic harmful properties aggravated by the absence of facilities for its proper prepa-
ration was undoubtedly the cause of the diarrhcea, scurvy and starvation, which killed
three-fourths of the prisoners who were buried at Andersonville, and contributed largely
to the fatal event in the remainder of the cases, all details concerning it have a high
etiological value. The following is therefore submitted from the Report of the Committee
of the House of Representatives, already cited:
The rations consisted of corn-meal, bacon, fresh beef, peas, rice, salt and sorghum molasses. The corn-meal
was unbolted, some of it ground with the cob, and often filled with sand and gravel. Much of it had apparently
Ijeen put up while warm, and had become sour and musty either during transportation or while in store. The liacon
was lean, yellow, very salt and maggoty; it had been brought to us unpacked, and was covered with dirt and
cinders; it was so soft with rust that it could easily be pulled in pieces with the fingers. The beef was slaughtered
near the prison, to which it was brought and thrown down in a pile in the north cook-house, where it lay until it
was issued to the prisoners. Here, in the hot climate, it was soon infested with ilies and maggots, and rapidly
changed into a greenish color, emitting an oft'ensive odor peculiar to decaying flesh; it was very lean, but the heat
AMOXtl UXIOX TROOPS IN COXFKDKRATE PRISONS. 41
i-endeieil it (|uite tciiiler beloie it was si'ive<l ii]). The article ilenoniiiiated lilu(^k peas, or cow-peas, was bioiiglit in
sacks, apparently Just as it liad left the ihieshing groniiil ol' tlii' |ii'oiliicer. haviiijr never heeii winnoweil or cleansed
of the line pmls or ilirt which natiuallv mingles with all le^nniinons plants while ^jrowins; in the lielil: hesiiles, they
weri' filled with lmj;s, and many of them were so eaten as to leave nolliini; Iml 1 he thick, loii;rh sUin of the ))ea in
its natural shape. The rice was sonr or mnsty, and had :i|i|i,nciit ly I n |ml up in :i hull' ilricd stale, when il liecame
healed anil wholly nntitted for nsi.
'I'here wel'i* two cook-houses used in eoniu'ction with the prison. The lirst of these was in process of erection
« hen the detachment to whic h I helonged entered the pen. and went into opi-ration ahont the middle of .May. II
was located on the north side of and near the swamp west id' the prison, anil was Kiilisei|neiitly enclosed hy the
defeii.sive stockades. Al the time it was hnilt il was supposed to he of sullicicnt capacity to perform all the cooUin;;
necessary for the jirisoiiors, and contained three laijje lirick ovens, and .several kettles sel in hriek-work, for holling
the meat and peas or rice: hut il lieiiij; found inadeiiiiatc to sni>ply the wants of ihe men. aiiolhcr linildin<; was
constructed .some time in the latter Jiart of August. 1 1 w;is local cil iilioiii :i hi mil led \ aids iioi lli of 1 he defences, on
a line with the west wall of the prison. This was desif;iieil and iisi-d exclusively for lioiliii;; ihc peas and the moat,
and contained perhaps a do/en larye ]iotasli kettles set in hrick-work. The old cook-house was thereafter used for
liakiii;; the corn-meal. A stron-; foice of paroled piisoueis was ap]>ointed to perform I he work in these look-houses,
lil'.t with constant lahor was iinahle In siqiply our wants, and ahoiit one-half of Ihc rations were issued riiw.
The meal was |)iepared for hakin<; hy lirst pourin;; it in iinautity into a lar-ie trough made for the (uirpose. A
little salt was then added, when water euoiij;h was giimred in to make it of the proper consistency, and the whole
stiried with sticks to mix il thoroiifjlily. The doiij;h was hakeil in slieel-irou jians twenty-four hy sixiceii inches
in surface and I wo and one-half inches deep. The whole was divided into )iones i'ontainin<j; alioiil a |iounil. and each
of these poucs constituted a day's ration of hread for one iiiuii. lln- iiliiiost cleanliness could iml In- iiliscr\ .d in
luixing this "slutf:" the meal, as ahove stated, was partl.v <oiii and )iailly coli,and often contained materials ihal
were neither of these: the water was <lipi)ed in i|nantity from the creek, and no means of cleaiisinjj it were furnished;
and these, with the haste lu-ecssary to he made in inep.iriiii; the doii!;h, conspired to make the mixluie unpahitable
and sickeiiiu;;, particularly when cold. The prisoners \\\\t< had charge of the cook-house undoiiliicdly tried to prtv
paie the food as well as they could, hut all of their etforts were in \ aiii wilh sui-li limited facilities as they had.
Ihe peas and rice were hidlcd in the north cook-lionse: they wcii' turned from the liai;s as they were brought
to the prison, without cleansing or .separating from the chatf and dirt, into the large giotash kettles lonlaiuiug the
water in which the meal had been boiled: the cooks here, as in the south cook-hou.se, had no means of cleansing the
raw material, and had they posses.sed the faiilities they had no lime to devote to the purpose. 'I'o winnow, semi-
weekly, a sntfieieiit amount of peas for lli.OdO rations, allowing a third of a i>int to each, ref|uires a long time even
with the aid of the best machines: hut for twenty men to jiick over by hand this vast amount is simply impossible.
Of these cooked rations there were daily issued lo each ]iiisoner about a pound of bread, a fourth of a ])Oiind of
bacon, or four or six oiinees of beef (including the hone) in )ilacc of the bacon, and ;i Icaspoonfiil of salt ; twice a
week a pint of peas or rice were issued iii addilion. and occasionally a coii|ilc of tahles]ioonfnl8 of .sorghum molasses.
Sometimes a sort of mnsli was made to lake the place of the pone, but. although il was a change from the monoto-
nous corn-bread, it w:is so un])alatable that Ihe bread was preferred. About half of the rations were issued raw;
one-half of the jirisoners rei'eiving raw food one day :ind cooked the next. 1 have here given the iiuantily
issued during t he early part of the season : but as the hot weather advanced and tin- number conlliicil here increa.sed,
the daily allowance diminished until it heeaiue but a mere morsel to each iiuiii. ' '
Sometime in the afternoon the ration-wagoii drove into the stockaih' laden with corn-meal, haooii and salt,
which were thrown down into a heap in an open sjiace about midway the emlosiire. It was a horrible sight to wit-
nesa the haggard crowd gathered about this ]irecioiis Jiile, while Ihe commissary su))erinlcnded its division among
the squad sergi-auts: ga/ing, meauwhih'. with wolfish eyes upon the little heaji as it diminished, or following their
sergeanl-commissary back lo his iiuarteis, as famishi'd swine follow clamorously the footsteps of their master as he
carries their food to Ihe accustomed trough. The rations were distiihuted by the division-sergeant to t lie mess-
sergeant, who then divided them among the men. To avoid i|iKirrclliug during the last distribution, it was the
custom aiuoug all the messes for the me.ss-.sergeani lo sepaialc the nitions into as many small parcels as there were
men in the mess: one man of the mess was placed a short distance olf, with his back towards the parcels, in such a
position that he could not see them: the mess-sergeant I hen ]iointed to one, with the words, "Who has this?" to
wliicli the man replied announcing the name of the recipiciil. whin il was given to him. In this manner the w hole
number was gone through with, with salisfaclion to all.
Iron hake-pans, like tlio.se used by the ('onfederate sohlieiN. had been issued to the prisoners who lirst arrived
at this |dace, in which to bake their own meal and fry their bacon: but nothing of the kind was ever given out
afterwarils, to my knowledge. The I'nited Stales soldiers, as is well known, were never provided with other cook-
ing utensils than niess-kellles and mess-pans, both too large to be transported in any other way than ii|ioii army
wagons. Aftlie lime of our ia]iture, in niimeriMis instances, the tin cups anil plates which we had were taken from
us; our knives, il will be remembered, were confiscated at IJanville; nothing, therefore, was left in our possession
with which to cook our raw food after il was given us. How to accomplish this necessary feat was a grave i|iiestion.
\\ c made shift, however, with chips, half canteens, tin cups that had escaped confiscation, ami ])icccs of sheel-iron,
lo hake one side of Ihe stiilf, while the other was scarcely warmed Ihrough. The solder of the tin, melting and
mingling with the Inead, added another to our almost innumerable hardships. Hut with all our care and labor, the
rations were at last devoured in a halt-cooked state — a f;ict which aided in the increase of the frightful misery that
subsequently occurred, quite as much as the small quantity that was issued.
Med. Hi.st., Pt. Ill— 6
42 SICKNESS AND MORTALITY
The prison hospital covered about five acres of ground. It was established in a grove
of forest trees which afforded a grateful shade to the unhappy and suffering men. Its
atmosphere was polluted by the foul effluvia from the stockade; but irrespective of this,
its own emanations rendered it as unfit for occupation as was the general pen. The men
were crowded together in old and ragged tents; neither beds nor straw were furnished, and
the patients lay in bunks or on the ground, often witliout even a blanket over them. Sick
men, unable to visit the latrines, made use of small wooden boxes in the lanes behind the
tents.
Millions of flies swarniod over everything and covered the faces of the sleeping jiatients, and crawled down
their open mouths, and deposited their maggots iu the gangrenous wounds of the living and in the mouths of the
dead. Myriads of mosquitoes also infested the tents, and many of the patients were so stung by these pestiferous
insects that they appeared as if they were suffering from a slight attack of measles. * ♦ » » -
The cooking arrangements were of the most miserable and defective character. Two large iron pots similar
to those used for boiling sugar-cane were the only cooking utensils furnished by the hospital for the cooking of near
two thousand men ; and the patients were dependent in great measure upon their own miserable utensils. They
were allowed to cook in the tent-doors and in the lanes, and this was another source of iilth and another favorable
condition for the generation of flies and other vermin.*
The rations of the hospital appear to have differed from those of the stockade only in
having an occasional addition of potatoes. Indeed, it would seem that but for the shelter
of the ragged tents, the shade of the trees and the increased area, the hospital joatient had
little advantage over the prisoner in the stockade. The supply of medicines was generally
deficient, often exhausted, and medical comforts were unknown.
At the time of Dr. Jones' visit one medical officer attended to the sick in the stockade
while three were on hospital duty. Generally, however, the medical staff consisted of six
or eight for the prison and four or five for the hospital. These officers labored faithfully
to alleviate the misery and suffering by which they were surrounded, but unfortunately
they were powerless to effect a change in the methods of the establishment.
Day after day, for weeks and months, those surgeons labored, breathing the unwholesome air, and iu constant
contact with those horrible diseases ; but they were patient, faithful men, and their sympathy with the victims often
benefited them as much as the medicines they prescribed. » » » j gladly record the little acts of kindness
performed by them, for they were verdant spots in that vast Sahara of misery. Dis. Watkixs, Eowzib, Thokxburn,
Eeeves, Williams, James, Thompson, Pilott and Sanders deserve, and will receive, the lasting gratitude of the
prisoners who received medical treatment at their hands during that memorable summer at Audersouville.t
The medical profession owes a debt of gratitude to the gentlemen mentioned in the
above extract, and to their colleagues on duty in the prison hospital, in that their labors,
however fruitless on behalf of the unfortunate men confined at Anderson ville, have jDermitted
one unsullied paragraph to appear on that foulest page of American or any other history.
The papers published by Dr. Jones, and by the Committee of the House of Representatives,
show that Dr. I. H. White, the surgeon in charge of the prison camp, repeatedly called the
attention of his superiors to the deplorable condition of the prisoners, appealing for medical and
hospital supplies, additional medical officers, an adequate supply of cooking utensils, hospital
tents and even for straw for bedding. It is true his requisitions and recommendations
should have been put in stronger language; but he probably recognized how utterly fruitless
and unprofitable would be appeals to the humanity of an authority whose inhumanity
rendered such appeals necessary. The following extract from his report, dated August 6,
1864, to General Jno. H. Winder, the Commandant of the prison, shows him neither
insensible to the suffering around him nor ignorant of the causes that made the prison-pen
a charnel-house.
• Jones, page .")20, f H. M. D.4Vlli.>iO\, 1st ' llii.. LiKlit Aitilleiy. page 4;i c.f tlic n-pcil ..f tin. Committee alvea.ly liteil.
AMONrt UNION TROOPS IN CONFEDERATE PRISONS. 43
The evils within the power of the iiiopci' autlioiities to (■onci-i :
I. The crowded roiidilioii of the prisonem. — The numher within tlie stockade shonhi not exceed fifteen thousand.
This wouhl allow ami)U' room for the remainder to be camped in order, with streets of sutlicient width to allow free
cirenlation of air and enforcement of police regulations. All that portion of the cam)) on the north side of the stream
conUl then lu' used for exercise, where roll-call could al>o lie held, thereby malcrially iiidinj; the commandant <d' llie
interior.
II. Construction of barracks and hosj'if'il aceommiutalinu. — There should be no delay in the construction of
barracks; with the greatest amount of energy it will be dillicult to complete them before the cold weather comes on,
when they will bo reiiuired more than at present. Too great stress cannot be placed on the necessity for the con-
struction of proper accommodations for the sick. There are at present two thousand two hundred and eight in hospital,
all poorly provided for, and some three hundred without any shelter whatever. There are also at least one thousand
men now in stockade who are helpless, and should be at once removed to hospital. Their ren)oval is prevented by the
absence of accomnu)dations. The construction of hospitals should be at once begun, and in the meantiu\e the sick
should be at once transferred to some point where they can be properly jjrovided for. An oftieer should be employed
to arrange the stream i)assing through the stockade. The bottom-land should be covered over with sand, the stream
be made deeper and wider, the walls and Ijottom covere<l with |)lank: the same arrangements to continue outside,
conducting the ilrainage freely to the creek beyond, ami if necessary, liuild a dairi to prevent the overflow of the
liauks. The stream from stockade to the railroad should also be improved, and the use of it by the troops outside
should be prohibited. Sinks should beat once arranged over the stream of such a nature as to render them i,;iviting;
at present, those; who have an inclination to use them have to wade through mud and faeces to use them. At the u]>per
part of the stream proper bathing arrangements should l)e constructed.
III. Enforcing utringent jiolice retiulations. — Some stringent rules of police should be established, and scavenger
wagons should be sent in every day to remove the collections of filth. A large quantity of mouldy bread and other
decomposing matter scattered through the camp and beyond the dead-line should be removed at once. If necessary,
sentinels .should be instructed to fire on any one committing a nuisance in other places than the sinks.
IV. Kslahlishmeni of regulations in regard to cleiinliness. — It should be the duty of Confederate sergeants, attending
roll-calls, or others, to see that all the men of their command bathe at stated intervals, and that their clothes are
washed at least once a week. For this purpose soaj) should be issued to the prisoners.
V. Tmproremciit in rations. — The meal should be bolted and sifted before being used. Arrangenu^nts should be
speedily made by which rice, beans and other anti-scorbutics should be issued during the present season ; green corn
might be issued in lieu of bread ration, if not regularly, at least three times a week. If possible, the jjrlsoners should
bo supplied with vinegar, and with an occasional issue of molasses in lieu of the meat ration, which would tend
greatly to correct the scurvy which prevails to a great extent.
The deaths at Camp Sumter, Andersonville, Ga., durnig the fourteen month.s of its
occupation numbered about 13,000, when the unrecorded cases are taken into consideration.
But these figures greatly underrate the mortality consequent on the treatment to wliich tlie
prisoners were subjected. Thousands of men died after their hberation iVom thi.s and other
southern prisons. There are no records on file showing the subsequent history of the
Andersonville captives; but the following communication indicates the probabilities with
respect to them, in detailing the condition of those exchanged from Richmond, Va.:
I have the honor to make the following general report of the condition of patients (sick and wounded) who
arrived at and were admitted to this hospital from "Belle Islan<l," Va., per flag-of-truce steamer "New York," via
City Point, Va., on the 29th instant :
This vessel left City Point with one hundred and eighty-nine sick and wounded. Hefore she arrived at Fortress
Monroe four men died; on the trip from Fortress Monroe to this place four more died — leaving one hundred and
eighty-one to be admitted.
Language is inadequate to express fully the condition of this number, and none but those who saw them can
have any apjjreciable idea of their condition. I do not pretend to particularize, for every lase presented eviih'iices
of ill-treatment : every one wore the visage of hunger, the expression of despair, and exhibited the ravages of some
preying di-sease or the wreck of a once athletic frame.
I only generalize, therefore, when I say their external appearance was wretched in the extreme. Many had
neither hats nor shoes, few had a whole garment; many were clothed merely with a tattered blouse or the remnant
of a coat, and a poor apology for a shirt. Some had no under-clothing, and, I believe, none had a blanket. Their
hair was dishevelled, their beards long and caked with the most loathsome filth, and their bodies and clothing
swarmed with vermin.
Their frames were in most instances all that was left of them. A majority had scarcely vitality to enable
them to stand. Their dangling, bony, attenuated arms and legs, sharp, ]iinchcd features, cadaveric countenances,
deep, sepulchral eyes, and voices that could hardly be distinguished (some, indeed, were unable to articulate) pre-
sented a picture which could not be looked upon without calling forth the strongest emotions of pity.
Upon those who had no wounds, as well as on the woundi'd, were large foul ulcers and sores, principally on their
shoulders aiul hips, produced by lying on the hard ground ; and those that were wounded had received no attention,
their wounds being in a filthy, otfensive condition. One man, who died on the trip from Fortress Monroe, told the
44
SICIvNKSR AND MORTALITY
surgeon previous to death that his wouud hail not been dressed since tlie hattle of (iett.vshur.i;-, Pa., where lie was
wounded in the liead. having both tables of the posterior part of the skull fractured.
Most of the cases were suffering with diarrhiea — some of them with involuutar.v evacuations — their clothes
being the onl.v receptacle for them, and the.v too weak to remedy the ditticult.v. This being the case, you can, of
course, ima.sine the stench emitted from them. Many had pneumonia ; some in the advanced stages were gasping
for breath. Delirious with fever, many knew not their destination or were not conscious of their arrival nearer
home; or racked with paiu, many cared not whither they went or considered whether life was dear or not; in some
life was slowly ebbing, from mere exhaustion and the gradual wasting of the system. How great must be the
mortality, then, of these men, and how dreadful among those still suffering the horrors of imprisonment. Every
man wlio could, rejoiced over his escape, deplored the scenes through which he had i)assed, and mourned the lot ol'
I hose he had left liehiud. Weak aiul debilitated, they wished but to die auunig their friends, a wish which, unfortu-
nately, will be realized in too many instances. — Letter of Aet'imi Amiatiint Surgeon J^. .1. R.vnci.lKFE, V. .S. A., Meil'irnl
Officer (if the diiy, iit the C S, General Hospitii!, Dirwion Xn. 1, JninqjoliK, Mil., repitrtiiKj In the Suriienii in ehnrije the rnn-
ilitioii of the nick irnd leoiniiJed aihnitted October 29, 1863,. /'I'om Belle Me, ri<i City Point, Va.
Tlu.' ivcord.< of tlie prison lio.spital at Danville, Va., extending from Noveiulxn- '2'A.
l(S6o, to March 27. 1865, furnish a total of 4,332 oases admitted. As l.")7 of these were
cases of wounds and injuries and 7 cases in which no diagnosis was recorded, thi> numher
remainin.i!: us due to specified diseases is 4,168. But since there is no recoi'd ni' what
liiH-ame of 429 of these cases, the numl)er of terminated cases of specified disease is reduced
to 3,739. (if whieh, l,l>74 or 28.7 per cent, were fatal. An exammaliim uf the following:
table will discowr the aljsolute and rcdative mortality of the lunmment diseases for com
parison with tlie Audersonville record, already presented, and with the i-ecords of our
Nortliern prisons, to be subruitted hereafter.
Tablk XVIL
Summarizinf/ the Records of the Priwn Hospit<il at Danville^ Va., Xof\ ?o, ISGo, to March :27, 1SG5,
Total oas«^s .
Wouixls and injuries.
Nut sitecified
Speritied iliseases
(.'iilltiimfd l'V\rl- . .
Malariiil l-'eviM-
Ernptivfr l''ev<MS
IJianlio-a and Dysi'iitery.
Debilitv
l>rnpsy
('oiiSUIllptloii .
Kheiiliialisin
Sdurvy
Uroiif^liitis
Piietltiiiiiiia ami I'leiinsy.
Other diseases
1!
IB
"A
:=£
i. .
■? i
a ?-.
Died.
■0%
°0 -SB
HI
m
III
<2
{
\ 'X\-^
4:)7
3, 89.-.
1.1184
l.',7
(i
131
10
o
(1
28.7
1 4, lfi8
42'J
:), 73>l
1,1174
12
1,000
l(i.7
1,000
i:><
la
.57
n.i
21.1
■.';r.
ISI
■>\6
17
oil. 4
1...8
7. 1>
HSU
i.W
1 ;•,»■_'
lli.-i
211.1
I.-.3. <;
2ti. .1
1,41S
51
l,:iii7
4.-.l(")
340. 2
4211.0
32. 8
]:h
18
ii;o
13
42.7
12. 1
8.1
fi-,'
ti
."iti
24
14.9
22.4
42.9
1.
1
17
7
4.3
li. 3
41.2
■M»
17
:t3l
18
83. .-.
Hi. 8
...4
111
i
89
6
21.8
5.11
tl. 7
SftI
12
2.i7
31
f.4.5
28. 9
12.1
;U4
19
a!i.i
88
75.3
81.9
29.8
;;sil
14
•J72
342
(».6
225. :l
80, (t
(<() l>r. WonDWAKIi, on \kii^^ Mfi, Fart II ol this work, jfivi-s the nninber of deaths fnmi diarrlupa and tly.'feiiterv as ;ii»-J instead nf 1.11. I \,f i.-. ..rd
shows that wliile ill l,3tJ7 tenniiiated cases there iM-eiirred t.'d tlealhs, hy lollt.wiiiif mit the histories i.J' iIh- ta.st-s ntlier than diurrliceu ami dysenteiy 141 «.f
these are found to have proved falid by the supervenlion i>f the prevailiuij; intei^linal Hux. This accounts, for instance, fur the high death-rate attai'hi;ig
to the cases tabulated under the caption of "'other diseases."
AMONG UNIOX TROOPS IN CONFEDERATE PRISONS. 45
DiarrlifBii ;iii(l tln' (rn|)tive fevers, sraall-pux ohiefly, occasioned the largest number of
admissions us will as of deaths. Diarrhoeas constituted 340.2 of every tliousand cases of
disease, and causeil 420 of every thousand deaths from disease. JUit scurvv. whicii
exercised so fatal an influence at Andersonville, was less manifest here, as it occasioned
only 21.8 of every thousand cases and 5.6 of every thousand deaths. The i^cncral |>er-
centaii,!' of fatal cases of disease in this prison was only 28.7, as compared with 73.7, the
Andersonville percentage. Evidently the prisoners at Danville were treated with i-oin
parative humanity, although the mortality among tin; cases was nearly three-fold that
reported among the Confederate soldiers treated in the Chiinhorazo Hospital at Richmond,
Xa." The ratios of sickness and deaths to the strength present were no doubt correspoml-
ingly augmented among the prisoners, although in the absence oi data it is impossible to
give any other than this vague expression of the facts.
IV.— PREVALENCE OF DISEASE, AND MORTALITY THEREFROM, AMONG THE CONFEDERATE
TROOPS IN UNITED STATES PRISONS.
The rebel soldiers that died in oin- Northern prisons numbered, according to the
monthly reports on file in the iSurgeon General's Office, 30,716. Death in 5,569 of these
cases was the result of wounds; in 404 the cause was unknown, and in 1,1 02 unstated.
There remain, therefore, 23,591 deaths reported as from specified diseases.
The Confederate prisoners were contined in a number of prison camps, many of which
have already been mentioned."}" The statistics of nine of these camps iiave been exam-
ined, consolidated and tabulated to uidicate the diseases and classes of disease that were
the principal causes of the sickness and mortality among the prisoners. The records of
these nine camps include 18,808 deaths from specified disease, or about 80 per cent. o{ the
whole number of d(uiths reported as caused by disease. The statistics of the smaller
camps might readilv have been added to these, but their addit;ion would have materially
increased the size of the tabular .statements without adding correspondingly to their value.
Everything of interest susceptible of illustration by mere figures relative to the diseases of
the prisoners may be gathered from the tigures given below. Table XVIII consolidates
the data of each prison; Table XIX consolidates the data of the whole, and deduces ratios
I'v which compiarisons mav be in.stituted.
( )n comparing the latter consolidation with Table XIII it will be fouuii that the items
making up the total immber of cases of disease among the prisonei's did not differ nuu'h
iVom those constituting the total among the Confederate troops in the field. Thus the two
classes of disease, diarrhoea and dysentery and the malarial fevers, which caused the largest
miniber of cases among both these bodies of men, have their prevalence expressed by very
similar Hgures. Among the Confederate forces cases of diarrhcea and dysentery constituted
277 of every thousand cases of disease, while the malarial fevers numbered 111 in the
thousand. Aniung the prisoners the corresponding tigures were 268 and 157. Tlie
eruptive fevers formed 54 of every tliousand among the troops on service, and 6S among
the prisoners; pulmonary aft'ectious 51 among the former, 58 among the latter; and
rheumatism 36 and 34 re.spectively.
• Sto Tabic XII. f Pages a«i-40, Part II, of this work.
46
SICKNESS AND MORTALITY
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AMONG CONFEDERATE TROOPS IN U. S. PRISONS.
Table XIX.
47
In which (he fads of Tnhk XVIII are consoli doled and ewpi^essed in average annual 7'aies i^a^ thousand
of strem/fhy with the ratio of cases of i<jH'cifial diseases to cases of all dij^easesy of deaths from
specified, diseases to <leaths from all diseases, and the percentage of fatal cases of sprcified disease.
Average strength present ^DjSto men.
Continued Fevers
MHlttriH) Fevers
Eruptive Fevers
Diarrliopa and Dysentery.
Auieiniti and Debility . . . .
Coni»auiptiun
KheiiniHtigm
Scurvy
Broncliitis
Pneiiinnnin umi I'li-iiiisy .
(.Mher diseases
Total specified diseases.
Ti.tnl
number of
cases.
2,5.59
Total
number of
deaths.
Annual ratio per thousand
of averugu strength.
Cases per
thousHiid
citses of nil
diseases.
10. 5
Deaths per
thnnsand
ileiitlis from
all illsou»ieN.
.59. 1)
Percentage
of fatal
eases.
43 3
Cases.
Deaths.
13.6
1,109
31.4
38,5g7
),fl2li
472.7
12. 6
1.57. 7
54. 6
2.7
le, 667
3,453
204.2
42.3
68.1
183.1)
20.7
er,, .580
5, 965
803.4
73.0
268.1
317.1
"I. 1
3,209
156
39.3
1.9
13.1
8.3
4.9
53.5
331
6.6
4.1
2.2
1 7. r.
61.9
8,340
95
102.2
1.2
34.1
1.1
16, 257
351
199.1
4.3
66.4
18.7
2.S
4,488
133
.5.5.
1.6
18.3
7. I
3.0
14,319
5, 043
17.5. 4
61.7
.58. 5
268. 1
3.5. 2
74, 151
1,147
908.3
14.1
303. I
61.0
1.5
344,692
18,808
2, 997. 6
2.30. 4
1,000
1,000
7.7
i>ul although this similarity existed among the cases, showing that the diseases prevail-
ing in the prisons were precisely tliose that were at the same time affecting the Confederate
soldiers wiio were not prisoners, the fatality in the cases of the confined men was 7.7 per
cent, as against 3.8 per cent, in the Confederate ranks. No doubt the relative mortality
was considerably greater among the prisoners than among the men on service, but the
increase shown by the statistics is in the main due to a failure to take up certain cases on
tiie sick report, the deaths consequently forming a larger percentage of those that were
taken up. The annual number of cases of disease entered on the surgeons' reports per
thousand prisoners was 2,997.6: the annual number among the troops in the Hold per
thousand of strength was 4,404. The apparently greater prevalence of disease in the field
was obviously due to the entry of men on sick report for slight ailments necessitating
temporary excuse from military dutv; and the greater fatality of disease, as figured by the
statistics of the prisons, resulti'J in part from the absence of such cases from the reconls.
Prisoners with slight ailments did not require the surgeon's signature to excuse them from
duty, as in general they had none to perform.
On the assumption that as many trivial cases occurred among the prisoners as among
the Confederate ranks — and it can hardly be supposed that there were fewer — the per-
centage of fatal cases would be 5.2 instead of 7.7. On the assumption that the trivial
cases outnumbered those occurring in the ranks, the prison rate of fatality would be pro-
portionately lessened.
The actual increase in the percentage of fatality was occasioned by the greater
prominence of diarrhoea and dy;;entery, the enqjtive fevers and pneumonia as death causes.
The continued fevers constituted a larger proportion of the mortality among the troops on
service than among the prisoners. This is explained by the greater prevalence of these
fevers in the regiments, where they contributed 45 to every thousand cases of disease,
48
.SICKNESS AXD MOETALITY
instead of 10.5 as among the prisoners. Nevertheless, the fatahty of the prison cases was
greater, 43.3 per cent., tiian that of those occurring in the ranks, 33.27 per cent.
The ternljlr prouunent'e nf diarrhoea, dysentery and scurvy as causes of sickness and
death at Andersonvdle''' is not manifested on the records of our northern prisons. Diar-
rhoea and dysentery, which occasioned 505.6, and scurvy, which occasioned 326.0 of every
thousand deaths at Andersonville, are seen by the above tabulation to have caused in our
prisons only 317.1 and 1.S.7 respectively. The large number uf deaths from these diseases
among the unfortunate Federal [)risoners reduced the pro[iortion caused by other diseases;
thus, according to tlieir records, the continued fevers are held re.sponsible for but 21.7 and
the malarial fevers for only 14.7 of every thousand deaths, as against 50.0 and 54.6 among
the captured Confederates. iS^ot that these and manv other diseases were more }>revalent
or more fatal in the northern prisons; tin; deaths were merely more generally distributed
among the various causes.
But the deatli rates per thousand of strengtli atlord a more ready means ot a.j)precia-
ting the relative mortality among these men. The inmates of the nine prisons tabulated
lost annuallv bv disease 230.4 out of every thousand [irc.-^ent, as contrasted with 53.48
among our white troops; 143.4 among iiur rolured troops; 167. o'j" in the rebel armies,
and 732.6 among the Andersonville prisoners. Tlie chief causes <.if these stated n\ortalities
are shown in —
Table XX.
Contrastiny the MortuUttj Ratex, per thoiniand of strenf/fh, among the White mid the Colored Troops of
(he U. S. Aniii/ and tlic Union find the Confedemte Prisoners of War.
ilortalily lalf pri l.Oini strfii,i;tli I'miiL —
All diseases.
Diarrbd'a ami Pv.si'iiterv.
J^iieuiiiiiiiia
Eruptive Fevers
('oiitiuuc'rt Fevers
Malarial Ff\ ci.s
Seurvv -
Northern
prisous.
L'30. 4
Anderson- White
ville. troops.
732.fi
53. 48
Colored
troops.
143.4
Tiill
tt;.">. t)
1.5. 82
35. 27
HI. 7
27. I
(i. :u
28.87
10. 5
x.-J'
I.. 50
18. 36
i:!.H
2(1. '-,
ll.liO
12.45
lli.K
12.2
5.04
1H.81
1.3
102. X
0. It)
2. 02
The cause.^ of the large mortalitv from diarrlu.ea and dyMMittTV. pneumonia, and the
eruptive fevers, will be better understood by investigating the sanitary surroundings of the
captives as described in the monthly reports of the Medical Inspectors. From these
d(_)cumeuts the following accounts have been compiled:
Pki.son-ca.mp anii Hospital at Camp iJortiLAS, nk.vk CmcAciO, Illinois. — 'riiis camp was estalilislied in
.laimary, 1862, and closed in .September, 1865. Its situation was within oue-fourth uf a mile of the shore of Lake
Michigan, and ahout one and a lialf miles from the southeastern snhurlis of the city of Chicago. The site was a Mat
and treeless prairie ahout fifteen feet higher than the level of the lake. It had been iireviously used as a fair-ground.
The enclosed area measured 80 acres, nearly one-half of which was set apart for prisoners, the remainder for the
garrison and hoS]>ita]. The soil was a sandy loam on a substratiuu of blue clay. As the surface of the camp was
not favorable to drainage it was often, in the wet weather of its earlier history, .-softened and nniddy, unpleasant
* .See T.ihle .\V, page 34.
t See stiprn, p.ige 'Xi.
AMONrj CONFEDERATK TROOPS IN V. S. PRISONS. 49
and iinlicaltliy. The Imildiugs Wfic at first poorly coiiKtructed wooden shanties arranged in |)aranel lines, east and
west, with avenues between. The whole camp was in form a paralleloj^ram. one long and one short side being used
for prisoners, the other short side for ottieers and the other long side for oftices. The average size of these buildings
was 48 X 25 x 10 feet, with kitchen in the rear 8 feet distant. These kitohens were small and were used also as mess-
rooms. The whole camp was surrounded by a high wooden fence, and the barracks being in close proximity to it,
very little fresh air, according to Dr. Keesey'S report for 8ei>tember, 1«62, fiuind its way into the dark, dingy and
poorly ventilated quarters. In the month mentioned 7,7it8 prisoners of war were conlined in this camp.
.\n extensive tire which o<curred shortly after this destroyed a large number of the barracks: the buildings by
whicli they were replaced were of a much l)etter character in all particulars. The insi>ection report for December,
!8li2, says of this: "Some of the barracks have been burnt and others more substantial have been built in their places.
The recent contiagrations have been attende<l with one salutary effect, in the immensi- destruction of animal life, in
the form of lice, and had less of the tilthy an<l rickety quarters been sj)ared still greater salutary cH'ects would have
been the result."
The report for .lune, 18t>l, says that these quarters were "onestory high, frame, illy constructed, floors raised
four feet from the ground, ridge ventilation and openings at .side and ends ample in number.'' Their condition was
further improved subsequently, for the report for October, 181>1, says of them: "Fifty-two in number, each
70 X 24 X 7.8 feet, with kitchens 20 x 24 X 7.8, attached, in good order ; eight new ones in course of construction."
In .lanuary, 1865, they were described by Dr. Coolidge as follows: " The prisoners of war are confined within
an ;irea of about forty acres, surrounded by a strong oaken barricade twelve feet in height, surnu)unted by a railed
platform for sentinels. The prison barracks are one-storied, ridge-ventilated buildings erecteil on posts four to six
feet from the grounil, to prevent escape by burrowing. These barracks are sixly-four In niiniber. four of which ape
for convalescents exclusively: thirty-one have been built since .January, 18(U. I'liey are arranged in streets of suit-
able width, and are all of the same dimensions, viz: !H1 feet long, 24 feet wide and about 12 feet to eaves. • • •
Kacli barrack is subdivided iuto a kitchen and dormitory, the former 21) X 24, the latter 70 x 24, the dormitories fitted
up with wooden bunks three tiers in height. In several of the barracks at the time of my inspection there were
1(;,"> men, each having a cubic space of 142 and a superficial area of 10 square feet. The laisoners of war confined in
this camp, ,Taunary, 18tVl, numbered "),I>-I9, and 7,ti")2 were received during the year, making a total of 13,301. The
eases of sickness treated during the year amounted to 23,037, and the deaths to l,15ti, of which 41() were from small-
pox. The number of prisoners present December 31, 1864, was 11,780, of whom 577 were sick in hospital and 1,547
in quarters."'
The prison hospital building, in common with that of the post, was described, in September, 1862, by Dr.
Keeney as follows : "The hospitals are pretty nmch the same as the men's barracks; though isolated from them
they occupy grounds in the square. They are more thoroughly ventilated, but still are very defective in this partic-
ular: on an average 23 patients occupy ."v ward where 7 should be, allowing 1,000 cubic feet of air to each patient."
In the report for the following month Dr. Kekney says: "The hospital accomnu>dations of this camp have
reached their utmost limit, * * sickness is on the increase.'' He recounnended that the serious ca.ses be transferred
from the camp hosjiitals to the general hospitals at Chicago, and this ai)pears to have been done.
The building is described in the inspection rei)ort for .June, 1861, as follows: "One building, two stories high,
with two wings, newly built, well-constructed frame, enclosed by a high board fence, well ventilated by the ridge
and base, windows and high stories; 180 beds, and 117 in ])est hospital ; air-space, 800 cubic feet in hospital and 1,200
in pest hospital: total beds, 297."
The pest hospital was composed of two buildings, isolated and comfortable in every way.
The report for October, 1864, says: "Buildings, two two-8tor.y pavilions, two one-story pavilions, and one
barrack for convalescents, all in good condition ; six wards, 325 beds ; air-space, 6.50 cubic feet ; superficial feet, 54
each; overcrowded." At this date there were 7,361 prisoners of war in camp, 397 in hospital and 860 in quarters.
In .January, 1865, Dr. Cooi.ipoe described the buildings as follows: "The prison hospital is within the garrison
grounds but outside the prison square, enclosed with a strong oak fence. It consists of a central building with two
wings, all two stories in height: four wards in each wing: the lower are 99 feet long, 27 feet wide and 12 feet high,
well lighted and ventilated by cold-air shafts opening in the floor and vertical shafts in the walls, opening some near
the floor, others near the ceilings. The upper wards are 99x27x11 feet, well lighted and ventilated by shafts
opening at the ridge. .\t time of inspection each of these wards had 60 l)eds occnjiied, so that each bed had 500 feet
of air-space and 45 feet of area. • • » In addition to the hospital proper there was a single barrack ward 80 X 20
feet, with 30 beds for erysipelas."
The pest hos]iital was about one mile from the camp, and consisted of two ridge-ventilated frame buildings,
204 x28 and 10 feet to eaves: divided into three wards, 1.50 beds. During the year 186-1 1,519 of the ])risoners were
admitted with small-pox or varioloid, and 416 of these died. During the same period 144 cases were admitted from
the I'niou troops at the post, and of these 24 were fatal.
Few alterations were made in these hospitals after this date except in minor jioints, all of which tei:ded to
improvement.
The diet of the prison-cani]) was the ordinary army ration with vegetables added. Some complaint was made
of a scarcity of these by Dr. Keexey, who said in September, 1862, — " I am inclined to believe the prisoners have
been stinted in vegetable matter. The best indication of this is the appearance of the scurvy lurking about the
command. There are many cases of incipient scurvy in camp." But the Luspection reports of later dates speak of
the rations .as good and suthcient.
The diet in the prison hospital was rendered superior to that of the prison by the addition of delicaciea pur*
Med. Hist., Pt. Ill— 7
50 SICKNESS AND MORTALITY
cha«ed by the hospital fund, which appears to have heen expended in this inauuer as fast as it accrued. Dr. C'OOLIDGE
reports for .lanuary, 1865, as follows: "The purchases by the hospital fund were as follows: (Some items only.)
Milk, 1,2:^7 gallons; potatoes, 167 bushels; dried apples, 427 pounds; butter, 994 pounds; chickens, 20 dozen; oysters
(cans), 5 dozen — a great contrast to the treatment of our men in rebel prisons." Excellent soft bread was issued from
the post bakery at all times to the prisoners in camp and hospital.
An abundant water-supply was brought from the lake to the camp by the city water-pipes.
The drainage of the camp was at first imperfect. Dr. Keexey speaks of it thus : "The drainage is exceedingly
bad. The commanding officer and the surgeon have repeatedly submitted plans of drainage to the department, urging
the necessity of such as a means for preserving the health of the camp. As yet, nothing has been done but to permit
long open sewers, extending for nearly a (juarter of a mile, lioth in front and rear of the quarters, containing the
garbage and other refuse of the kitchens of months' standing, to add their miasms to the already noxious air jiervading
the camp." Again, in October, 1862 : "The grounds are so low that no drainage, without much expense, can be had.
Every rain converts the camp into a mud-hole, and in consequence of the flatness of the ground ami the want of
drainage, all the filth and refuse of the company quarters, of the men's sinks, and of the hospital, are to be removed
only l)y the process of evaporation. Already there exists in and around the company iiuarters and hospital sufficient
animal and vegetable matter to contaminate the whole camp and generate fevers of the most uuilignant type.''
This condition of aflairs appears, however, to have been remedied, for the report for Jiine, 1864, speaks of the drain-
age as "naturally bad, liut artificially good." The camp was well graded, and a system of sewers built which
could be flushed into the lake.
The sinks at early dates were shallow pits, many of them merely surrounded by a few poles and brush insuffi-
cient to afford privacy. Dr. Kee>-ey, in his report for September, 1862, says: "The sinks are numerous, near the
men's quarters and badly constructed ; they are not sufficiently deep, nor are they filled up often enough and renewed. ■
The wood-work is not close enough, consequently the mephitic gases are wafted to the quarters, hospitals and over
the parade grounds. This stench is intolerable." At a later period these privies were built over a large sewer and
the excreta effectually removed by flushing.
Prison and Hospital at Alton, Illinois. — The priscm at Alton, 111., was opened in .January, 1862, and
closed in June, 186.'). Its site was that of the Illinois State Penitentiary, on the hillside at the northern end of the
city of Alton, overlooking the Mississippi river, high, dry, well-drained and considered healthy, though subject to
malaria from the river bottom at certain seasons of the year.
The buildings, nearly all of limestone, formed a square which was surrounded by a high wall. Many of the
smaller buildings, used as executive offices, etc., were isolated. The north side of the prison was formed by a building
containing 2r,f) cells, arranged in four tiers in the interior, each tier consisting of two rows facing the north and
south walls respectively. The cells were each 7x7x3+ feet = 171.5 cubic feet; they were ventilated and lighted by
the gratings which formed their doors. They were used only for refractory prisoners or when the prison was crowded,
which the inspection reports show to have often been the case, particularly in the earlier months of its occupation.
Bunks were erected along the corridors, between the central cell structure and the walls of the building. In addition
to this there were two large rooms, each 45 X 15x10, occupied as quarters, one of them at one time exclusively by
Confederate officers.
Dr. Le Conte in his report for May, 1863, says: " In the main building many of the cella are occupied by men
who are not confined therein, but sleep there for want of better place.' He recommended that "the capacity of the
prison should be considered as not greater than 1,000, and that not more than that number should be confined within
it at one time." The prison had been built to accommodate 300 convicts, and at the time of Dr. Le Coxte's visit it
contained 1,500 prisoners. Dr. Keenev in his report for July, 1863, says: • * * "Fifteen hundred prisoners,
both Federals and Rebels, have each about 100 cubic feet of impure air for respiratory purposes. This deficiency of
pure air alone is a sufficient cause to explain the great mortality within its enclosure." In August, 1863, there were
1,200 prisoners; in October, 1863, 1,446; and in November, 1863, 1,800.
In order to afford increased accommodations for the prisoners, tents were at times erected, and the prison hospital
was removed from the permanent stone building to one specially erected of wood, thus giving additional space for
the inmates of the prison.
The reports at first speak of the hospital as consisting of one large ward in the basement of the penitentiary.
In April, 1863, the hospital department was removed into a separate brick building in the prison yard, having room
for 70 beds. An additional building was used as a pest-house.
In August, 1863, out of 117 sick in the hospital 60 were small-pox patients, and to properly isolate these a new
building was erected at " Sickleyville,'' on an island in the river about three-quarters of a mile from the town of
Alton. This building was of wood, well built and comfortably arranged; capacity, 100 beds with 670 cubic feet of
air-space per bed.
In order to afford increased accommodations for the relief of the over-crowding in the prison quarters, a new
two-story wooden pavilion buUding was erected inside the prison enclosure as a hospital, and all the permanent
buildings were henceforth used as quarters. This new prison hospital was divided into two wards, 183+ X40 Xl3 =
95,420 cubic feet each, the lower story being used for executive purposes, the upper only for the sick. A fine and
well-appointed bath-room was attached to this ward ; in fact the hospital arrangements were complete in every par-
ticular. The small-pox ward on the island was 200 X26x 13 feet clear = 67,000 cubic feet, and had 67 beds. It was
well constructed, one story, with roof and side ventilation. Thus the hospital accommodations at this place were
at length made comfortable and complete.
The rations of the prisoners in quarters and hospital are reported as abundant and good. The hospital ftind,
AMONO CONFEDERATE TROOPS IN U. S. PRISONS. 51
as it accrued, was liberally expeiulcd in the purchase of delicacies for the use of the sick, the siinouudiiif; funiw
furnishing vegetables in abundance.
The water-supply was at tirst hauled from the river to the prison by teams; later a steam force-pump was
employed and an abundant supply was ol)tained.
The sinks were at tirst shallow pits situated too near the quarters, ofti'n over full and fiml-smelliiif;. At this
time no water-closet was attached to the hospital, and the excreta had to be removed by hand. But these defects
were remedied. The report for April, 18B5, says of those attached to the hosiiital — '■ Wuti-r-closets clean and build-
ings good. ' The remarks on those of the prison are less satisfactory; "Water-closets .and sinks ample l>n1i as foul
as possible." In fact the condition of t!\e sinks in the prison was generally severely criticised by the medical
inspectors. The bathing facilities were characterizeil as ''ample and good, with good furniture and lixtures.'"
The drainage was naturally good and the sewerage satisfactory during the early occupation of the prison ; but;
in -Vpril, 18t>'i — "most of the .sewers having been clogged with trash, have been opened their entire length, and are
open gutters of fieces, slops and all kinds of tilth. The sewers not thus opened are choked ; con.se(|uently the whole
establishment stinks intolerably and the stench extends to the private residences in the vicinity of the prison walls.
It is proposed to put earthen sewers here, and the work should be done at once."
The following extracts show the condition of this prison when at its worst:
Dr. Kkexey, November, 1862: "The quarters are poorly ventilated, and some have no ventilation at all.
The grounds and quarters are in a shocking condition. The prisoners are permitted to lounge about in their
tilth, with no other duty to perform seemingly than to amuse themselves by slaughtering the vermin crawling about
their filthy persons. This seems to be their general avocation and amusement.
The kitchens are shining with grease, the floors seldom washed, the tables and otln-r kitchen furniture also
filthy.
The cooking arrangements are good; the ranges large and ample for all purposes.
The rations furnished are of the best <iuality, excepting tlour, which is bad. lint there is a great dispropor-
tion between animal and vegetable matter, a deficiency of the latter. Unless more vegetable matter is furnished
scurvy will soon make its aj)pearance.
The grounds around the company quarters and kitchens are I he comuiou receptacles for bones, damaged meat,
mouldy bread, etc.
The prisoners do their washing on a slope where all the soajiy water runs ui)ou the ground and dries uji
under their feet.
The sinks are located in their midst and are exceedingly foul: the pits but tlirei- or four feet deep. There
is no drainage to them, consequently they soon become filled up, and if not often removed they become an intol-
erable nuisance; such is the case now. I have called the attention of the commanding otticer to this, and have
recommended them to be filled up and new pits dug twenty feet deep and walled ii]i.
I also find prisoners occupying the cells where the air is cold and damp and without ventilation, and where
pneunu)nia and rheumatisni were fast increasing. As the.se occui)ants were not condemned to the cells, I recinn-
mendcd the commanding ofticer to remove them immediately to a large open room where tlu; sun's rays might
occasionally brighten their dingy walls.
As above stated, there are 1,040 prisoners inside these walls. Sick in hospital till; in ((uarters 70; total IHO.
The prevailing diseases are erysipelas, pneumonia, dysentery, typhoid fever and diarrhtea. The prevalence of the
last disease arises fiom the sour bread furnished by dishonest contractors, under the administration of an inetJicient
commanding officer.
The hospital accommodations consist of one open ward with low ceiling and bailly ventilated. The walls are
dingy, the floors dirty, the Ix^dding filthy, and the patients unwashed and alive with vermin.
The medical attendants, four in number, are Confederate pris<mers of no account as medical practitioners.
Dr. Hakdex has not time to give his attention to individual cases. The ward is now crowded, one bed riding
another. In this loathsome ward each patient has about 200 cubic feet of foul air for respiratory purposes.
Among the sick I found some eight or ten cases of erysipelas fast running into a contagious form. It is on the
increase."
Dr. Keexey, .Jtily, IStiS: "The percentage of deaths h,as been as high as SO. Through the ald(5 administration
of its ])resent commander. Major IIexdkicksos, l^. S. .Vrmy, and its present medical officer, Assistant Surgeon Wall,
77th Ohio Volunteers, the mortality has been re<luced to 12 or 1.5 per cent.
The general state of police of the entire prison is now almost faultless, including the two wards used for
hospital purposes. The rations are issued in abundance and of the best quality, and the cooking is both well
done and served. The patients in hospital, some 85, are well provided with underclothing from the Government,
and are amply supplied with everything to make them comfortable as far as the present capacity of room will
permit. In this there is a sad deficiency, and humanity demands an immediate change for the better. In one ward,
in the very midst of these 1,-500 prisoners, there are 20 or more cases of small-pox under treatment; in the other and
only ward are typhoiil and malarious fevers, erysiiielas, scabies, pneumonia, etc., etc.
Erysipelas often makes its appearance, assuming a contagious form from the vitiated air and animal poi.sons
constantly being eliminated from the body. In fact , all forms of disease that would be mild with i>lenty of pure air,
have in these <lingy and loathsome rooms assumed the most virulent forms and batilcd medical treatment.
In oriler to check in a measure this great and unnecessary mortality from disease, I have recommended the
commanding ollicer to jirocurc immediately a suitable buildiog a mije or so from the pri.sou aud city, and have it
fitted up for the accoiuuiodation of the small-pox cases.
.')^ SICKNESS AND MORTALITY
- As this loathsome disease seems a eoustaut iumate of the prison iu sjiite of vacoiuation, it will he necessary to
keep up the small-ixix hospital continually, and to employ an able physician to attend to this hospital alone. The
persistence of small-pox iu the ]irison is due to constant importations of the disease.
1 have also recommended tluit the best ventilated and most isolated rooms now occupied by the well inisoners
be approiiriali'd to the erysipelatous and other contajfious di.seases, and the room now occupied by tlie small-pox
cases be turned over to the well prisoners as soon as it is in proper condition to receive them.
I would also call your attention to the great necessity of innncdiately authorizing Major Hkndrickson to
cuiiiiiiy two able physicians, one to attend to the small-pox hospital as soon as opened, and tlio other to assist Dr.
VVai.i, to attend tlu' prison hospital. The duties in this hospital are too much for one num to do Justice to the
numerous bad ca.ses of disease.
If tliese suggestions are carried out the condition of the sick will be ameliorated and tlie percentage of deatli
lessened."
Pi!isoN'-i!.\Ki!ACK.s AND HOSPITAL, RocK ISLAND, ILLINOIS. — This prison was established November 13, 1863,
and discontinued about August, 1865; the prison hospital was opened in December, 1863, and closed in .June, 186.5.
Ruck Island, embracing about 1,000 acres, is situated in the Mississippi river between the cities of Rock Island,
Illinois, and Davenj)ort, Iowa. The .soil is a stiff loam on a limestone foundation. Its well-wooded and undulating
surface was considered to offer a healthy site for a i)rison-camp.
The barracks consisted of eighty-four one-story wooden pavilions, each of which was considered suitable for
the accommodation of one hundred men. They were well built and comfortably arranged, ventilated by the ridge
and well lighted; their floors were raised from the ground, and were comfortalily bunked. They were built in streets
1(10 feet wide, crossing each other at right angles, and there was a central avenue 200 feet wide. Each barrack was
100 feet long, 22 feet wide and 10 feet high, but 20 feet of each was partitioned otf to form a kitchen and mess-room.
The whole area, 1,200 x 850 feet, was enclosed by a strong wooden fence 12 feet high, with a railed platform near the
lop on which the guard patrolled.
Dr. ToWN.SHEND reports the result of his inspection in January, 1864, thus: " The prisoners on the island num-
ber 6,.500. They are comfortably quartered in barracks well built and well arranged for comfort and security. The
appearance of the men is highly creditable to themselves and to the officers having them in charge. In good weather
the prisoners are emjiloyed iu various duties, which secure to them the benefits of out-door exercise; these duties
are therefore regarded by them as a privilege. The discipline of the prison is admirable, being efficient without
being harsh."
The prison-hospital buildings, from January to Ajiril, 1864, consisted of a number of the barrack pavilions
inside the prison enclosure. At the last-mentioned date ten of these barracks were used as hospital wards; but in
May a new prison hospital was opened for the reception of patients. The buildings consisted of seven one-story
frame pavilions arranged en echelon, tolerably well constructed, with ridge ventilation along the entire length of the
roof. Each ward contained 50 beds and had a lavatory, bath and water-closet attached.
The increasing necessity for additional hospital accommodations caused seven additional pavilions of the same
pattern to be erected, and the inspection report of January, 1865, describes them as follows: "The prison hospital
is situated on elevated ground near the centre of the island. It consists of an administrative building two stories
in height, 60 X 40 feet, and fourteen pavilion wards, each 140 x 24, 10 feet high at the eaves and 14 feet to the
ridge, a small space being partitioned off for nurses and attendants; 50 beds to e.ach ward, giving a cubic space of
645 feet to each bed." A kitchen and mess-hall was also erected, 112 X 40 feet, situated between the two rows of
wards; to this building was also attached a well-supplied laundry.
In addition to the above tliere was a small-pox hospital consisting of six pavilion wards, each 150 x 24 aiid 12
feet high to the ea^■C8. Each ward contained 50 beds, and gave 864 cubic feet and 72 square feet per bed. These
buildings were isolated from the liospital luoiier, being situated on the Illinois side of the island. They were well
drained and supplied with every convenience.
Notwithstanding the natural advantages of the site and the substantial and complete character of the
buildings at this place the rates of sickness and mortality appear to have been high, chiefly due to an outbreak
of small-pox. Dr. Townsiiend's report, already quoted, says: "The present condition of the hospital may be con-
sidered good; but much suffering has occurred, and many deaths during the present month from causes beyond the
control of the officers in charge. Many of the prisoners arrived during the extreme cold weather, a large proportion
of whom were subsequently attacked with pneumonia. The same cold weather interfered with railway communica-
tions and prevented the receipt of hospital stores and medicines. In addition to the above, many of the prisoners
were found to have small-pox, and, of course, had subjected many others to exposure. These unforeseen difficulties
appear to have l>een met with the utmost promptitude liy the medical officers and the post commander."
The diet of both the prison and the hospital was always of good quality, ample means being afforded for
cooking the rations. No complaints appear under these headings in any of the inspection reports. In the hospital
the fund was liberally expended in the purchase of delicacies for the use of the sick. Good light bread and corn
bread, with potatoes three times a week, were issued to the prisoners.
The water-supply was abundant and of fair quality. It was pumped from the Mississippi river into a reservoir
and distributed to the camp and hospital by pipes. An artesian and three ordinary wells inside the prison enclosure
furnished a good supply in addition to that from the river.
The sinks were at first simply pits, from which the accumulations were removed by carts and thrown into the
river. At later dates these were abandoned and a large latrine was constructed in the prison, conmiunicating with
the river by means of a trench. Daily flushing swept the deposits into the river. The sinks in the hospital were
provided with ziuc buckets, which were emptied twice daily.
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AMONG CONFEBEEATR TROOPS IN U. S. PRISONS. 58
The (liaiiiaijo of tlio cauip ami hosiiital was iiatiually goud ou acoouiit of llic rolliii}; Kuifacc of the gKuiiid;
and this was improved from time to time until the drainage system was considered exeollent. ISetween (lie prison
and the hospital there was a sUiugli or hayou of some extent which was partly tilled tip and drained. ('oin[dainl
was Kometinics made in the inspection reports of the unsatisfactory character of tln^ drainajje in cold weather
when the drains were frozen up.
The following, hy Assistant Surgeon M. King Moxi.ey, U.S. Vols., is datcil February, 18lil:
" The prevalence of snmll-pox and its iiroiiorlioiuilly great mortality is a sniiject of serious eonsi<leration. 'I'lie
disease made its apjiearanco about the lust of December. The number of those alTected increased so rapidly thai
men had to be allowed to remain in barracks after the eruption appeared, thus infecting the whole )>rison. Three
small houses were used as a pest hospital. Each was capable of containing ten patients, but three times as many
were crowded into them. Two large buildings were erected soon after I assumed charge, .January IS, IKOI. 'J'li<>se
lield .lO ])atients each, allowiug over WR) cubic feet of air per man. liut as the number of cases augmented to an
alarming extent, I asked the commanding oflicer for the erection of another similar building. Five days elapsed
before the order was given to build. Meanwhile the cases increased on my hands; there was no place to ])ut theui
but in one of the barracks used for hospital jiurposes in the prison enclosure; this was filled in two days. Surgeon
A. M. Ci-.vHKE, U. S. Vols., Acting Medical Inspector, found me with 38 cases in the barracks, the accnnnilatiou of
two days, although I was removing them at the rate of twenty a day and crowding the pest-hospital in ho])es of
soon getting into the new building. Had this building been erected when asked for, no case would have been left
in the barracks an hour after being reported. Another of the prison-barrack buildings was then taken, and then
another, and one more barrack used as a ward in the hospital, making four used as small-pox wards within the
enclosure. About February 22, for several days as many as thirty-live new cases were reported daily, and during tlu^
latit two weeks of February there was an average of 20 cases each day. Three new barracks at the pest-house were
erected, making six in all. One of the small houses previously used is now used as ;i kitchen. The foftr barracks in
the Imspital and prison are now cleared of the small-pox; all I ho patients ixri'. in the six barracks anil two small
houses. There are at this time, February 29, 130 casiw; each building, intended for 50 men, contains 70, including
the nurses. A house is lieiug erected as a dormitory for nurses; this will leave more room for the patients daily
reported. There has lieen a scarcity of clothing for convalescents returning to prison, although 1 iiuido a timely
api)lication for a supply. Hence, many had to be retained who could have made way for new cases. The great
mortality results from several causes: Ist. Over-crowding, which could not be avoided. 2d. Want of proper bed-
ding, rough cots with straw being the only beds that could be procured, though now there are in n.se aliout two
hundred bed-sacks which were obtained from the iiuartermaster. 3d. Want of clothing to give the ])atients a change
on coming into hospital, in view- of their previous want of cleanliness. 4th. Insufficient vaccination. Nearly every
prisoner had a large ugly scar on his arm, the result of impure virus imposed on him while in the Southern army.
This did not jirotect him in the least. Prisoners have been received on whom the eruption a])pear(ul the ui^xt day
following their arrival, thus showing that they had contracted the disease befon! coming her(\''
Piusox AND Hospital at C'ami' JIoktox, X'Eak Ixdiaxai'Oi.is, Indiana. — This (h^pot, uscil as a camp for
t'nion troops from Apiil, 1861, was opened as a prison for rebels .lanuary 2(), lXt)2, and closcsd in August, I8(ir>. It
was establishi'd on the State fair-ground, one mile and a half northwest of Indianapolis, Indiana. The site was a
level plain, undulating but slightly in some parts, and hence possessing very poor natural drainage. The soil was
an alluvial clay ou a subsoil of gravel. The area enclosed for prison purposes was at first about twenty acres,
suliseiiuently increased to thirty, and was abundantly shaded by fine forest trees. The great objection to the site
was the absence of running water, which deficiency was repeatedly noted by the various medical olliccrs wlio
inspected the post.
The prison barracks at first consisted of a number of poorly constructed wooilen buililings which bad lieen
erected and used by Union troops. They are described in July, 18(11, as "nine dilapidated barracks, each I'lU x 24
and 10 feet high."' The ventilation of these was by ridge openings running along the entire huigth of the roofs
and by openiugs in the walls and doors at the ends and sides. They were fitted with three tiers of bunks. At
this date there were also 210 condemned tents in use for the accounuodation of the prisoners. Nevertheless these
nuarters were much crowded, there being only (JO to 80 cubic feet ]n-v man in the barracks, whili! five nuui were
crowded in each "A" tent and nine men in each bell tent. \ small isolated building within the enclosure was used
for a few cases of variola that occurred. This crowded condition continued until Sei>tember, 181)4, when the prison
area was increased by adding to it about ten additional acres of ground. In November, 18l>4, six men were crowded
into each "A" tent w hile m-w pavilion barracks were in process of erection. In May, ISfi.'), the barracks were stated
as thirteen in number, each 1.50X18 feet and 9 feet high, giving "sufficient space." Little change appears to have
occurred after this date.
Ho.spital buildings were at first extemporized by the occupancy of some of the prison-barrack buildings already
described. It ajipears that at this time many of thi^ sick and wounded were sent to the Indianapolis City IIosi)ital
for treatment. In Jnne, 18(>3, the stated capacity of these buildings was 83 beds, occupied by 100 men, many of whom
were <Mi double beds. The report for .July, 18(>:i, says: " Enlarged hospital accomnujdations are much needed at this
phne. The present facilities are too limiti'd and are often crowded beyond tlnrir capiicify." In these buildings the
air-space was often reduced to 3.50 feet per num. Few facilities wen- aflV)rded for bathing; bath-tubs were in position,
but as water had to be c;irried a distance of one hundred yards in buckets, they were seldom used. To expatid the
hospital a number of tents were pitched, but these also soon became crowded.
In December, 18(i3, the hospital department was much improveil by the erection of two new pavii.„n buililiugs,
by which the air-space was increasi'd to ooO cubic feet. In .July, 1804, these buildings were described as follows:
64 SICKNESS AND MORTALITY
"The hospital bnildings are four in numljer, one 114x20 and 12 feet high; one 100x20 and 12 feet high; one 40x20
and 11 feet 3 inches high : and one 99x24 and 14 feet high. Furniture good and sutificient. In addition a mess-room
30x24 feet, 12 feet high, and good kitchen accommodations."
The diet in both prison and hospital was good and sufficient; vegetables were freelj" used and tlie hospital
fund libei-ally expended in the inirchase of delicacies for the sick. Soft bread of excellent quality was issued daily
from the post bakery.
The water-supply, derived from wells, was sufficient for the requirements of the camp. Drainage at first was
imperfect. A ditch of irregular depth ran through the camp and carried off the rainfiill. In dry weather stagnant
water collected here and there in the deeper parts of its irregular bottom. These were repeatedly denounced by
inspecting officers, and as a result the ditch was ultimately straightened deepened and converted into a main drain
with which laterals from the area of the camp were connected.
The sinks were simply pits in the ground within the enclosure, and often so near the quarters of the prisoners
as to be oftensive. Lime was used daily as a disinfectant.
The condition of the camp during the last year of its occupation is not known, as no detailed accounts of a
later date than July, 18&4, have been found on file.
The figures for Camp Morton, presented in Table XVIII, do not include the statistics anterior to June, 1863.
An estimate of the mortality previous to that date is contained in the rejiort of Dr. Humphreys for September, 1864,
as follows: "There have been treated in the City Hospital of Indianapolis 846 rebel sick and wounded. Tliey were
all of the Fort Donelson prisoners; out of this number 7.5 died. The men were broken down in health by previous
hardships and exposure. The limbs of many were frosted while working in the trenches at Fort Donelson. The
prevalent diseases amongst them were typhoid fever and typhoid pneumonia, occurring in persons in whom the vital
forces had been reduced to the lowest possible degree; many 'dropped dead' while walking about their quarters,
without having manifested any disease, organic or functional, except great general debility. In persons of tliis
class, while moving about looking apparently in medium health, the action of the heart and arteries would be so
feeble as to be scarcely perceptible in pulsations at the wrist. These men were subsisted and treated medicinally
and surgically in the same manner as the sick and wounded of the United States forces ; the same air-si)ace in
hospital, and every facility afforded our own troops were given to the rebels. The records of the nunilier of rebel
prisoners received at Camp Morton since the commencement of the war are incomplete. Colonel Biddle of the
71st Indiana Infantry has been in command of the camp since the 28th of January, 1863. This officer reports the
number of prisoners of war in this camp since the above date to June 10, 1863, to be 4,604. The sick in hospital out
of this number were 591; of whom 43 died. About one-half of the 591 treated were wounded, among whom were
many cases of hospital gangrene. The total number of rebel prisoners brought to Camp Morton since the war began
exceeds 10,000. From the undertaker who personally superintended all the interments of the rebel dead at this
post, I learned that the total number of deaths up to May 8, 1863, amounted to 3.53; total number of hosjjital cases
treated in the period referred to 1,685."
Prison-camp and Hospit.vl at Jouxson's Island, near Saxdu.sky, Ohio. — The inspection reports of tliis
prison-camp present a most gratifying picture of its sanitary condition. It was opened some time in 1862 and closed
in October, 1865.
The island, three and one-eighth miles from Sandusky. Ohio, has an area of 360 acres. Its natural advantages
as a depot for prisoners of war were very great; the soil was aUuvial on a limestone basis; the drainage excellent;
water from the lake abundant and of good quality, and the salubrity of the site unsurpassed.
The buildings in the camp, frame structures two stories higli, with bunks along the sides, were well lighted
and ventilated by doors and windows, and at a later date by artificial openings. They accommodated 2,000 men,
giving an air-space of 300 feet per man. Their capacity was largely increased in 1864. The prison-camp was
surrounded by a high board fence, enclosing an area of 15 acres. Officers were mainly confined in this prison.
Tlie prison hospital was a two-story frame building, giving 700 feet of air-space to each of 80 beds. It was
divided into four wards with lavatories in each. Bathing facilities were afforded by the abundant water-supply
from the lake. The supply of bedding was abundant. The diet was similar to that furnished to the Union soldiers
in the post hospital. Ice was furnished in abundance. Vegetables and delicacies were freely used. The medical
officer in charge was assisted by Confederate surgeons confined in the prison.
The sinks at first were excavations in the ground, but later box-sinks, capable of being drawn out and emptied
into the lake, were substituted for the old vaults.
The natural advantages of the site rendered but little artificial aid necessary to perfect the drainage. Garbage
was stored in barrels and carted daily from the camp.
The following extract from the report of Surgeon T. Woodbridge, 128th Ohio, in charge of the hospital, sums
up the conditions affecting the prisoners under his care in a few words. The report is that for June, 1863: ''The
rations are of good quality and the cooking exceUeut. We have plenty of vegetables and an abundance of fresh
fish; pure air; pure water; plenty of wood; a police system rigidly enforced; a natural salubrity unsurpassed.
We are as perfect in what pertains to hygiene as possible."
Prison-c.*^mp and Hospital at Camp Chase, xe.\r Columbus, Ohio. — The precise date of the establishment
of this camp and hospital is not shown by the records of the Surgeon General's Office. It was used as a prison-camp
for political and military prisoners early in 1862, but the reports on file antedating January, 1863, are valueless.
The hospital was not closed until December, 1865, although few prisoners remained after July of that year.
Camp Chase prison was situated in the southeastern part of the enclosed camp, four nnles from Columbus, Ohio,
on the National road. The site had previously been a race-course and fair-ground; it was treeless and nearly fiat or
AMONG CONFEDERATE TROOPS IN TJ. S. PRISONS.
65
Somewhat basin-like, and surrounded by forests, which made it close .iiid warm in sunwner. Tlie soil was stifV,
clayey and watcr-lioldiiif;, poorly drained and destitute of runninp; water.
The buildings in the prisou-canip at early dates were poorly constructed wooden barracks, ue<rding constant
repairs to render them habitable. Dr. UrMrilUEYS considered them little better than the huts ordinarily in use for
the juoteetion of iloniestic aninuils. They were divided into three sets, known as prison No. 1, for otiicers, and Nos.
2 and 3 for enlisted men. Each prison was separated from the other, and th(> whole was surrounded by a close board
fence, fifteen feet high, with an elevated platform for the guard. These old barracks were fitted with three tiers of
bunks, and the space per uum was very small. To accommodate the largo numbers of prisoners received, tents were
pitched in the avenues between the barrack buildings, and the crowding was great. The dinu»nsions of these
buildings and the particulars of their construction are not clearly stated. At the inspection in .September, 1863,
the quarters were crowded; at this time there were confined 1,703 prisoners, of whom only 27 were sick — 25 in
hospital and 2 in quarters.
During 18(>4 the prison underwent a radical change: its area was increased, its buildings remodelled, and some
of a better character erected. Division No. 1 of the prison consisted of two barracks, No. 2 of seventeen barracks
and No. 3 of twenty-seven, making a total of forty-six barracks. Each was 100x22x12 feet, and was intended
to a<'commodate i;i2 men, giving 137 cubic feet per man. They were all of the i)avilion pattern, with door and
windows at the sides, floors well removed from the ground, ridges ventilated, and the tiers of bunks reduced to two.
Tlu^ jirisou-hospital building in 1862 and the early part of 1863 consisted of a small one-story wooden barrack,
79 X 20 X 12 feet, divided into two wards, having 600 feet of air for each of 36 beds. It was situated within the
enclosure and too near the high close fence for good ventilation. It was well sup])lii'd with furniture and cooking
apparatus, lavatories and sponge-baths. The capacity of the hospital was increased about December. 1863, by the
erection of a new pavilion, which, however, was of an inferior character. It was built of old lumber preserved
from some condemned buildings. Its size was 84 X 12 feet and only 8 feet high, allowing a little over 400 cubic
feet of air per bed. lioth of these buildings were afterwards condemned and abandoned. Now and superior hospital
pavilions were erected outside the prison enclosure. They consisted of six wards each 100 X 25 x 12 feet, affording
8.50 feet of air-space to each of 216 beds.
In additiim to these, three isolated buildings south of the prison enclosure constituted the |)e8t-hospital. Two
were used for .small-pox and one for erysipelatous patients. The small-pox hospital was 240 x 24 x 12 feet, having
a capacity of 120 beds, to each of which it afibrded a cubic space of 576 feet. These buildings were of the pavilion
pattern, well ccuistructed and .su))plied with everything needful for the comfort and well-being of the ])atieiits. The
attendance was good and careful and the supplies ample and of gooil i|uality.
In a special report dated March 14, 1865, Dr. Co()Lin(;E compared the barrack occupancy of the I'niou troops
and Confederate prisoners.
Barracks for —
No.
Length.
Width.
Height.
Bunks.
No. of
men to
each.
Air-
space.
Area.
United States paroled
18
20
Fttt.
100
60
60
100
Fut.
24
24
24
22
Put.
12
14
14
12
48
48
48
48
192
96
96
192
Fett.
150
210
210
137
Put.
12. 5
1.5.0
1.5.0
11.4
United States garrison
United States recruits _
Confederate prisoners
20
46
The diet in the prison-camp was the army ration with the addition of vegetables, potatoes, onions, etc., the
po.st bakery at all times furnishing a good supply of light bread. There appears to have been a prisoners' fund, but
no account of its expenditure is on record. The kitchens of the prison-barracks were furnished with brick furnaces
having cast-iron tops with holes for kettles. There were few complaints made by the inspectors under this head,
the whole appearing to be quite satisfactory.
The prison-hospital diet was of the same quality as that of the prison, with the addition of such delicacies as
were purchased by the hospital fund, which was expended as fast as it accrued, ,ind, according to the inspection
re|iorrs, it a])pears to have been ample for the purpose.
The supplies in both prison-cami) and hospital are spoken of throughout as having been good and sutiicicnt.
The water-supply was derived from wells, which in the early months of the occupation were not commended,
although they were regarded at a later period as capable of yielding an abundant supply of good but somewhat hard
water for drinking and cooking; it was, however, never sufficient for bathing or washing purposes, and on a few-
occasions, after prolonged dry weather, the low w.ater in the wells rendered some precautionary economy advisable.
In consequence of the nearly level surface of the camp great difficulty was experienced in eflccting a satisfac-
tory drainage. The system consisted of a main drain or ditch running through the prison-camp from west to east,
with lateral branches opening into it. But, as in the absence of running water these drains could not lie satisfactorily
flushed, they became foul and emitted disagreeable odors. On the remodelling of the camp and hospital buildings
the drains were planked or boxed, and provision was made for flushing the system by means of water from a cistern.
The defective drainage of this camp, arising from its physical conformation, was noted in almost every inspection
report, and the advisability of removing the prisoners to another and healthier site was frequently suggested.
56 SICKNESS AND MORTALITY
The sinks at first were merely pits in wliich lime a:id ashes were used as deodorizers. Much difiieulty was
experienced in keeping them in good condition. They were afterwards filled up lest they should contaminate the
water-supply, and new sinks were constructed over the drains, which were flushed periodically. Gar"bage was col-
lected in barrels and carted ofl" regularly.
Prison-cajip aIs'D Hospit.vl .\t Elmira, N. Y. — Elmira barracks were built at the beginning of the war as
a general recruiting dep6t; but in July, 1864, Division No. 3, of the barracks, called afterwards Camp Chemung,
was converted into a prison-camp. This division was situated on the river-bank a mile and a quarter west of the
town. The site was believed to be healthy; it was level, and having a sandy soil resting on a stratum of coarse
gravel a few feet below the surface, aft'orded good underground drainage. At the date mentioned twenty of the
old barrack buildings were considered fit for the occupation of the prisoners and ten new ones were constructed.
The former, 88 X 18 X 8 feet, were intended to accommodate each one hundred men. The latter, 80 X 25 X 12 feet,
were each fitted with bunks for one hundred and forty-eight men. Mess-halls and kitchens were suitably furnished.
The barracks were built of pine; they were well lighted, warmed by stoves and provided with ridge-ventilation.
The bakery could turn out six or seven thousand rations per day. Good water was obtained from two wells, and
any deficiency was supplied from the river. Lavatories and baths were not at first specially provided. Drainage waa
by means of pits dug to the porous subsoil. The sinks were covered pits, which were filled up when necessary.
The grounds of the camp, comprising thirty-five acres, were surrounded by a fence twelve feet high with a
platfornr four feet from the top. In August, over a thousand tents were pitched, each to accommodate five persons.
In one inspection report the drainage is said to have been into an open pond within the camp, thus forming what
was called a perfect pest-hole ; Vint on the recommendation of the inspector this pond was afterwards drained and au
underground sewer constructed, while defects in the surface drainage were remedied from time to time. Nevertheless
the grounds were frequently reported as in a muddy condition during wet seasons.
The prisoners were insutfieiently clothed, there being at the same time a great want of blaukets, especially
among the prisoners in quarters. A supply is said to have Ijeen received on one occasion from the Confederate
authorities. Sometimes the want of clothing was incompatible with the nuiinteuance of health, and hospital
patients, after having sufficiently recovered to be up, were obliged to keep their beds for w;iut of pantaloons.
Needs of this kind, and others less urgent, on becoming known, were relieved by the issue of hospital clothing.
Bedding was supplied in quarters only to the sick, and cousisted of sacks of straw and a Idanket. The men in con-
finement here had the full prison ration as supplied at the other prison depots. They had also a fair supply of veg-
etables purchased by the prison fund. Desiccated \egetables were at first furnished, but as they were not acceptable
to the prisoners, fresh onions and potatoes were substituted. Inspector Lymax reports on November 11, 1864, that
onions and potatoes were supplied on three days out of five, and in each of his subsequent reports speaks of the supply
of vegetables as sufficient. On one occasion he reported the beef as of inferior quality, but generally the diet is rep-
resented as good and well cooked, the kitchen being under the supervision of a special officer.
On the arrival of the prisoners, and while the hospital was in course of erection, the sick were treated in a
pavilion set apart for their recejition. Medical supplies and accommodations were deficient at this time. An inspec-
tion report dated .July 1.5, 1864, says: ''They are absolutely without the necessary medical and hospital supplies.
Requisitions were made three weeks ago. Until the day of my inspection the sick were laid on the naked liunks
from the inability to o})taiu straAv, Tliis was finally procured by the commaniliug officer after considerable difficulty,
and arrived during my inspection. When the reiiuisition for medicine and hospital supplies is filled they will be in
every respect suitably provided in a sanitary view." In August, medicines were reported al)uudant: but the sick-
ness was large and the mortality great. " This,"' said the inspector, "is due to the broken-down condition of the
prisoners on their arrival." There were at this time 9,170 prisoners, of whom 553 received hospital attendance and
558 were prescribed for at sick-call.
The medical staff consisted of a surgeon in charge and eleven or twelve assistants. Confederate surgeons
sometimes assisted in attending to the sick. Visits by the medical officer were made twice a day, and in special cases
oftener; and any complaint against a medical attendant of inattention or harshness was promptly investigated.
Competent persons were selected from among the prisoners to compound prescriptions and to act as nurses and cooks.
In August the hospital consisted of three wards of seventy beds each, and one of eighty-two beds, with 624
cubic feet of space per bed. On October 4th there were 9,063 prisoners, of whom 3,873 slept in the l)arracks and
5,190 in 1,038 tents. The air-space in the larger barrack buildings was 111 cubic feet per man, in the smaller build-
ings 92.5 cubic feet. There were 1,560 men on the sick report. The hospital had been extended, consisting now of
six new wards averaging 62 beds each, with 654 feet of air-space per bed, and four barrack-buildings averaging 70
beds, with 342 cubic feet per bed.
On November 11, an additional hospital ward of 62 beds, with 654 feet of space per bed, had been completed,
and one of the old 70-bed wards was vacated for use as quarters.
In January, 1865, with a view to diminish the sickness and lessen the mortality, the Medical Inspector made
the following recommendations: "1st. That additional wards be constructed and provision be made for hot-water
bathing of the sick. It is impracticable to give this thoroughly in the wards, and it is very much needed. 2d. That
hospital clothing be allowed, which would aflbrd an opportunity for cleansing the woollen and underclothing of the
patients. 3d. That all the old barracks be provided with additional windows. In the winter season the men con-
fine themselves to the wards as much as possible for warmth, and the closing of the doors and windows renders these
barracks too dark. 4th. That more cubic and superficial space be allowed by the erection of additional barracks.
The type of disease among the prisoners is that which results from over-crowding : there is no acute disease,
everything assumes a typhoid type."
AMOXG CONFEDERATE TROOPS IN V. S. PRISONS. 57
Tlio condition of the camp at tlic date nientioneil is tluis descrilicd: "The whole appearance of this cam)) is
greatly iminovcd since the last inspection. The sick in hospital and (|uartcrs are now vigilantly watclicd; the food
is good and well I'ooked: coal stoves have heen sulistitnted for wood, and the police of the barracks is ipiite as good,
and. I think, hetter than in most regimental liarracks." Small-pox hrokc ont anmng the prisoners about this time.
From December I, 18t>4, to .lannary 21, IStio, there had been 397 cases. To isolate these properly a small-pox hospital
liad been improvised with tents: lint a new pavilion was being coustnictcd to replace it. Dnriug .January ."ijiKK)
vaccinations and revaccinatious were performed. To replace, and ati'ord better shelter than the tents, twenty-four
new barracks, each 10() X 2-1 X 12 and 3 feet pitch of roof, had been completed by the midille of March, and six
more were in course of construction. These are .said to have given 180 cubic feet of air-space per man. At this
period there were 1,738 on the sick-list in a total of 5,934 prisoners, and nniny of those iu (jnarters were very sick
and stood aa much in need of suitable ward-accommodation as those in hospital, into which, for want of room,
they could not be received. "The condition of the patients is pitiable," says the inspector; "the diseases are
nearly all of the typhoid type, and much of the sickness is justly attributable to crowd-poisoning. In addition to
this, the clothing during the winter was insuflicient. The deep mud prevents the exercise of the jirisoners in the
ojicn air. and there is no occupation for most of them to relieve, in a measure, the depressing intluencc of prison-life.
The Fort Kisher prisoners, especially, arrived in cold weather very much di'])ressed. poorly clad, and great numliers
were soon taken sick with pneumonia and diarrluca, rajiidly assniuing a typhoid character. The surgeon was
recommended to press constantly upon the commandant the necessity fur ai)iiropriating some of the best barra<^ks
for additional wards, the immnliatc completion of the Hoor-ventilalion, thi' alteration already connnenceil in the
hos))ital latriiR's. and the free use of permanganate of potash throughout the barracks and of bromine in the wards.
1 would renew the recommendation, made iu my .January rcjiort, that additional light be given to the old barracks,
and greater fiicilities for warm and cold bathing as prophylactic measures."' Subse(|uently, up to .June 22, 181S,
the date of the last report, the sanitary condition of the camp and buildings is reported as having been good. The
number of prisoners continued to diminish and the ratio of mortality grew steadily less.
Prlsox Dei'At .\t Fort Delaware, Delaware. — This fort assumed importance as a prison depot in June, 1803,
when 8,400 men captured by (ieneral Urant in his operations against Vicksburg were sent to it for confinement. On
.June 3. Medical Inspector E. 1'. Voi.l.f.M, T. 8. Army, inspected the post in accordance with instructions from the
Surgeon (icneral, to determine the character and extent of the hospital acconunodations to be provided. At this
time barracks for 8,lW)0 men were in course of erection. The coiulitiou of the post and prisoners when at its worst,
that is, shortly after the arrival of this large body of men, is fully depicted in the following report by Assistant Sur-
geon C. H. Al-DEX. r. S. Army, dated July 11, 18(!3, on the causes of the sickness and mortality in the canij) :
"Fort Delaware is situated on an island iu the Delaware river, below Philadelphia and nearly opposite Dela-
ware City. The island has an area of about 90 acres and the soil is of a low marshy nature. Fort Delaware proper
is a large casemated work of granite and brick, which accommodates but a small i>art of the inhabitants of the
post. It has within it the different oflices of the post, officers' quarters, rooms where the officers, prisoners of war,
are confined, and guard-house for the prisoners of the U. S. troops. Outside the fort are numerous wooden build-
ings of more or less recent date, accommodating the rank and file of the prisoners of war, workmen, the hospitals,
sutler's store, etc., with a few cottages for officers' quarters, and a number of tents occupied by the troops composing
the guard. There are now some 7,100 prisoners confined on the island, including about 3(lO officers. The guard
numbers about 8t)0 men.
The barracks for the prisoners of war are two in number, the old and the new, each composed of one-story
wooden builitings enclosing a rectangular piece of ground. They are ordinary shed-buildings with shingle roofs.
The ventilation of these buildings is very defective. The old barrack has small windows along the side at consid-
eralde intervals, and a ridge ventilator along the whole length of the building. The new barrack, though some-
what higher, is still worse in its facilities for ventilation, the ventilators at the ridge being only occasional and placed
at considerable intervals. The interior is arranged with a central aisle and on either side three tiers of bunks or
rather shelves, inclining towards the centre. The prisoners lie on these shelves with their heads directed to the
exterior of the building. In the old barrack are confined 3,500 men, a number, it seems to me, far too great for its
capacity. A rough estimate, but I believe a tolerably correct one, shows that each occupant has less than 100 cubic
feet of air, iu connection with which should be remembered the small opportunity offered for the renewal of the air.
The new barrack is not yet entirely occupied, owing to a portion of the building having given away and re(|uir-
ing repair. This will in a measure account for the crowding of the old barrack, which will, I was assured, be
relieved as .soon as the new is in condition to be occupied. There are also attached to the barracks mess-halls
and kitchens. The mess-halls have long narrow tables at which the prisoners stand at meals. The barracks,
mess-halls, kitchens and the prisoners themselves were in a very dirty condition : some portions of the buildings much
more so than others.
The island is intersected by several ditches and inlets, but the drainage is very imperfect, and the grounds
insiile the prisoners' barracks were rendered very muddy by the recent rains. The water is now excluded from the
moat around the fort to enable the workmen to Iiuild the counterscarp. The filth received into this moat from the
drains and privies of the fort is therefore not removed by the water and lies exposed and decomposing, causing most
disagreeable effluvia on a warm day. The water-closets for the prisoners, as well as for all those living outside of the
fort, are on the edge of the island projecting over the water.
The water on the island is chiefly rain-water of good quality. At intervals along the outside of the liar-
racks are tanks for the collection and storage of the rain-water. Of the.se there are a large number, and many of
them appeared pretty full from the recent rains. There are also tanks connected with the hospitals and other build-
Med. Hist., Pt. Ill— 8
58 SICKNESS AND MORTALITY
ings aiovind tbe fort. Under the casemates of tlie inain work are a series of large cisterns which are designed to
be filled hy the rain-fall on the parapets percolating through the earth, sand and gravel (forming a filtering
arrangement), down into them. They are of large capacity, hnt at present have a small supply in them. AVhcn
rain-water is scarce it has been the practice to send for water by vessel to the Brandy wine; some of the water now
on the island is from this source. The water of the Delaware river, which surrounds the island, is, I learn from
credible persons who have lived there some years, considered entirely fit for drinking in the winter and early spring.
At other .seasons it is soniewliat brackish. If taken at low-water, however, it is not even in summer considered
decidedly injurious. As far as I could learn, and I took the statements of several officers and of the prisoners them-
selves, the supply of rain-water has as yet been sufficient for the garrison, and has been enough also to aftbrd drink-
ing water to the prisoners. The latter use the river water in part, if not entirely, for cooking purposes. With the
present number of persons on the island the supply of water on hand would certainly fall short soon. Measures are,
however, being taken, by bringing water from the Brandywine and by pumping up (by steam apparatus) water from
the river, throwing it over the parapets and allowing it to filter through into the cisterns beneath, to obtain a
good supply. A condensing apparatus has also been ordered.
The ration issued to the prisoners is the ration issued to the U. 8. Army before the late increase in quantity.
The meat is brought, already butchered, from the main land, and appears to be of good quality. The bread is partly
baked on the spot and partly procured from Delaware City. The latter is very good, but the former, though of
tolerable quality generally, appeared in one or two instances a little sour. Besides this, hard bread is also supplie<l
to the prisoners.
There are five hospitals on the island, one for the garrison and four for the prisoners of war, all outside the
fort. They are frame buildings. Two are old, badly ventilated and poorly adapted for the purpose; the three
others are mere sheds, which have, however, the advantage of being tolerably ventilated through the chmks of the
rough boarding. One of the wards of the post-hospital was particularly small, and though it had but 17 men in it,
they had an allowance of less than 300 cubic feet of air per man; it was besides liadly ventilated. Two hospital
tents are also occupied by sick prisoners of war. All the hospitals, but more particularly those of the prisoners,
were in poor police; the grounds around them particularly so. There was a great deficiency, or rather an almost entire
want of stores, clothing and medical supplies of all kinds; bedding was also ^ery insufficient. There were no bed-
steads for most of the sick prisoners of war. A sufficiency of stimulants for immediate use is, I was informed,
obtained through the Quartermaster's department.
Assistant Surgeon H. E. Sillimak, V. S. Army, is in charge. It is due to him to say that he was assigned to
this post but a few days ago. I have no doubt he will immediately make efforts to have the defects above mentioned
corrected. He informs me that four days since he made requisition for all necessary supplies on the Medical Director
at Baltimore. The books and records of the hospital were in much confusion, or rather none were, I believe, kept
except a register of the sick of the garrison and a morning re'port.
This want of correct records makes it difficult to obtain exactly the number of sick, deaths, etc., but the fol-
lowing data are believed to be tolerably accurate: There are 210 sick prisoners of war, among whom are included a
few wounded .iu.st received from tbe battlefields in Pennsylvania. The morning report shows that there are 69 of the
garrison sick, 24 being in hospital and 45 in quarters. The chief, and I may say almost exclusive, disease is chronic
diarrhiea. Hospital reports reveal the fact that the disease and the incident mortality is almost entirely confined
to the members of the rebel regiments from Alabama, Mississippi, and other southern states, taken prisoners by Gen-
eral Grant's army around Vicksburg. A large part of these men came hither broken down, emaciated and already
the subjects, for some weeks or months, of this disease. The long journey from Vicksburg to this place seems to
have exhausted all their vital powers, and many died soon after their arrival. There is very little sickness and
hardly any mortality among the prisoners of war brought from General Lee's army, or "any other source than the
army around Vicksburg. All are equally exposed of course to any imperfect hygienic influences existing on the
island; but the fact that the sickness and mortality are almost entirely confined to the prisoners from Vicksburg,
shows, I think, that the conditions under which they are now placed are chargeable neither with their sickness nor
mortality.
It is important to bear in mind that the majority of the prisoners have been upon the island but a few days.
The want of ventilation, the over-crowding and bad ])olice of the pri.soners' barracks, which I have mentioned, have
not as yet had time to produce any marked effect on their health. I cannot but conceive, however, that serious
results will ensue, if these causes are allowed to operate for any length of time, especially at this season.
I deem it my duty, in view of the pressing necessity of the sulyect, to call the attention of the commanding gen-
eral to the want of ventilation of the barracks, the over-crowding and the want of police. The iirospect of a deficient
Bupjily of water had fully engaged his attention, and he was using his liest efforts to provide for it. He requested
nie to point out the fact that the tanks attached to the barracks should have been double the size, also the need of
a water-tank boat for bringing water, and suggested that the new hospital for 600 beds, now in progress of contruc-
tion, should have tanks twice the size of those contracted for.
The attention of the medical officer in charge was called to the urgent necessity of taking measures to provide
hospital stores and medical supplies. He was advised to make an immediate special requisition on Surgeon MURRAT,
the Medical Purveyor at Philadelphia, for such articles as were most needed, stating the emergency. He was also
advised to have the hospitals and the grounds around them thoroughly policed, applying for a detail of men, if
necessary, and to have the buildings wliitewashed inside. It was recommended to oljtain additional hospital tents
and remove into them the sick from the crowded wards of the garrison hospital, and also to have a pig-sty near one
of the hospitals taken away. Several benevolent individuals having oft'ered contributions, he was advised to accept
AMONG CONFEDERATE TROOPS IN V. S. PRISONS.
59
and invite tliem, e.s))f(iall.v of uncU'relotliiiij; anil liospital stores. This seems to be the more neoesHiiiy, as at presiMit
there is no husi)ital fnnil with which to ])iii'(hase extras.
The snhject ofalhnving the ]>risoiiers to hathe unfortunately escajjeii my attention. I was informed, however,
liy one of the oltieers of the ))ost, that it had not l)een i>erniitted for the othcers, and tin; coiulitiou of the men eer-
tainly indieated tliat tliey have not enjoyed an.v greater privihiges in tliis respect. If occasional bathing could not
onl.v he allowed hut conii)elled, it would of course contribute materially to tlio health of tho prisoners, and there
seems to be no good reason why, umh'r proper and sutlicicnt regulations, this could not safely be provided for."
Prisox-C'.\m1" and Hospitai. at Point Lookott, Makyi.and. — This camp was establishi-d in August, 1K68, on
the eastern side of the point at some distance north of the site of the Hammond (ieneral Hospital. In his re)iort for
.Tuly of that year Medical Inspector (ieneral .1. K. Baunks, V. S. Army, mentioned the j)roposed settlement of ten
thousand prisoners in the vicinity of the liospital, and called the attention of the Surgeon (leneral to the i\irt that
at least 700 of the beds of this establishment would be reiiuired for the use of tlie sick among this nunilier of pris-
oners. The point was sandy and sparsely dotted with shrubby vegetation. The site was considered liealthy, Tho
prison-area was surrounded on three sides by a stockade; on the east side it opi-ned on Chesapeake Bay. One or two
gun-boats guarded the water-front of the camp. The prisoners were sheltered in Sibley and A tents, which were
pitched in regular lines separated by well-graded streets. One divisicm of tho prisoners occupied cracker-bo.v huts,
built by themselves out of such timber as was obtainable on the point and shingle-like fragments of the empty hard-
bread boxes. At first the sick were sent to the Hammond Hos|)ital, but after a time a prison hospital, in which cases
of a less severe character were treated, was established w ithin the stockade. The water-supply was from a nnnrber
of wells which yielded each from utM) to 1,000 gallons daily, liut diarrlnea was sometimes attributed to its use. The
soil of the camii-site was kept unusually free from excreiiu^ntal taint, as the sinks were built over the waters of the
bay, which promptly carried off the depositeil filth.
The first, and perhaps the only, report of special interest from this camp contains a protest against over-
crowding. It was written by Surgeon Jas. II. Thomi-son. U. S. Vols., Surgeon in charge, .lune 30, 18&1 : "Several
thousand prisoners captured during the present campaign have been received into c.iniii during the month of .June.
Many of these wen^ suft'ering from exhaustion and diseases incident to an active campaign. It will he perceived by
a reference to the mortuary report that most of the deaths during the month occurred anu)ng these new arrivals.
The types of all diseases occurring in camp have been nmre aggravated than during previous months. Wounds,
though generally progressing favorably, have in several instances proved troublesome from gangrene and proneness
to secondary ha-morrhages. Only one case of variola has occurred and fifty-five cases of measles; the latter disease
is increasing, the former nearly extinct. Requisition has been made for vaccine lymph to protect the new arrivals.
Subjoined is an extract from a report forwarded to the commanding officer of the Post June 2S, 1864 : —
' I have the honor to call the attention of the commanding officer to the already crowded condition of the pris-
<niers' camp at this post, and as sanitary officer of the camp to respectfully protest against the reception of additional
numtiers of prisoners, there being now fully fourteen thousand persons within the camp, and nearly twenty thousand
on the point, including the I'. S. Hammond General Hospital with one thousand three hundred wounded men, the
contraband cam]) of indefinite numbers, the Qnartermast<'r's department and troops of the garrison. In addition to
tliese are the Quartermaster's stables with, I suppose, two hundred and lift.v horses and mules.
The reasons why I am urged to make this protest are:
1st. The limited area of the camp and of the occupied surface of the point.
2d. The already insufficient and injurious quality of the water. According to the results of analysis th<^ water
of some of the wells is unfit for use, and to this I attribute largely the increased prevalence ami fatalit.y of disease
during the past month.
3d. Though the police of the camp is, and has been for several months past, most excellent, still every precau-
tion against epidemic disease, -with this over-crowding of the camp not only continued but rumor says yet to bo
increased, will, I fear, prove futile, and we may see ere the summer is past an e))idemic that will decimate not only
the ranks of the iirisiiners, but affect alike all the inhabitants of the point, —
I therefore recommeu<l to the consideration of the commanding officer:
1st. That no greater number of prisoners or troops than at present oecujiy the ground be allowed upon the point.
2d. That condensers be at once j>ut nj) to furnish a sufficient quantity of pure water.
3d. The diminished issueof salt pork and the largely increased issue of fresh vegetables; this in consideration
(d' the scorbutic tendency and character exhibited in the majority of diseases oci-urring in the camj).
4th. The immcdiale construction of barrack-hospitals for the accommodation of two hundred sick.' ''
The condensers were not furnished, but to supply the increased necessit.v for water a numlier of new wells
were dug. Free issues of vegetable food were made to the prisoners and a post-hospital of six wards was commenced
outside the stockade. Large numbers of the prisoners were employed under guard on this and other work in the
vicinity of the camp. The details for such duty were eagerly coveted as furnishing occupation and change of scene,
and entitling the laborer to extra rations or special issues of tobacco, as might be desired.
By orders datc<l .\ugust 31, 18f)4, fron\ headquarters of the military district in which the cami) was situated,
the jirovost marshal was charged with the duty of inspecting the camp and hospital of the prisoners of war. Daily
inspections were enjoined, and weekly reports required, covering such points as personal ideanliness, clothing and
bedding, (juarters, kitchen and messing, police, sinks and drainage, hospital wards and attendants, etc.
From a perusal of these rejmrts, now on tile in the office of the Adjutant (Jeneral of the Army, it is evident
that few prison-camps were in better condition than this depot at Point Lookout. During the warm months tho
prisoners were required to liathe and change their underclothing once a week. In fact, many took frequent .idvantage
60 SICKNESS AND MORTALITY
of the general permission to 1)athe in the waters of Chesapeake Bay. During the winter the facilities for personal
cleanliness were not so satisfactory. The water-supply from welhs, twelve to twenty feet deep, was at first sufficient
for all the needs of the camp; hut as fresh coniraituients were made new wells had to be diig, and on a few occasions
of large and unexpected increments of the population, as for instance, on April IG, 186.5, when over 5,00(1 were
received, iirecaiitions had to be taken against waste of water until new sources of supply became available.
Besides the ordinary body-clothing, every prisoner was furnished with an overcoat and blanket and a change
of underclothing. On each of th(^ weekly reports are noted the number of prisoners received and the articles of
clothing, etc., Issued. Sometimes, when ,a large commitment was made, the clothing on hand was insufficient for the
supply of the new arrivajs. Thus, although during the week ending October 16, 1864, 1,000 overcoats, 1,800 blankets,
402 blouses, 202 pairs of drawers, 168 pants, 650 shirts, 6,50 pairs of shoes and 380 pairs of socks were issued, it is stated
that to make the prisoners comfortable and provide each with a blanket, further issues of 4,000 shirts, 3,000 pants,
2,500 pairs of shoes and 1,500 blankets were imperatively recjuired. Requisitions for needful articles were as a rule
promptly honored. The quartei-ma.ster had on hand at this time a large number of pants, but as they were of the
regulation blue color it was deemed inadvisable to distribute them. The similarity in the dress of the guard and
prisoners would have facilitated cscajie, particularly as over 900 of the prisoners were daily employed on the public
works outside the stockade. During the winter some of the prisoners received extra articles of clothing from their
friends in the south, and on February IS), 1864, twelve bales of blankets and one case of socks arrived from New York
through the Confederate Agency for the supply of prisimers. These, and suUsec^uent supplies from the same source,
were distributed by a committee of prisoners to whom this duty was assigned. The report of March 5 states that
two other lots of clothing had been received from General Bk.\le, the rebel agent in New York, and that of March
26 has the further statement that "the supplies of clothing furnished by the Reliel authorities are quite liberal
and timely."
The quarters consisted of Sibley tents, twelve men to a tent, and A tents with four men in each. No descrip-
tion is given of the character of the make-shift shelters constrncted of cracker-boxes and fragments of old lumber,
but as permission to build was regarded as a favor, it seems as if these compared favorably in point of comfort with
the tents, one-third of which, towards the end of the occupation of the camp, were reported as unserviceable.
.Six kitchens, with large mess-halls attached, were used in the preparation and consumption of food. The
rations were uniformly of good quality and well cooked. At the time these inspections were instituted vegetables
were issued freely to counteract the tendency to scorbutic manifestations among the prisoners, and these issues
appear to have lieen kept up to the end.
The camp was jireserved in an excellent state of police. All cleaning was completed before 9 A. M., at which
time the iirisouers formed line in their respective divisions and were inspected by the provost marshal. To supple-
ment the sinks, boxes were in use for the convenience of the prisoners during the night. These were removed in the
early morning by the police parties.
At the suggestion of Surgeon Thompson nine hospital wards of sixty beds each were built outside the stock-
ade; they were reported finished on October 30. There were in addition one hundred and twenty hospital tents
floored with lumber and fitted up with hospital beds. Wards were set apart for the treatment of measles, small-pox
and erysipelas. These, with a full stall' of medical oHicers and attendants and ample supplies of medicines and medical
comforts, were provided for the cure of the prisoners when sick and as a relief to the wards of the Hammond Hospital,
which, however, continued to keep its doors open for the reception of prisoners when, as was usu.ally the case, the
prison-hospital failed to accommodate their number. On December 18 Surgeon Tho.mp.son insisted lui the necessity
for increased hospital facilities, but no action was taken on this recommendation as the Hammond Hospital at all
times acted the part of a prison-hospital.
Occasional remarks on the reports of the provost marshal by Brigadier General James Bitrne.s, cununandiug
the prison-camp, testify to the existence of a uniformly satisfactory condition of affairs. "I have," he s.ays on the
report of November 6, "nothing particular to add to the statement of the inspecting officer except my general
testimony to the kindness manifested by the different officers connected with the duties of the government and
discipline of the camp. Fortunately the general good conduct of the prisoners renders unnecessary any act of
severity towards them, and is at the same time sufficient testimony as to the mode of their treatment."
The following extract from a report of Assistant Surgeon J. C. McKee, U. S. Array, dated .July 1, 18ti2, shows
the insanitary conditions at one of the minor or temporary prison-camps — that established near Springfield, Illinois:
" Camp Butler, Ii.unols, is situated on the Great Western Railroad, six miles from the town of Si)ringfield.
The camp is established on a rather high and rolling piece of ground, surrounded by a high board fence, enclosing
some fifteen acres of land. It was originally intended as a camp of instruction for volunteers. The barracks were
built for two regiments. They are mere shells, single boards forming the sides and roofs; the sides very low, about
eight feet in height ; the roofs covered with tarred paper. Erected by contract they afford protection neither
from storms nor heat. During this month the thermometer has been steady at 102° for days in my own room. The
effect of such intense and continued heat on the sick and well in these miserably constructed barracks has been
prostrating in the extreme. Tho prisoners of war, over two thousand in number, occupy the rows of barracks on
the right ; in front of these there are two rows of tents on a main street also occupied by them. Four of the bar-
racks in this row are used as hospitals, part of another as a drug store. A line of sentinels surrounds all, leaving
ample room for the prisoners to exercise; but they are generally indifferent to this and to their personal cleanliness.
Two other hospitals outside of these lines are now allotted to convalescents on account of the shade. On my
arrival here in May I found the hospitals, six in number, in a miserable sanitary condition. No one had taken
the authority or trouble to better this. The floors were filthy; deodorizing agents were not thought of; slops and
AMONG CONFEDERATE TROOPS IN U. S. PRISONS.
61
liltli wore thrown imli8crimiuately around. Tho sick were crowded in wooden bunks; some on tlie tloor, many
without blankets, and nearly all without straw, either new or old. No attentiou was paid to ventilation or drain-
age. Tho stench of the wards was horrid and siekeninj;. Food was abundant but badly prepared; niedioiues were
delieient. The stewards were ignorant ami negligent of their business; the nurses and cooks insubordinate and
inattentive to the wants of their sick companions. The condition of the prisoners, many of whom had been brokeu
down in service prior to their capture, ojjened a favorable and unlimited (ield for the develoi>meiit of low types of dis-
ea.se. and accordingly typhus aud typhoid fevers, pneumonia, erysipelas, etc., raged, with violence and great fatality.
To carry out my ))lans of improvement reciuired much explanation and persuasion. I was successful in what
1 undertook for the comfort of these unfortunate sick. Floors were scrubbed; lime applied freely on the walls and
Hoors; ventilation aud drainage attended to. A fever hospital (making seven) was established; another hospital
was used for pneumonia ; another for erysipelas. The surgeons (i)risoner8 of war) were assigned to their own
hospitals : stewards and nurses were encouraged to emulate each other in the cleanliness of their wards — all
with tlie happiest etfects. Cooks were supplied with necessary kitchen furnifuro; barrels were procured for slops;
water was furnished in abundance for the sick: wards were limited to the number of 30 patients. The hospital
fund procured many necessary articles such as ice. The Medical Purveyor at Chicago sent nu' a full supjdy, according
to the Standard Supply Table, for six months. A drugstore, under an excellent druggist, was established. A(iuantity,
surticient for a change, of shirts, drawers and sheets was obtained from the Quartermaster; fresh straw and lied-sacks
were also secured. Ihider these changes the ditl'erence in the mortality of my hospitals was remarkable and exceed-
ingly gratifying. During the month of May one hundred and twenty-three died, whilst in June only thirty died.
Of twenty-four ea.ses of camp fevers (typhus) four died ; of fourteen cases of tyjihoid two died; of thirty-
three cases of coninion continued fever two died. In two cases 1 was unable to diagnose whether they were typhus
or typhoid until after a post-morteni examination. The former disease was sudden in its attacks; in two cases
the patients died on tho third day. Ammonia, tonics and stimulants had to be used in large quantities. One case
(I thought of fatal relapse) was saved by blistering the whole length of the spine with ammonia and liiustard.
Typhoid or enteric fever was treated much in the same way, with the addition of oil of turpentine, of which I cannot
sjieak too highly. Quinia had to be employed freely among these nu>n in nearly all diseases. They generally come
from miasmatic districts. I can speak with the highest satisfaction of the use of muriated tincture of iron in the
treatment of erysipelas; alternated with quinia it-coutrolled the disease in all its forms. I found local ap))lications,
as of iodine and nitrate of silver, unsatisfactory in their results, not controlling the spread of the di.sease. I
abandoned their use and applied emulsion of flaxseed, saving pain and trouble to my patients. The two fatal cases
reported were complicated with other diseases."
Having obtained from this investigation of the reports of the medical inspectors some
idea of the unhygienic surroundings of the prisoners at these dep6ts, the following table,
contrasting their mortality-rates from all diseases and from certain prominent classes of
disease, may be consulted with advantage:
Table XXI.
Comparing the Annual Sichiess and Mortalily from certain Specified Diseases at the Principal Depots
for Rebel prisoners.
Name of Prison.
Camp
Douglas,
Alton,
111.
Rock
Island,
IlL
Camp
Morton,
Ind.
Johnson's
Island,
Ohio.
g^»P Elmira,
Fort
Delaware.
Del.
Point
Lookout.
Md.
All these
depots.
Anonal sick-rate per 1,000 strength . . .
3,757
lo.ora
1,575
1,485
811
i, ■. .. 1.544
3,549
2,471
2, 997. 6
Annual death-rate from —
Continued Fevere
19.2
12.7
36.7
3ai
2.1
70.7
24.5
62.0
188.0
80.2
2.1
96.6
6.4
6.1
51.0
42.5
1.6
46.4
7.0
19.9
14.3
52.8
1.0
82.5
5.9
2.3
3.8
10.5
0.0
5.7
10.4
6.7
71.6
44.6
1.0
188.6
21.2
9.9
58.9
211.5
3.0
117.3
12.7
14.2
38.5
32.4
7.7
32.7
12.3
9.2
18.9
116.3
9.5
23.7
13.6
12.6
42.3
rj.0
4.3
61.7
Diarrhtea and Dysentery
Scurvy '.
AU diseases
314.5
509.4
186.1
196.8
35.4
34a a
444.1
179 1
snfi. fi
o-ui 4
[ Percentage of &tal cases
5.7
5.0
11.8
13.2
4.4
7.2
sas
.5.0
8.4
7.7
Annual death-rate from disease per
1 1,000 men admitted.
44.1
55.0
98.0
46.7
9.8
75.2
241.0
45.4
46.4
6a 7
62 SICKNESS AKD MORTALITY
The average death-rate from disease, 230.4 annually per thousand prisoners present,
was exceeded at the three depots, Alton, 111., Elmira, N. Y., and Camp Chase, Ohio. At the
first named of these prisons the high rate of 509.4 annually per thousand, calls for special
inquiry into the conditions that produced it. Excepting scurvy, every one of the diseases
mentioned in the above table had at this post a death-rate higher than among the prisoners
generally. The exception suggests that here the inmates had a better and more varied
diet than was served at prisons where the death-rate from disease was below the average,
as at Fort Delaware and Point Lookout; the diet, at least, was apparently not responsible
for the great mortality. This large death-rate seems at first sight an argument against the
use of permanent brick or stone buildings, like this convict prison, as depots for the safe-
keeping of prisoners of war. The annual rate from the eruptive fevers, 188, as against 42.3,
the average among the prisoners in all the depots, miglit be held as illustrating the ravages
of small-pox when such close ill-ventilated buildings become infected. The death-rate for
the continued fevers, 24.5, nearly double that of the same fevers among the prisoners as a
whole, might be regarded as further testimony to the influence of crowd-poisoning within
substantial walls as compared witb the influences developed by similar crowding in tents and
cheaply constructed wooden pavilions. But when it is observed that malarial fevers also
were largely more fatal than at any of the other depots, although the penitentiary was on a
high, di-y and well-drained site, it must be concluded that the facts, so far as presented, do not
include everything bearing upon the mortality-rate per thousand of strength at this post.
The vast number of cases, 10,072, taken sick annually at Alton in an average strength of
1,008 men, equivalent to ten entries on sick report per man during the year, also requires
explanation. This is found in the fact that the strength present was not a settled population ;
it consisted of constantly varying elements. Detachments of prisoners were receiv^ed, bring-
ing with them their sick to augment the sick report, while generally only the well men,
those fit to travel, were exchanged, released on oath or enlisted into the service, the sick
remaining to swell the mortality lists of the post. The number of persons committed to
this depot was 9,330, and as the average strength was only 1,008, the stay of each prisoner
must have been of comparatively short duration. Practically the strength present was
changed 9.2 times during the period of its occupation as a military prison, or 3.2 times
annually. When the deaths are viewed in connection with these facts, Alton will be found to
have been by no means the terrible pest-hole suggested by the enormous rate of its cases to the
average of its strength, or bj- the annual demise of more than one-half of its population.
All the other depots except Fort Delaware and Johnson's Island had a larger percent-
age of fatal cases of disease than the Alton jienitentiary. The Fort Delaware rate of 5.0
per cent, equalled that of Alton; only at Johnson's Island was the rate of fatality smaller,
4.4 per cent. The ratio of deaths to cases among prisoners is, however, not of much value,
as uncertain numbers of slight cases were not taken upon the report. But when the deaths
are considered in relation to the number of persons who entered the penitentiary, the annual
rate of 55.0 per thousand will be found less than the average rate of all the prisons, 65.7 .
per thousand.
Alton may not, therefore, be considered as having been the worst specimen of our
northern prisons. On the contrary, but for the heavy mortality of its sraall-pox epidemic,
it would have compared favorably with any of the others except the depot at Johnson's
Island, Ohio.
AMONG CONFEDERATE TROOPS IN U. K. PRISONS. 63
Similar changes, to some extent, took place at all the other prisons; and their influence
must be considered in estimating the unhealthiness of these depots from the death-rates
expressed as ratios of the average strength present. A statistical table contained in a
report of the Adjutant General of the Army, appended to the Report of tlie Committee
on the Treatment of Prisoners of War, gives the total number of commitments to eai-h
of the prison depots: Gamp Douglas, 111., received 26,060 men; Alton, III, as already
stated, *9,330; Rock Island, III, 11,458; Camp Morton, Ind., 12,082; Jolinson's Island,
Ohio, 7,627; Camp Chase, Ohio, 16,335; Elraira, N. Y., 12,147; Fort Delaware, Del.,
25,275; and Point Lookout, Md., 42,762.*
When the deaths are calculated as annual ratios per thousand of these commitments,
the depot at Elmira, N. Y., and not that at Alton, 111., stands forth as the most insalubri-
ous of these prison-camps. Not only had it a high mortality-rate, 444.1 annually per
thousand of strength, but the percentage of fatal cases, 28.8, was more than double that of
any other depot. The latter rate, like the corresponding figures from tlic Audersonvillc
prison, gives no true expression to the ratio of deaths to cases, but it indicates sucii an
extensive prevalence of disease that only the serious cases, too often destined to be fatal,
were taken up on the registers of sick. The death-rate was equally high when viewed in
relation to the commitments, 241.0 annually per thousand, as compared with 55.0 at Alton,
or 65.7, the average of the prison-camps. Diarrlupa and dysentery, which caused more
deaths at this depot, in proportion to the strength present, than were occasioned by all dis-
eases at some of the other camps, and pneumonia, which produced a rate nearly double
that of the average of the prisons, were the diseases which gave Elmira its unenviable
notoriety. From the reports of the medical inspectors it is evident that while a large
mortality was undoubtedly referable to over-crowding, insufficient hospital accommodation
and insufficient protection from the cold of a northern climate in the earlier history of the
depot, the main influence underlying all these and raising them into strong relief, was the
broken-down condition of the men at the time of their commitment: most of them suflPered
from diarrhoea of a chronic character. Of the 1,394 deaths attributed to diarrlioja and
dysentery on the records of this camp, 1,376 were reported as from chronic diarrhoea and
only 6 from acute diarrhoea, 7 for acute dysentery and 5 for chronic dysentery.
Turning from the high rates prevalent at Elmira, it is a pleasure to point out the 35.4
per thousand of strength which constituted the annual niortalitj^-rate at Johnson's Island,
Ohio, its fatality rate of 4.4 per cent, of the cases and its 9.8 deaths annually for every
thousand commitments.
The absence of Confederate records showing the general condition of the mun on active
service deprives us of the ability of learning from that source their probable state of health
at the time of their capture. The few statistics presented in Table XIV indicate that the
Confederate sick-rate was considerably greater than that of the Union forces, and that
diarrhoea, dysentery and pulmonary affections, exceedingly prevalent in both armies, were
more prevalent among the southern troops. In Table XIII these diseases were observed
to yield at the same time a much larger percentage of fatal cases in the rebel ranks, the
deaths from pulmonary disease constituting as much as 18.89 per cent, of the cases as
compared with the federal rate of 2.34 per cent. The unbolted corn-meal, which formed
the farinaceous staple of the Confederate ration, was certainly a prolific cause of intestinal
* Op. cit., page 760 U seq.
64 SICKNESS AND MOKTALITY
irritation, especially in troops subject to the influence of strong predisposing conditions.
The high rates in pulmonary affections may readily be referred to the exposures of the
poorly clad and imperfectly protected southern soldiers during service in a northern and less
genial climate than that to which they were accustomed. No information is on file con-
cerning the prevalence of scurvy in their ranks; but that it was present to a greater extent
than among the federal troops may be taken for granted, in view of the liberal ration of
the latter, the efficiency of their sup}ily system and their greater facilities for purchasing
by j>rivate funds. It seems, indeed, highly probable that much of the scurvy reported on
the sick lists of the prison-camps affected the prisoners at the time of their capture. At
Johnson's Island, Ohio, where no death from scurvy took place, and where the abundance
and variety of the diet negatived the idea of its development in the prison, there were,
nevertlieless, fifty-eight cases reported among the inmates, most of whom were officers of
the rebel army. These cases must liave reached the island in the scorbutic condition
which necessitated their appearance on the sick list. And if scurvy affected the officers,
its presence to a greater extent among the men cannot be doubted.* To the better condi-
tion of the officers of the Southern army, as compared with that of their men when the
fortune of war consigned them to Johnson's Island, Ohio, must' be in great part attributed
the slight amount of sickness and mortality that affected them during tlieir detention.
They were subject to the same rules and regulations, and had the same ration as the pris-
oners in other camps. They had 300 feet of air-space in quarters, a more liberal allow-
ance than was commonly furnished; but, as will be seen directly, the niortality among the
prisoners generally cannot be ascribed to the limitation of bed-space.
The presumption is that, at the time of their capture, many of the prisoners were
suffering from diseases resulting from insufficient diet and from the exposures and continued
fatigues incident to the military movements preceding the disaster that brought about their
captivity.
But no doubt exists as to their condition on their arrival at the prison. This is recorded
by many of the inspecting oificers. In fact, "the debilitated condition of the men from pre-
vious hardships and exposures," or words of similar tenor are of frequent occurrence in all
reports relating to the sickness and mortality of the prisoners, as in those from Elmira already
noted. To this is sometimes added a reference to the depressed mental condition consequent
on their status as prisoners of war. Dr. Alben states very decidedly that the mortality from
diarrhoea and dysentery among the prisoners at Fort Delaware in July, 18G3, was almost
entirely confined to the men from Alabama, Mississippi and other southern states taken
by General Grant's army around Vicksburg. Most of these men arrived in a broken-
down condition, emaciated, and already the subjects of the disease for some weeks or
months, while at that time the prisoners from General Lee's army, also confined at Fort
Delaware, were in good condition. Dr. Alden's inference that the influences to which the
prisoners were subjected at Fort Delaware were not to be charged with the sickness and
mortality tlien occurring among them seems thoroughly sustained.
The following extract from a report on the sanitary condition of the depot at Hart's
Island, New York Harbor, dated June 21, 1865, by Geokge H. Lyman, Medical Inspector,
* Dr. JONES says : " Tlie large armies of the Confederacy suffered more than once from scurvy ; and as the war progressed, secondary haemon-hage
and hosi>ital gangrene increased to a great extent from tlie deteriorated condition of tiie blood, dependent on the prolonged use of salt meat; and bat for
the extra supplies received from home, and from the various benevolent State institutions, scurvy, diarrhtea and dysentery would have committed still
greater ravages." — TT. S, San. Com. Memoirs, p. 481,
AMONG CONFKBERATE TROOPS IN U. S. PRISONS. 65
U. S. Armv, is submitted as a special illustration of the point in question, while showing at the
same time that the insanitary influences affecting the prisoners at the smaller depots were
similar in character to those already described as characteristic of the larger prison-camps:
The chief cause of the mortality is to bo found in the fact that large numbers of the prisoners arrived at the
depot broken down, in advanced stages of disease, some in fact moribund, and others past all hope for treatment.
The New l!erne detachment, cajiturcd chiefly in the C'arolinas, were nearly all broken down on arrival. It is
said that less than IdO of them lould he considered as well men or even in fair health. The surgeon then in attcnil-
aiuc having been relieved, more preci.se information on this point is not now available: but it is certain that the
largest percentage of sickness and mortality occurred in that (letachment.
The largest proportion of deaths occurred from chronic diarrhcea brought with them, and pneumonia, which
began to apjiear a few days after their arrival. The men being poorly clad, the weather wet and cold, and the bar-
racks provided with no other bedding than such as the prisoners brought with them, the pneumonic cases developed
rapidly, and the reduced vitality of the patients favored a typhoid type of that disease, increased probably to some
extent by the crowded and unventilated condition of the barracks. These appear b_\'measurcment to have alforded
102 cubic feet of air-space to each man, and with no other ventilation than that allbrdcd by the doors and windows
on one side. Quite recently openings for ventilation have becii made upon the other side of the barracks, it consti-
tuting the outer wall of the prison enclosure.
The rations have been good and in the quantity ordered by the Connnissary General of Prisoners, which is
sufljcienlly liberal. The hospital r.ition has lu'cn such as is used in our own hospitals.
The drainage from the barracks is superficial but good. The sinks are outside the camp and over tiile-water.
The water for cooking and drinking is :vbundant and of excellent quality; it is derived from wells.
The prisoners have had access, under guard, to the beach, and have availed themselves of it freely for salt-
water bathing. They have also been rvquired to take daily exercise.
Over-crowding was regarded by the inspectors as the most serious of the insani-
tary conditions bearing on the prisoners during the period of their detention. But this
comprehended more than the mere limitation to so much dormitory space. Under it
were gathered all the evil consequences of suddenly assigning a large number of men to a
camp which had not been systematically arranged for their reception. The prisoners were
generally destitute of clothing and blankets, and one-tenth of them on arrival required
hospital treatment. The exposures consequent on their destitute condition speedily
increased the disparity between the hospital accommodations and the requirements of the
sick. The wards became crowded, and the more recently developed cases had to remain
in the still more crowded general quarters of the prisoners, lacking the comforts which tlie
hospital provided for its less unfortunate inmates, and adding grievously to the harmful
influences of the quarters containing them. Generally, also, healthful exercise was pre-
vented by the mud and dust begotten of the surface-soil by the tramping of many feet in
the ordiuaiy occupations of prison life. Defective police and inadequate arrangements for
the disposition of excreta rendered tKe external air in many places foul and sickening. A
hastily dug series of pits often emitted their polluted exhalations in close proximity to the
quarters, because if placed at a greater distance the sick men, especially at night, would
fail 1o reach them. The prisoners had foul air without and fouler air within their quarter.-*.
Under these circumstances the extension and aggravation of diarrhoeal cases, and the typhoid
type assumed bj' febrile diseases such as pneumonia,. naturally followed. The evils directly
referable to the commitment of an excess of depressed, debilitated and destitute men to a
given camp were the causes of the large sick and mortality rates that prevailed. Over-
crowding, as restricted to a limitation of bed-space, was a concomitant but minor evil, as it
alone would have required some time to produce its typhous effects.
Without exception, the officers in charge of these camps and hospitals, and the medical
inspectors in their monthly rounds, recognized the conditions in fault; and their earnest
efforts at improvement are worthy of all commendation, since they saved many lives to our
re-united country and preserved our annals stainless.
Med. Hist., Pt. Ill— 9
66 SICKNESS AND MORTALITY
The history of each of these camps shows at first a jieriod of overwork, anxiety and
grave responsibility on tlie part of the officers in charge when their failure to provide for
the urgent necessities of the occasion would have been attended with disastrous results.
In no instance does it appear that the food-supply was at any time deficient; but clothing,
bedding, shelter and kitchen utensils for those who were well, and hospital accommodation,
supplies and comforts for tliose who were sick, had often to be provided at short notice and
under various difficulties. Hospital clothing was issued to the destitute until the arrival of
authorized su2;iplies. Tents were obtained for use until barracks were built. Barracks
were used as hospitals until special buildings were erected. Sinks were dug for the excreta
until some less objectionable method of disposal was planned and carried into effect.
Trendies were opened for drainage until a covered system was provided. Nor did the
improvements end when all were sheltered and fitted out with comparative comfort. New
barrack buildings were constructed after improved plans, and the old were destroyed or
retained to increase the available air-space. New hospitals with better conveniences
replaced the old, which became converted into increased barrack-room. Lavatories and
baths and the accessibility and abundance of the water-supply for flushing and other pur-
poses received attention. In fact, from the establishment of the prison-camp until its disuse
at the close of the war, the improvement of its sanitary condition was progressive and
uninterrupted.
The sites selected were usually such as were considered healthy; that at Elmira liad
been used from the beginning of the war as a recruiting depot, and the twenty barrack
buildings formerly occupied by the recruits formed the nucleus of the prison-camp, — nor was
this a solitary instance of the kind. The bed-space allotted to each man in c^uarters was
sometimes less than one hundred cubic feet, as at Fort Delaware where three tiers of bunks
ran along each wall of the pavilion separated by a central or median aisle. Over-crowding
to this extent was, however, not confined to the prison-barrack buildings. The wooden
shelters built for the Union regiments at depots which were considered permanent were
fitted up with similar shelves. The experiences of the war educated our people in sanitary
matters. At an early period of its progress medical inspectors urged, with some hope of
success, a reduction of the bunks to two tiers in the prisoners' quarters as well as in those of
our own troops. Their request must not be esteemed a measure of what these officers con-
sidered needful. They did not ask for all they wanted, but only for what they might be
likely to get.*
That the mortality among the Confederate prisoners was due, as suggested above, to
other causes than the mere limitation of barrack-space, is shown conclusively by some of
the reports. In the summary of the sanitary history of Camp Chase a tabular state-
ment is given of the occupancy of the barrack buildings by the Confederate prisoners
and their Union guard, showing that the latter had an air-space of 150 to 210 feet and an
area of 12 to 15 feet per man, while the former had 137 cubic feet and 11.4 of superficies.
There occurred in January, 1865, while the buildings were thus occupied, 8 deaths among
1,683 Union troops, or 1 in 210, and 283 deaths among 7,583 prisoners, or 1 in 26.79; in
the following month the deaths among 6,414 Union soldiers numbered 36, or 1 in 178,
while of 8,259 prisoners 495 died, or 1 in 16.68. These enormous differences in the death-
rates cannot be attributed to the comparatively trivial differences in the air-space.
* The double-tiered buuk was not finally expelled from its last retreat in a western military pust until ten years after the war.
AMONG COKFEDKllATE TROOPP TN IT. s. PRISONS.
67
Small-pox followcJ diarrhoea, dysentery and jincuinonia in order of importance as a
cause of death among tiie prisoners, having occasioned 32.1* of the 230.4 deaths that
occurred annually from disease in every thousand of the average strength presunt. Nothing
is on record concerning the prevalence of this disease in the southern armies. Table XITT
shows that among the unknown number of the Confederate forces there were up to Decem-
ber, 1862, 44,438 cases and 2,274 deaths from the eruptive fevers, as compared with lowrr
figures amonof the certainly larger number of the Union troops. But these statistics iiudude
measles, etc., as well as small-pox. Nevertheless its frequent occurrence among them
may be inferred in view of the fact demonstrated by its ravages in the prisons, — the
insufficiency of their protection by vaccination. Certainly in some instances it was appar-
ently introduced into the prisons from the Confederate ranks. The eruption is reported
as having broken out on some of the prisoners within a day or two after their arrival at
the depot.
Our medical officers appear to have faced the emergency with spirit, isolating, some-
times with difliculty, as at Rock Island, and protecting by vaccination, also with difficulty
sometimes, as at Camp Douglas and Alton, until the scourge was controlled. In reporting
the condition of Camp Douglas in June, 1864, Dr. HrMPiiREYS says:
Of tlKi.se prisoners who have heen vaccinated in inison with vims tlial prcxliiced no liad cllectH in Ignited States
tr<»i]>s, l)()8 have healed tardil.v, while 912 vaccinated are surteiing fiom jiliagedenic or indolent or irrital)lo ulcers.
This ditt'erence in the results from the use of the same virus in federals and rebels must be attributed to the cachectic
aiul scorbutic condition of the latter.
In a report for January, 1863, Dr. AVall, the surgeon in charge at Alton, remarks as
follows :
Epidemics both of small-pox and erysipelas visited us, the former with fearful violence, and what rendered it
very unfortunate for us, the vaccine virus that we obtained from St. Louis, Mo., proved worthless, — thus rendering
abortive for a while our attempts to stay its progress by vaccination. I am confident that if we had been successful
in procuring good virus we would have modified the epidemic to a ver.y great extent.
Tlie probability of a marked scorbutic taint in the southern troops has already been
suggested as accounting for much of the sickness and mortality directly charged against
scurvy by the prison records. The ration furnished by our Government to its prisoners of
war was more liberal in its quantity and variety than that issued by'the Confederate Gov-
ernment to its soldiers on active service. Other things being equal, scurvy was therefore
more likely to affect them before than after their capture.
The Confederate ration, in accordance with Army Regulations, consisted of;
Three-fourths of a pound of pork or bacon, or one and one-fourth pounds of fresh or salt beef; eighteen ounces
of bread or flour, or twelve ounces of hard hread, or one and one-fourth pounds of corn-meal ; and at the rate, to one
hundred rations, of eight quarts of peas or beans, or in lieu thereof ten pounds of rice, six pounds of coffee, twelve
pounds of sugar, four quarts of vinegar, one and one-half pounds tallow, or one and one-fourth pounds adamantine,
o. one ]K)und of sperm candles; four pounds of soap, and two quarts of salt. On a campaign or on marches, or on
hoard transports, the ration of hard bread is one pound. * ' * When the officers of the medical department find
anti-.scorliutics necessary for the health of the troops the commanding ofiicer may order issues of fresh vegetables,
pickled onions, sour-krout, or molasses, with an extra i|uantity of rice and vinegar. (Potatoes are usually issued at
the rate of one pound per ration, and onions at thc^ rate of three bushels in lieu of one of beans.) Occasional issues
(extra) of niola.sses are made — two quarts to one hundred rations — and of dried apples of from one to one and one-
half bushels to one hundred rations.
During the early period of the war, when the full ration was issued, scurvy was com-
paratively rare. At later dates the supply department became unable to furnish coffee;
corn-meal had to be largely substituted for wheaten bread or flour; fresh beef was irregu-
* See Table LIII, p. 02'J, infra.
68 SICKNESS AND MORTALITY
larly supplied, and the issues of rice, beans, molasses, vinegar, potatoes, dried apples and
vegetables generally were diminished in frequency and in quantity. Scurvy appeared in
consequence, manifested, according to Dr. Jones :
In the frequency of night-blindness, in the numerous accidents after vaccination, in the increase of secondary
haemorrhage and liospital gangrene after ■nounds, as well as in the actual manifestations of tlie disease, indisjjosition
to exertion, spongy gums, uncertain and ill-defined muscular pains, and obstinate diarrhu>a and dysentery.*
The Subsistence Department of the United States Army allowed the same money
value for the subsistence of the Confederate prisoner of war as for the Federal soldier.
In other words, the ration allowed to the prisoner was the same in all its parts as that
allowed fo the United States volunteer. But the experience of our army had demonstrated
that the troops seldom consumed the whole of their ration. Arrangements were therefore
made by which the money value of the unconsumed portion accumulated in the hands of
the subsistence officers, forming a fund by which the diet of the men might be varied by
the purchase of articles not kept for issue by the subsistence department as a formal part
of the ration. A surplus of bacon or coffee could by this means become converted into
fresh vegetables if needful for the health of the command. Cooking utensils and articles
of mess-furniture for the comfort and convenience of the men were also authorized to be
purchased with this fund. A similar system was adopted at the hospitals, and milk, eggs,
chickens, oysters, fruit, vegetables or other articles not issued by the subsistence or medical
departments of the army, and needful for the use of the sick, were obtained by means of
the money value of the bacon, flour, coffee or other articles of issue which they did not
consume.
This system, in use in the forts and garrisons of the United States, was extended to
the prison-camps and their hospitals. The Commissary General of Prisoners published
from time to time the articles and quantities to be issued for consumption by the prisoners,
and the difference between the money value of the ration thus issued and that of the full
ration allowed by law to the United States soldier was set aside as a prison fund for the
purchase of such articles as were necessary for the health and comfort of the prisoners, and
not expressly provided for by the Army Regulations.
The saving on the ration was the chief but not the only source of the prison fund.
The sutler or camp-trader was taxed a small amount for his privilege of trade, and this tax
made a part of the general fund, as did also all current money left by deceased prisoners
of war or accruing from the sale of their effects, and all current money clandestinely for-
warded to prisoners or found concealed by them.
The following table shows the ration in kind allowed to the prisoners by circulars of
the dates mentioned from the olBce of the Commissary General of Prisoners, together with
the full ration of the United States troops at the same dates, and the difference in the
value of the two rations credited to the prison fund. Prior to April 20, 186-4, no specific
instructions were published limiting the quantities of the constituents of the ration to be
issued, but commanding officers of prison-camps were directed to withhold from the ration
all that could be spared without inconvenience to the prisoners, as a basis of a fund for
their benefit. After the establishment of a special prison-issue, commanding ofiicers were
authorized to report to the Commissary Genei'al of Prisoners, if at any time it seemed
advisable to them to make any change in the scale :
*jilein. V, 5. SanUani Oymmimon^ p. 624.
AMONG CONFEDERATE TROOPS IN U. S. PRISONS.
09
Pork or biicon, or
Fresh or Milt beef
FU<iir or bn-ail (soft ), »ir
Iliircl brenti, nnd
Com-ineal
To eacli 100 mt'ions : —
Beans or peas, and i.
Rice or hominy
(■olTee. preen, or
Coffee, roasted nnd ground, or...
Tea
Sugar
Vinepir
CandU'S. udaninntino
Soap
Salt
Molasses
Potatws (fresh)
Pepper
PmsoxKiis OF War.
April 20,
1864.
10 oz.
1-1 oz.
18 oi.
14 oz.
l.« ciZ.
6qt8.
^• Ib.-^.
7 lbs.
.5 lbs.
18 02.
14 lbs.
June 1,
1864.
10 oz.
14 oz.
16 oz.
14 oz.
ir. oz.
19i lbs.
H lbs.
...(*)..
...(♦) .
'.! <|ts.
Employed on
public works.
Juno 13, 18li4.f
Average cost price cts . .
Credit i>€r ration to prison fund ots. .
') candles.
4 lbs.
2qts.
Iqt.
30 lbs.
16.48
9.76
4 lbs.
3} lbs.
13.63
12.61
12 oz.
16 oz.
18 oz.
16 oz.
ll^OZ.
14 lbs.
10 lbs.
7 lbs.
5 lbs.
16 oz.
12 lbs.
3 qts.
PKISONKKS 01' Wau.
U. S. Troops, 1864.
4 lbs.
3} lbs.
Iqt.
30 lbs.
90.31
5.93
ISoz.
20 oz.
23 oz.
16 i.z.
20 uz.
8. Its. (!,•, Ibs.l
in lbs.
II) lbs.
.- lbs.
i; U.S.
1.') U.S.
4 qts.
14 lbs.
4 lbs.
33 lbs.
1 gall.
100 11)8. three times
a week.
January 13,
1865.
10 oz.
14 or..
It;../..
Ill oz.
I(i c.Z.
12J lbs.
8 lbs.
. () .
.. I*) . ..
. I )
...(•)..,
2 qts.
2 lbs.
2 lbs.
16.81
10.92
Employed
on public
works.
19 o«.
ir.uz.
llioZ.
12 oz.
18 oz.
l."i lbs.
Ill lbs.
7 lbs.
.1 lbs.
1 II.,
12 lbs.
3 qts.
4 lbs.
3% lbs.
24. 90
3.53
1-. S.
Troops,
I8li5.
12 oz.
2(1 oz.
18 o/..
12 oz.
20 oz.
l.'i lbs.
10 lbs.
10 lbs.
8 lbs.
li lbs.
15 lbs.
4 qts.
IJlbs.
4 lbs.
3] lbs.
* .Sugar and coffee or tea were issue<i to the sick and wounded only, every other day, on the recommendation of the surgeon in charge, at the rate
of twelve jH.unds of sugar, five pounds of gnnuid or seven pounds of green colTee or one pound of tea, to every hundred rations.
t Prisoners employed on public works other than the proper police duties of their camps were allowed, if mechanics, ten cents per day, anil if
laborers five cents per day, from the prison fund, which allowance was authorized to be paiil in tobacco to those who preferred its expenditure in that way.
Dislmi-.scments cliarf^i'd against tlie prLson fund were made l)y the Commissary of Subsistence on the order of
the eoiimiaiiiliiif; orticcr, and all siuh ex]ienditiuvs of funds were accounted for liy the commissary on his monthl,y
statement of the prison fund, showing the issues made and the articles and (jnantities purchased, the prices ])aid,
the services rendered, etc. .\inong the articles authorized to be purchased by this fund were all table furnidire and
cooking utensils, articles for iiolicing puri>oses, lied-ticks and straw, and the means of improving or enlarging the
liarrack accommodatioiis. F'.xtra pay was allowed from it to clerks who had (charge of the camp post oltice, who
ke]it tlie accounts of moneys deposited by tlu' prisoners with the commanding otiicer or who wen' otherwise engaged
in lal)or8 connected with the ]>risoners.
The hospital fund accumulated from tlie savings of the ration of the sick men was disbursed on the recom-
mendation or rei|nisition of the surgeon in charge, approved by the commanding officer. It was kept .separate from
the fund of the hospital for the troops. Disbursements from it were cliiefly for the purchase of articles of diet, but
when the fund was sutticiently large, it was permitted to bo expended for shirts and drawers for the sick, the expense
of washing clothes, articles for policing pnrposes and all articles and objects indispensably necessary to promote the
sanitary condition of the hospital.
Clothing was not charged against the prison fund. The commanding otficer. through his (inartermaster, made
re(|nisition on the nearest depot for such clothing as was absolutely necessary for the prisoners, and the papers wore
submitted for the approval of the Commissary (ieneral of Prisoners. The articles when furnished were issued by
the quartermaster under the supervision of an oHicer detailed for the purpose, whose certificate that the issue had
liecii made in his presence was the (|iiartermaster's voucher for the clothing issued. From Ajjril .SO to October!
neither draw<'rs nor socks were allowed except to the sick. When army clothing was issued the buttons and trim-
mings were removed and the skirts cut short to prevent those wearing such articles from being mistaken for United
States soldiers.
The efficiency of the ration allowed the prisoners of war deiieiidecl, as in the case of
United States troops, on the method of its management, and on the market price of vege-
tables in the neighborhood of the camp. The portions of the ration issued were certainly
70 SICKNESS AND MORTALITY
insufficient to prevent the appearance of scur-vy, for that disease was manifested among our
own troops on the full ration during the war, and has been observed since the war at west-
ern posts where vegetables were scarce and correspondingly high-priced. Assuming the
ration as issued to have contained a sufficiency of the nutritive elements to repair the
waste generated by the internal work of the body and the slight amount of outward mani-
festations of force exerted by the prisoners in their enforced confinement, the want of variety
in the diet would in time have produced a distaste for the food and developed the scorbutic
condition. Their protection from this depended on the proper application of the prison
fund. Every guard was apparently placed on the expenditure of this fund. The subsist-
ence officers purchased only on the approval of the commanding officer, and their action
was reported in detail at monthly intervals to superior authority. Inspecting officers
usually devoted particular attention to the condition of the prison and hospital funds and
the details of their expenditure. In many of the reports the extra articles of diet pur-
chased during the month are itemized; in others, when a scorbutic tendency was detected,
larger purchases of such articles were recommended. Generally, however, the issued
rations supplemented by the purchases were considered by these able and impartial officers
as an ample provision against the scorbutic taint. It may therefore be concluded that had
the prisoners been healthy on their arrival, instead of broken down physically by previous
hardships and depressed mentally by present conditions and anxieties, their sick and mor-
tality lists would have been no more burdened with scorbutic cases than were those of our
own men who underwent the strain of active' service upon the same allowances.
In summing up the results of this study of the inspection reports of the prison depots,
it may be said that the hardships and exposures entailed on the men by the military events
that ended in their capture were the main causes of the disease and mortality with which
they were afflicted during tlieir subsequent confinement. The hurried marches, want of
sleep, deficient rations and exposures in all kinds of weather, by night and by day, that pre-
cede and attend the hostile meeting of armies result in larger losses by disease than those
that are directly attributed to the engagement. And as the wounded of a defeated army
are more exposed to capture than the uninjured, so the exhausted and debilitated rather
than the vigorous become included in the li.^ts of prisoners of war.
Fatigues and exposures en route to the prison depots supplemented those already
endured in exhausting their strength and producing sickness. The prisoners seldom caj-ried
from the field a sufficiency of clothing and blankets to protect them from ordinary weather-
changes, and to tljese the journey frequently added changes of a climatic character.
The depression of spirits consequent on defeat and capture, the home-sickness of the
prisoners, the despondency caused by scenes of suffering around them, the gloomy and
vacuous present, and the uncertainty of the future, conspired to render every cause of
disease more potent in its action.
The sudden aggregation of these men at camps unprepared for their reception devel-
oped many insanitary conditions which combined with pre-existing causes in evolving sick-
ness and stamping it with a greater virulence. The most prominent of these were: the
temporarily defective police of the camp, which contributed to the spread of diarrhoea
and dysentery; the insufficient protection in quarters, which induced inflammations of the
respiratory organs and gave them a tvphoid character by the over-crowding; and the
insufficient hospital accommodation, which, in leaving the sick in quarters, tended to the
AMONG CONFEDERATE TROOPS IN U. t?. PRISONS. 71
development of new cases, or, in taking them into hospital, lessened the chances of recovery
of those already there.
But the evil intlaences exercised by the camp conditions would not have been followed
by the same sickness and mortality had the ground and shelters been crowded to the same
extent with well-disciplined troops awaiting the opening of a campaign. The broken
health and broken spirits of the inmates were the main factors in the production of disease
and death.
CHAPTER II. — INTRODUCTORY TO THE PRESENTATION OF THE CAMP
FEVERS.
The fevers which prevailed in our armies were reported at the beginning of the war
under the respective headings of ii/phus, typhoid and common continued fevers, remittent
fever and quotidian, tertian, quartan and congestive intermittent fevers. Each of these
names indicated, with more or less precision, a particular series of morbid phenomena. The
aggregation of symptoms which gave the disease in each instance its individuality might
be stated from an extensive personal knowledge of the clinical and pathological views held
by the medical men who dealt with these febrile cases, but this would be admissible only
in the absence of general and more trustworthy data. The lines dehning each of these
specially reported fevers might be drawn from the clinical records of the regimental and
general hospitals of the time; but the presentation and study of these must be made later
and in other connections. Nor is it necessary that this study should be attempted at the
present time, for the clinical and other facts implied by the titular diagnoses of our medical
men in 1861, in febrile cases, may be gathered from a brief reference to the important dis-
coveries concerning the non-identity of certain fevers which had been made some years
before, to the character of the fevers prevalent in this country at the outbreak of the war,
and to the volumes on practice of medicine which were furnished by the Medical Depart-
ment of the Army to its officers as books of reference.
Typhus and Typhoid Fevers. — Many observers from the time of Willis and Syden-
ham described epidemics of fever 'differing notably in their characteristics from those of
the typhus, which, under such names as pestilent, malignant, putrid, contagious, camp,
ship, jail and hospital fevers, prevailed from generation to generation as a well-known
scourge. These anomalous cases were afterwards named sloiu, mild, nervous fevers, or low
continued fevers; and their occurrence was considered due to some peculiarity of the
epidemic constitution from meteorological or other alterations in the condition of the
atmosphere.*
At the beginning of the present century it was stated by Frost, on the authority of
autopsical observations, that these fevers had their seat in the mucous membrane of the
•Sydenham suggested this peculiarity of the epidemic constitution as arising " from some certain secret and hidden alterations takinj^ place
within the bowels of the earth and pen-ading the atmosphere; or that, l>erhaps. it might chiefly depend upon some influence of the heavenly bodies."
Sydenham Sorictyt Sydtnliam, London, 1851), Vol. II, p. 191.
72 KEMARKS IXTKODUCTORY
intestine; and foi" some years afterward it was taught in the French schools that they were
essentially an enteritis. In 1813 Petit and Serres showed that the lower part of the
ileum was specially affected, and that the disease, thus differing in its site from an ordinary
inflammation, must be of a specific character. Bketonkeatj's observations in 1818-27
localized the inflaramation in the solitary and agminated glands, and demonstrated a want
of correspondence between the severity of the local lesion and the gravity of the general
symptoms. He regarded the disease as an internal exanthem, — dothienenterite.
Two years later, in 1829, the observations of Louis recognized the lesion of the
intestinal glands as the essential or characteristic of the specific fever which he described
as the typhoid affection. The profession in America became familiar with Louis' work
through Dr. Bowditch's translation published in 1836.
Meanwhile pathologists in England failed to discover the glandular lesions in their
fever cases except occasionally in such as presented some variations from the type of true
typhus. Bright in London, and Alison in Edinburgh, in 1827, reported cases in which
were found the intestinal lesions of the French observers. Thus, while the French
pathologists considered the glandular lesions essential to typhus as it occurred under their
observation, the British regarded them only as a comparatively rare and accidental com-
plication. These opposing views were reconciled by a demonstration, made in Philadelphia,
of the non-identity of the British and French fevers. At this time the continued fevers of
the United States were neither so contagious nor so deadly as those of Britain. In the pre-
face to his translation of HiLDEiSfBKAND on Contagious Typhus, published in 1-828, Prof.
S. D. Gross said of our so-called typhus: "Nor is it perhaps precisely of the same nature
and characterized by the same symptoms as the typhus of Europe." But Drs. Gerhard
and Penhock of Philadelphia, who had studied the typhoid affection under Louis, and seen
British typhus in London, recognized in the former the prevailing continued fever of their
own country, and were able to identify the latter when it appeared in an epidemic form in
Philadelphia during their service at the hospital Blockley. Their experience of this out-
break* established its identity with the contagious typhus of Britain, and showed the charac-
teristics which distinguished it from the familiar typhoid or dothienenterite. These were
the activity of its contagion, the suffusion of the eyes, the dusky-red color of the counte-
nance, the stupor, the petechial eruption and the absence of special abdominal symptoms,
together with the general progress of the individual case as manifested in the succession of
the symjitoms. In 1839 Dr. Shattuck of Boston insisted on the existence of two fevers
in London similar to those described in Philadelphia by Gerhard. His paper, read before
the Medical Society of Observation of Paris, was made the basis of an argument by M.
Valleix on the error of the English in confounding their fevers, one of which was identical
with the Parisian typhoid.
As a result of these investigations Louis, in the second edition of his work issued in
1841, recognized that the typhoid afll'ection of Paris was a different disease from the con-
tagious typhus of Britain; and in our country Bartlett in 1842 and Wood in 1847,
described typhus and typhoid as distinct affections. Some opposition was raised to these
new doctrines, but its influence was slight. Professor Dickson of Charleston, S. C, in his
Elements of Medicine jiublished in 1855, adhered to the view that fever had but a single
cause, and that the variations in its manifestations, which had given rise to such names as
* American Journal Medical Sciences, February and August, 1837.
TO THE CAMP FEVERS. 73
typhus (jrarior and mitior, putrid and nervous fevers, vcrcbral and abdominal f>/])J>us, were
due to variations in the intensity or concenti'ation of the poison and to influences exerted
on the condition or jiredisposition of the subject; as, for instance, where ochlesis gave to each
of the forms the character of putridity or malignancy. Tie quoted approvingly from
Campbell:* "It is undeniable that the two diseases are inseparabl}^ bound together in ties
of the strongest and most indissoluble, though mysterious affinity; the necessity which any
theory may involve of separating them is enough of itself to declare its absurdity."
Nevertheless he was constrained to treat of typhus and typhoid in his Elements under two
separate heads, in deference to the almost universal usage in America at the time.
Dr. Bartlett had already shown, in discussing the locality of typhoid fever, that it
was the common continued fever of our Easteru States, and that it occurred, although
{lerhaps with less frequency, in the West and Soutli, where interraittents and remittents
prevailed; but most of the instances cited by him were of epidemics occurring in towns.
Some years later Dr. Jas. E. Reeves brought prominently to the notice of the profession
the fact that enteric fever was of common occurrence iii sparsely settled rural districts as
well as among urban populations.^
The works on Practice of Medicine supplied to the Medical Department of the Army
in 1861 were those by Wood, J Watson|| and Bennett.§ In the first the distinction
between typhus and typhoid was clearly given, and the name enteric fever was suggested
in place of typhoid to era])hasize the distinction. Dr. Watson, influenced by Dr. .Tenner's
presentation of the arguments,^[ had recently subscribed to the doctrine of non-identity; and
in the volume under consideration be taught the notable differences which existed in the
symptoms and course of the two diseases, as well as in their comparative fatality and
exciting causes, regretting that the affinity of the names imputed a similarity in the dis-
eases, and approving Dr. Budd's suggestion to replace the name typhoid by intestinal fever .
In Dr. Bennett's lectures the views of .Tenner were given, but the author did not support
them. He recognized typhoid and typhus clinically, but considered them as "evidently
]iroduced by vajciations in tlie intensity or the nature of the exciting cause. "
It appears evident from these considerations that our medical officers, in identifying a
case of idiopathic fever ast}-plioid, liad well-deHned ideas concerning the aggregation and
sequence of symptoms to whicli this term should be applied. Of typhus they had practi-
cally no knowledge; but they had such conceptions of this disease and of the characteristics
which distinguished it from typhoid that, when a diagnosis of typhus was given, it neces-
sarily meant that the disease differed so materially in some points from the familiar typhoid
fever as to suggest that the unfamiliar typhus of Britain was under observation.
Common Continued Fever. — Many medical officers no doubt looked upon this a|)pella-
tive on the s-ick reports as an obsolete term. The studies and observations which developed
a knowledge of typlioid fever as a separate disease sliowed so many instances of obscurely
marked fever in connection with well-marked epidemics, that these lighter cases were con-
sidered due to the prevailing typhoid cause, peculiarities in its manifestations being
referred to variations in the individual constitution. Thus, while separating a specific
■ p. 28.'; (if bis KkmenU.
t In ih._' UufTalo MeUical Journal^ l&oG, and in a Practical TrealtM on Enteric Fever, Philadelphia, Pa., IS.'iD.
; .1 Treatise on the Practice of Medicine, by flEORGE B. Wool>, M. D., Philadclpliia, 1847.
II Vecturrx nn the Prinriplai awl Praclicr of Physic, by Tnn.MAS W.VTSOS, >I. !>., <di<«l by I>. F. CONIiIE, M. D.. I'liiludelphia, 1858.
§ Clinical lectures on lite Principles and Practice of Medicine, by J. HL'UI1C8 HEXNKrr, M. !»,, F. R. S. E. AniPnrun edition. Xpvv York, 1860.
U In Ihe Edinburgh Monthly Journal of Medical Science, Vols. IX and X, IB49-50.
Med. Hist., Pt. HI— 10
74 REMARKS INTRODUCTORY
typhoid from a specific typhus because individual or epidemic constitutional peculiarities
seemed insufficient to account for the notable differences in the average cases of each, they
liesitated to push the argument and thereby separate fevers of short duration, unaccom-
panied by typhoid symptoms, from the cases of fully developed typhoid fever. Others, on
the contrary, recognized in these febriculse or ephemeral fevers a distinct clinical entity, and
reported them as common continued fever irrespective of etiological considerations. The
unknown or suspected cause, whether conceived to bf the poison of typhoid or of typhus
modified in some way, a specific poison differing from these, or a non-specific irritant, had
no weight in the formation of the diagnosis. Dr. Wood recogni?ed an idiopathic fever
resulting from causes of irritation having nothing specific or peculiar in their mode of
operation — an inflammatory fever, tlie synocha of Cullen, but without any local lesion
other than an occasional slight inflammation of the fauces wholly insufficient to account
for the intensity of the general symptoms. Bennett and Jenner also recognized a febri-
cula, though differing in opinion as to its nature, the former considering it a modified
typhus and the latter an essential fever due to a specific cause. The clinical features of
the cases reported under the name of common continued fever may therefore be readily
appreciated.
Remittent Fever. — The paroxysmal fevers of the West and South were well known at
the outbreak of the war, even to those of the profession whose practice anterior to their
Tiiilitary service had been in non-malarious localities. The importance of these fevers, and
the national character of the great medical schools of the North, called for as thorough a
discussion of the malarial fevers as of those which constituted the common fever of the
North and East. The text-books gave prominence to the endemic fevers. The Amei'ican
edition of Watsons Practice contained an article by Dr. Condie on remittent fever to fit
the work for its new sphere of usefulness. The medical journals showed that the energies
of the profession were as much engaged on malarial disease as on typhus and typhoid.
The medical oflicer from the North was therefore well prepared to recognize malarial remit-
tents when presented to him, and perhaps better qualified than the southern practitioner to
recognize tlie to him familiar typhoid fever when occurring in the habitat of malaria.
Bartlett had shown that typhoid fever was to be found in such localities, and Wood, in
speaking of the diagnosis of enteric fever, called special attention to the miasmatic
remittent as one of the diseases liable to be confounded with it, especially when the remit-
tent was protracted or attended with 'typhus' symptoms. The figures, reported by our
medical officers during the war under the heading remittent fever, may therefore be
accepted as giving a fair expression of the prevalence of this form of fever. Mistakes in
diagnosis no doubt occurred, — remittent fever may have been recorded as typhoid,
especially when it assumed an adynamic form, and, on the other hand, typhoid may have
been set down as remittent in localities where the latter was endemic; this will be con-
sidered hereafter. It is sufficient for the present to know that the name remittent fever
was given to a definite and generally appreciated clinical picture.
hitermitting Fevers. — The intermittent^, including the congestive form, were usually
characterized by such marked and well-known j^eculiarities that the conditions indicated
by the diagnosis are easily understood.
On June 30, 1862, two changes affecting the method of reporting idiopathic febrile
diseases were made in the sick reports. The first involved the disuse of the term common
TO THE CAMP KEVKRS. 75
continued fever. No instructions were issued regarding the disposition to be made of such
cases as had heretofore been reported under this designation; but from what lias been
stated above concerning the tendency developed by the study of typhoid fever, it may be
assumed that many of the cases were thereafter reported under that heading while the
remainder may have found place under Other Miasmatic Diseases. During the year
endinc; June 30, 1862, when the term common continued fever was in use, there were
reported under it, per thousand of strength, 42 cases, 1.25 per cent, of which were fatal,
while under the term other miasmatic diseases there were reported only 27 cases, with .41
per cent, fatal. During the following year, when no special provision was made for the
classification of the cases formerly reported as common continued fever, the cases returned
as other miasmatic diseases rose to 50 per thousand and their fatality to 2.84 ]>er cent. A
lar^e number of the common continued cases may, therefore, iiave been returned under this
indehnite heading.
The second change consisted of the insertion in the reports of a new term, Tijpho-
malarial. The writer has not been able to find the report of the Board that recommended
these changes, and is, therefore, ignorant of the arguments which led to the abolition of
the one term, but Dr. Woodw.\rd has detailed the circumstances attending the introduc-
tion of the other.* In the autumn and early winter of 1861 the medical officers of the
army called attention to the fact that the camp fevers then coming under observation dif-
fered in many particulars from the enteric fevers which they had treated in civil practice
before the war.f A Board consisting of Surgeon A. N. McL.'VREN, U. 8. A., Surgeon G. H.
Lym.\n, U. S. Vols., and Assistant Surgeon M. J. AscH, U. S. A., was convened, December
16, to investigate and determine whether the fever then prevailing in the army was to be
considered an intermittent or bilious remittent fever in its inception, assuming in its course
a typhoid type, or a typhoid fever primarily. The board examined the fever in several of
the division hospitals of the Army of the Potomac. It communicated by circular letter
with many medical officers whose commands could not be conveniently reached. The
replies received, in their general tenor, confirmed the opinion which the board had formed
on the basis of its personal observation, that while a certain number of cases of ordinary
typhoid existed in the army, the large majority of the febrile cases were bilious remittent
fevers which, not having been controlled in their primary stage, had assumed that adynamic
type which is present in enteric fever. This officially pronounced adynamic remittent pre-
vailed extensively during the Peninsular campaign of the following year and was familiarly
known as Chickahominy fever. Dr. Woodward had served with the army in this cam-
paign, and had formed the opinion that these fevers were hybrid forms resulting from the
combined influence of malarial poisoning and the causes of typhoid fever, modified in
individual instances in accordance with the preponderance of one or tlie other of these
influences and occasionally by the presence of a scorbutic taint. At this time he was
detailed a member of a board to revise the form of sick report in use in the army, and
actuated by the strength of his opinions, he induced the board to recommend the insertion
of the term typho-malarial in the blank form for the monthly sick report as a suitable
designation for the complex conditions which he believed to be present in these cases. He
afterwards regretted that he had nt)t also urged upon the board the preparation of a circular
• Tuphomatarial Frrer : ft it a Special lyp< of Ferer } Philadelphia. 1876, pp. 10-12.
t Fur an illustration of the rhara<:ters uf the fevers occurring at Ih« time specified, refer infra, p.21G</ so]., to the admirable clinical records of the
Seminar}- Hospital, (leorgetown, D. C.
76 REMAKKS INTRODUCTORY
lettei' to accompany the new sick report, explaining why this term had been adopted, and
calling for special reports with regard to the cases whicli it was intended to designate.
This omission was indeed unfortunate, as it left the medical officers without a guide for the
use of a term not only of indefinite meaning but absolutely of double meaning. These
fevers, in accordance with the views then current, were either remittents with low or
typhous symptoms, or they were cases of enteric fever with accidental malarial complica-
tions. The uncertainty attaching, in the absence of the necessary instructions, to the value
of the first part of the compound word, permitted it to be used as a diagnostic title for both
of these series of cases. Indeed it was perhaps better suited to meet acceptance as a
designation for low remittents than for cases of true typhoid marked by malarial symptoms,
for tlie compound term tyj)hoid-pneumonia was familiar as a household word at the time,
and no meaning was conveyed by it involving the presence of the specific poison of enteric
fever. Nevertheless Dr. Woodward subsequently claimed that the prompt acceptance of
the term typho-malarial showed how widely the opinions he had formed were shared by
the medical officers of the army. But the sense of the profession cannot be thus construed
in sup})ort of the viev>^ of a 'specific enteric essential in the typho-malarial cases reported at
that time. During the month of July, 1862, the first month of the use of .the new term,
2,283 cases were reported, while Dr. Woodward's opinions were unknown except to a few
personal friends. Indeed his views were not published until the issuance, on September 8,
1863, of Circular No. 15, Surgeon General's Office, Washington, D. G. In this the mean-
ing designed to be attached to the term typho-malarial was for the first time made known
in the following words:
Moreover, while a certain amount of nnconiplicated enteric and remittent fevers certainly did occur, especially
at the commencement of the war, the vast majority of the camp fevers of the army were of a mixed character,
exhibiting undoubted enteric iihcnomena variously combined with the periodicity and other peculiarities of malarial
disease, and still further modified by the tendency to incipient scurvy, which is the ordinary concomitant of camp
diet. To indicate this mixed nature, the term typho-malarial fever, which I had the honor to suggest to the Depart-
ment in June, 1862, aj)pears appropriate, and, at the present time, is coming into very general use.
Up to the close of the month of August, 1863, shortly before the publication of this
circular, 27,399 cases of typho-malarial fever had been reported in a total of 49,871 such
cases during the war. In other words, more than one half of the cases were reported during
the fourteen months which intervened between the appearance of the term on the reports
and the publication of a casual reference to the meaning designed to be attached to it.
The nomenclature of the fevers as officially given in the army sick reports at the
lieginning of the war gave expression to species witli marked clinical distinctions. Uncer-
tainties attached to the etiology of the small percentage reported as common continued
fever, but the nature of the uncertainties was fully appreciated — and the segregatinu o(
the cases rendered them available for special study. The removal of this term from the
sick report complicated the statistics thereafter furnished by doubts as to the disposition
made of ephemeral and other febrile cases not distinctly typhoid. What proportion of
these were sent to swell the lists of typhoid, how many complicated with the eft'ects of
malaria were added to the typho-malarial list, and how many were dropped out of consid-
eration altogether by being placed among other miasmatic diseases, are questions wliich
constantly recur in studying the statistics of fever furnished after June 30, 1862. The
insertion of the term typho-malarial was also a grievous complication. The true value of
the statistics given under this heading can never be known in the absence of a complete
record of all the cases. Such cases as were reported with more or less of detail will be
TO THE CAMP FEVEKS. 77
presented hereafter, and tlie figures themselves, and tliose allied to them, will be examined
in this connection. In the meantime a consideration of the conditions under which the
diagnoses were made will show that clinically typho-malai-ial cases may have presented
great diversity, from the severe and jjrotracted remittent ending fatally with great prostra-
tion, low delirium, stupor and coma, and the equally severe cases .of typhoid fever ending
fatally in like manner, but with some modification in their progress from concurrent
malarial poisoning, to the mild enteric and abortive cases viewed doubtfully as typhoid,
and diagnosticated, when such diagnosis was officially admissible, as common continued
fever, yet recorded with propriety, in accordance with the views of Dr. Woodward, as cases
of typho-malarial fever, in the presence of indications calling for the exhibition of quinine
as an autiperiodic.
CHAPTER III.— ON THE PAROXYSMAL FEVERS.
I. — THE STATISTICS OF THE MALARIAL FEVERS.
I.— MALARIAL FEVERS AMONG THE U. S. FORCES.
Prevalence and Mortality. — During and immediately after the war, one-fourth
of all the reported cases of disease among the white troops was of a malarial character.
There were 224 cases of malarial fever in every thousand cases of reported disease. Typho-
malarial fever is included in this statement, as, irrespective of the views entertained con-
cerniug its typhoid element, its malarial factor was definitely recognized by all parties. It
seems proper, therefore, to consider it in a discussion of the prevalence of malarial disease,
although it may be needful to know more about it before its mortality can with propriety be
admitted to weigh in the scale with that due to the purely malarial fevers.
The simple intermittent constituted by far the greater proportion of these febrile cases,
2,003 cases per 1,000 of mean strength having been reported in a total of 2,814 of malarial
disease; in other words, a distinct peril "1 of intej'mission was recognized in five-sevenths of
the paroxysmal fevers. These figures represent only the number of cases in which inter-
mittent fever was the most obvious abnormal condition present. They by no means express
the extent to which this disease prevailed, even in that part of the army represented in the
statistical tables. As the system of reporting provided no method of recording complica-
tions, it very generally happened that cases of intermittent fever complicated with serious
diarrhoea, dysentery, pneumonia or other grave affections, were reported under the head of
these disorders without any mention of a co-existing malarial affection. But, although under-
stating the facts, the statistics convey a clear idea of the extensive prevalence of this form
of malarial disease. Out of 1,213,685 cases of malarial fever 863,651 were cases of
simple intermittent. How many of these were first attacks, and how many recurrences in
individuals already affected by the malarial influence, cannot be determined. It is probable
78 MALARIAL FEVERS
that the majority of the primary attacks are included in the number, for a soldier
who experienced an ague-fit for the first time was usually disposed to be alarmed at the
violence of tlie symptoms, and to seek medical assistance, even if the nature of the duties
required of him at the time was such as to render it needless for him to report for the pur-
pose of being relieved from their performance. On the other hand, it is certain that many
of the recurrences which took place were not reported. Men became accustomed to attacks
of this kind, and visited the dispensary after the paroxysm, not to report as sick, but
to procure a supply of quinine to prevent a return; even when on important duty which
they were incapable of performing during the attack, such men would he temporarily
excused by their company officers, the medical officer of the command remaining in igno-
rance of the recurrence.
In more than one-half of the agues the cycle of morbid j)henomena was completed in
twenty-four hours. Tertians folkiwed closely in order of iVecpiency. Quartans were com-
paratively rare, forming only one-twentietli of the whole number. Of the 2,003 cases of
simple interraittents occurring per 1,000 of mean strength among the white troops during
the five and one-sixth years covered by the statistics, 1,037 were quotidians, 870 tertians
and 96 quartans.
Congestive fever was fortunately of infrequent occurrence, it having furnished but 32
cases per thousand of strength, constituting 3 of the 224 cases of malarial disease which
were recorded in eveiy thousand cases of all diseases.*
Remittent fever gave 664 of the total of 2,814 cases of malarial disease wliich occurred
per thousand of mean strength, or 53 of the 224' malarial cases recorded per thousand cases
of all diseases. Excluding the typho-malarial cases, the 664 remittents formed part of
2,699 cases of pure malarial fevers which occurred in every thousand men of the command,
or 53 of the 215 pure malarial fevers recorded in every thousand cases of disease. In
simjjler figures, the remittents formed one-fourth or 24.6 per cent, of the purely malarial
fevers, and a little less than this, or 23.7 per cent, of all malarial fevers, including the cases
recorded as typho-malarial.f These typho-malarial cases, 115 per thousand of strength,
formed only 9 of the 224 malarial cases which occurred in every thousand cases of disease.
The deaths reported among the white troops as occasioned by malarial fevers num-
bered 12.199; but if to these be added a due proportion of the 42,869 deaths from
unspecified diseases, the number becomes augmented to 16,225. Of the 12,199 deaths
specially referred to malarial fevers, 4,059 were considered due to typho-malarial mani-
festations, 3,853 to remittent, 3,370 to congestive and 917 to simple intermittent fevers.
Although congestive fevers were infrequent and remittents formed only one-fourth of the
purely malarial fevers, the deaths from these forms of malarial aftection were in striking
contrast with those from the simple intermittents. The latter numbered less than 2 per
thousand of strength, and the former somewhat over 7 and 8 per thousand respectively.
Of 1,000 deaths from all diseases, 94 were caused by malarial fever, 31 of these being
due to typho-rnalarial, 30 to remittent, 26 to congestive and 7 to simple intermittent fevers.
In the last column of the table which follows is shown the light rate of mortality in
the intermittents, one death in every thousand cases of quotidian or tertian ague, and one
* The relative frequency of t}ie types of intermittent fever expressed as perrentu^es of tlie total number of intermittent cases which occurred in
each of the military departments will be found in Table XXXIII itifra, p. 98.
tTbe table mentioned in last note gives also the relative frequency of the forms of malarial fever expressed as percentages of the total number of
malarial cases which occurred in each of the departments.
AMONG THE V. ?. FORCES.
79
death in every five hundred of the quartans. The greater mortality in the last-mentioned
form is at variance with the opinion which regards the quotidian as an expression of a
higher degree of the malarial poisoning than is present in the tertian or quartan. Man}'
of these deaths might be passed to the credit of congestive fever, as the fatal result was
due to the occurrence of a paroxysm of an aggravated type; while others with equal pro-
priety might be transferred to remittent fever, as, although the case was intermittent
originally, and so reported, the fatal issue did not take place until after the fever had
assumed the remitting type.
Kemittent fever gave a fatality-rate of 1.31 per cent., or one death in 76 cases, and
congestive fever 24.65 per cent., or one death in 4 cases. But notwithstanding this high
rate of the congestive fevers, such was their infrequency as compared with the less dan-
goix)Us forms of the disease, that the deaths from the purely malarial diseases amounted
oidy to seven-tenths of one per cent., or, including the deaths from typho-malarial fever,
to one death in every hundred cases.
Table XXTI.
Statevient of the Frequency and Mortality of the several forms of Malarial Fever, giving the totals repoi-ted
from May 1, ISGl. to June 30, ISUG, with the ratio of eases to strength and to cases of all diseases,
and the ratio of deaths to strength, to deaths from all diseases and to cases of Malarial Fever.
WHITE TROOPS.
1
Dl.SEASE.
Xnmber reported
during the period
from May 1, 1861, to
June 30, 1866.
1 11 "3.2
Ratios per 1,000 ] §^
of strength. _-'3
't "3
^ X X
Deaths i)er 1,000
of deaths from
all diseases.
Percentage of
fatal cases.
1
Cases.
Deaths.
Cases.
1, 037
870
96
1
1
Deaths.
X X ^
» 2 5
2 S -~
O
Quotidian Intermittent
Tertian Intermittent
Quartan Intermittent
447,258
375, 170
41,223
452
381
84
.96
.81
.18
82
69
8
3.49
2.95
.64
.10
.10
.20
.16
24.65
1.31
Total simple Intermittent '.
Congestive Fever .
863,651
13,673
286, 490
917
3,370
3, 853
1
2,003
32
664
1.95
7.20
8.23
159
3
53
7.08
26.05
29.78
Remittent Fever
Total j)ure Malarial Fevers
1,163,814
49,871
8,140
4,059
2,699
! 115
i
17.38
8.67
215
3
62.91
:ii.:i7
.70
8.14
Typho-malarial Fever
Total Malarial Fever.s
1,213,685
12, 199
2,814
26.05
224
94.28
1.00
But although the mortality from these fevers was comparatively light, their influence
in detracting Trom the efficiency of the array must have been very great. We have no
means of ascertaining how manv men constantly on sick report would represent this loss,
nor can we learn how many were permanently removed from active service by discharge
on account of the pernicious influence of the fever-poison on the constitution. The statis-
tics show that 373 men were discharged for remittent fever and 480 for intermittent fever;
80
MALARIAL FEVERS
but when it is recognized that there were 2,224 cases in which dropsy figured as the cause
of disability necessitating discharge, 14,500 having debility as the nominal cause, and
25,915 in which tlie cause was not stated, we are left to speculate upon the influence whirh
these fevers may have exercised in the production of temporary and permanent disable-
ment to our armies.
The malarial fevers as they affected the colored troops are shown in the following table:
Table XXIII.
Statement of the Frequency and Mortality of the several forms of Malarial Fever, giving the totals reported
from July 1, 1S63, to June 30, 1866, toith the ratios of cases to strength and to cases of all diseases,
and the ratios of deaths to strength, to deaths from all diseases and to cases of Malarial Fever.
COLORED TROOPS.
Disease.
Number reported
during the period
from July 1,1863, to
June 30, 186G.
Rates per 1,000
of strength.
Cases per 1,000 of
. cases of all dis-
eases.
Deaths per 1,000
of deaths from
all diseases.
Percentage of
fatal cases.
Oases.
Deaths.
Cases.
Deaths.
Quotidian Intermittent
63, 992
51, 045
3,923
58
54
15
1,047
835
64
.91
.85
.23
106
84
7
2.11
1.96
.55
.09
.10
.30
Tertian Intermittent
Quartan Intermittent
Total simple Intermittent
118,960
2,536
30,645
127
794
1,002
1,946
42
501
1.99
12.42
15.67
197
4
50
4.62
28.88
36.43
.10
31.31
3.27
Congestive Fever
Remittent Fever
Total pure Malarial Fevers ...
152, 141
7, 529
1,923
1,301
2,489
123
30.08
20.35
251
12
69.93
47.31
1.26
17.27
Tvpho-malarial Fever
Total Malarial Fevers . .
159, 670
3,224
2,612
50.43
263
117.24
2.02
In comparing this table with that given for the white troops, it must be remembered
that while the latter includes the statistics of five and one-sixth years the former embodies
the records of onlv three years of service. If it be assumed that the rates of prevalence
and mortality which were found in these three years among the colored troops would have
prevailed liad the observations been continued for five and one-sixth years, the ratio of
cases per thousand of strength would have been 4,498 as compared with 2,814 among the
whites, and the deaths 86.88 as compared with 26.05, or, in other words, for every 100
cases occurring among a given number of white soldiers in a certain time, 160 cases would
have occui'red among the same number of colored troops in the same period, and for 1()(J
deaths from malarial fever occurring among the white, 334 deaths would have been recorded
in the same time among the same number of colored troops. This is definitely shown in
Table XXVI, where the sickness and deaths for lioth races are tabulated as annual averages.
But the element of time does not affect the comparative value of the figures in the
last three columns of the table at present under consideration. Thus the increased mor-
AMONG THE U. S. FORCES. 81
tality wliicli has just been indicated is in the last riiliuiin distrilnilcd among the various
forms of lever. Of 100 cases of congestive fever among tlie colored troops 31.31 died, or
1 in 3.2 cases, as against 1 in 4 among the whites; of the same numlier of remittent cases
3.27 died, or 1 in 30, as against 1 in 76 among the whites; of 100 typho-malarial cases
17.27 died, or 1 in 5.8, as against 1 in 12 among llie whites. The intiuencc of this
increased mortality in the more dangerous forms of malarial fever among the colored troops
was such that the percentage of fatality of the malarial fevers as a class among the colored
men is found to be as large again as that which obtained among the white soldiers: thus,
the purely malarial fevers gave a mortality of 0.7 per cent., or 1 in 1 13 cases among the
latter, and 1.26 per cent., or 1 in 79 among the former; while, if tvplm-malarial fever is
taken into consideration, its greater fatality among the blacks will be found to raise their
percentage of fatal cases to 2.02 as compared with 1.00 among the white troops. But
it may not be inferred from these facts that negro troops ai-e more liable t-o malarial
seizures, and more prone to succumb to the uialarial influence thai) white troops, until it has
been shown that both bodies of men were exposed to similar influences.
The tabulated statistics of malarial disease have reference solely to the fevers. It is
not possible to ascertain the actual number of men who suffered from chronic malarial
poisoning during the civil war. ]\[ost of them were undoubtedly reported under the head
of the intercurrent diseases which were developed iluring the progress lA' the cachexia.
Large numbers were registered as cases of general debility or other diseases of the mias-
matic order. Under these headings 101,892 cases with 1,981 deaths were reported among
the white troops, and 11,887 cases with 535 deaths among the colored troops; moreover,
there were 14.500 white, and 540 colored, soldiers discharged tlie service for debility.
Under the head of anaemia 21,892 cases, 438 deaths and 317 dis(-liarges on certificates
of disability were reported among the white troops ; 2,771 cases, 258 deaths and 35
discharges among the colored. Men broken down by the most diverse morbid condi-
tions were included in these figures; and although all who had opportunity of observing
large numbers of such (!ases during the war will testify to the frequeimy with which the
malarial cachexia occurred among them either as the chief morbid condition or as a com-
plication, there is no possibility of giving even an appro.ximate numerical expression of the
fact. It may be added that, according to the tables in the l/^rst Medical Volume, 1,977
cases, 17 deaths and 171 discharges on account of diseases of the spleen were reported
among the white troops, and 55 cases, 3 deaths and 3 discharges among the colored men ;
and although the majority of these cases were instances of malarial enlargement of the
organ, it cannot be supposed that the numbers represent any very considerable proportion
of the actual cases, which were usually recorded under other heads, such as intermittent
fever, debility and ansemia. Xur is it possible to determine the number of cases of malarial
cachexia that terminated in dropsy, though it must be believed that a large number recorded
as i/eneral dropsy, ahdominal dropsy, and dropsy from hepatic disease had this origin.
Under these headings 7,337 cases and 398 deaths were reporti.'d among the white troops;
and 2,224 men are said to have been discharged for dropsy. Under the same headings
1.127 cases, 272 deaths and 109 discharges were reported among the colored troops.
(.)f neuralgia, another manifestation of malarial poisoning, 58,774 cases were noted
among the white, and 0,018 among the colori'd troops. .\ number of these cases may have
Med. Hist., Pt. Ill— U
82
MALAEIAL FEVERS!
been due to malaria, but it i.s difficult to believe that the majority were so, for neither in
their geographical distribution nor in the season at which tliey were most pi-evalent do the
figures reported agree with the distribution of the reported cases of intermittent fever.*
The occurrence of malarial fever in connection with diarrhoea and dysentery has
already been shown.f
Annual variations in prevalence and mortality. — Turning now to Table XXIY, illus-
trating the relative frequency and mortality of these febrile affections among white troops
during the several years covered by the statistics, it is found that their prevalence increased
gradually to the fourth year, or that ending June 30, 1864, when the war maximum was
attained, diminished somewhat during the fifth year, and experienced a marked increase
during the sixth, or year succeeding the war. This marked advance to the fourth year,
and slight diminution during the fifth year, was due to the influence of the mass of the
intermittents on the figures representing the prevalence of the other forms; for both con-
gestive and remittent fevers were slightly more prevalent during the second year than
during any other of the years of the war.
Table XXIV.
Relative Frequeticy of cases of Malarial Fevers, and Deaths caused by them, during the several years of
the war and the year following the ivar, expressed in annual rates per 1,000 of mean strength.
WHITE TROOPS.
Diseases.
1860-1.
1861-2.
1862-3.
1863-1.
1864-5.
1865-6.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
56.17
:>'). 63
10.25
144. 36
95.81
.11
.11
.01
les. 01
134. 23
16.07
.21
.18
.06
330. .51
210. 44
22.67
.17
.19
.03
221. 93
184.38
19.39
.21
.12
.03
364. 92
295.58
24.70
.32
.26
.01
Tertian Intermittent
1S6. 05
5.20
•>.=i-T 7q
.24
1.25
313. 31
6.45
.45
^ J. 55
463.82
6.16
.39
1.53
425.70
4.90
.36
1.12
685.20
8.20
.39
2 26
.Oi? 7 !':'
Total
131. 25
43.60
.02
260.78
143.26
1.49
1.28
319. 76
140. 38
2.00
1.76
469.98
114. 12
1.92
1.27
43a 60
127.84
1.48
1.86
693.40
159. 70
a. 85
2.57
174. 85
. 02 404. 04
2.77
460.14
38.00
3.76
1.78
584.16
18.93
a 19
1.71
558.44
22.91
3. -34
a. 27
853.10
16.62
5.42
254
Total Malarial Fevers
174.85
.02
404.04
2.77
498.14
5.54
60a03
4.90
581.35
. 5.61
869.72
7.96
The increased prevalence of malarial fever during the year succeeding the war was
probably due to the occupation of Southern and malarious territory by the army, and
the concurrent discharge from service of troops stationed in Xorthern and less malarious
sections. Although this increase is observable in all the forms of malarial fever, each
reaching a higher figure per thousand of strength than in any of the previous years, the
intermittents constituted absolutely and relatively its greater portion. As will be seen
hereafter in Table XXXII, the troops in the Department of Arkansas had the highest
malarial record, and among them intermittents Were relatively more frequent and remittents
less frequent than among troops in less malarious localities.
* See article on Neuralgia, infra, page 874.
tin the secoiui jiari ol tlii.s worli, pp. S87, 398, 495 and 637.
AMONG THE U. >s. FORCES.
83
Typlio-inalarial I'ewr, howrvcr, (liu-iag these years did uol follow tliu course of ihe
uiunodified malarial fevers. Its presence was not reported during the hrst two years,
einbrai't'd in Table XXIV. During the year-ending Juno 30, 1863, there were 38 cases
per thousand of strength. In the following j^ear, when malarial fevers were at their war
ma.ximum, typho-malarial fever fell off one-half, to 18.93, increasing slightly during the last
year of the war, and subsiding to its minimum when the pure malarial fevers were at tln'ir
maximum during the year succeeding the war.
In general the mortality of the malarial fevers increased with their increased frequency :
thus, in the year after the war, with 853 cases per thousand of strength thcrt^ were 5.42
deaths, while in 1861-2, with 404 cases the deaths were 2.77. J5ut in the typho malarial
fevers an increased mortality was associated with a diminished prevalence: in the year
1862-3, with 38 cases per thou.sand of strength, the corresponding death-rate was 1.78,
while in 1865-6, with 16.62 cases, the ratio of deaths rose to 2.54.
Similar results are obtained by an examination of the statistics from the colored
commands, as given in —
Table XXV.
Relative Frequency of Cases of Ilalarial Fevers and of Deaths caused by them among the Colored Troops
during tiro years of the tvar and the year following the icar, expressed in annual rates per 1,000
of mean strength.
DiSE.VSES.
1863-4.
1864-
-5.
1865-6.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Quotidian Intermittent
362.60
276.50
23.96
.46
.41
.13
308.67
235. 19
21.57
.29
.26
.08
398.94
345. 34
19.02
.19
.21
.04
Tertian Intermittent
Quartan Intermittent
Total .sinij)lo Intermittent
Congestive Fever
663. 06
23.62
1.00
7.76
565.43
11.12
.63
3.42
763.30
9.97
.44
2.33
Total
686.68
147.04
8.76
(i. 13
576.55
173.48
4.05
4.72
773.27
173.73
2.77
5.04
7.81
5.49
Rrniittcnt Fever
Total pnin Malarial Fevers .
833. 72
56.15
15. 19
10.85
750. 03
37.47
8.77
5.51
947. 00
34.21
Tvpho-nialarial Fever _. .
Total Malarial Fevers
889.87-
26. 04
787. 50
14.28
981.21.
13.30
These figures cover only the last two years of the war and the year succeeding the
war. The year ending June 30, 1864, yielded a higher ratio of cases than that which
followed it, but, as in the case of the white troops, not so high a rate as was attained after
the cessation of hostilities. Here also the preponderance of the intermittents is tlie cause
of the varying tides in the annual progress of these fevers; for, while the congestive
cases were most prominent during the first year, corresponding in this respect with tlu'
intermittents generally, the remittents were least prominent during that year.
84
MALARIAL FEVERS
. Typlio-malarial cases were most prevalent, 56 jier thousand of mean strengtli, during
tlie first year of tlie service of the colored troops, diminishing to 37 and 34 per thousand
during the two following years.
Relative prevalence and mortaUty amo/i'j the white and the colored troops. — The fol-
lowing table consolidates the data of the last two tables, giving the annual average ratios
per thousand of strength as deduced from the experience of five and one-sixth years of
service by the white troops and of three years of service by the colored troops:
Table XXVI.
Relative Frequency among the White and the Colored Troops of Cases of Maternal Fevers and of Deaths
caused by them, as shown by the average number annually recorded, reduced to ratios per 1,000 of
strength.
Diseases.
WiuTE Troops.
Colored Troops.
Cases.
Deaths.
Cases.
Deaths.
Quotidian III teriuitteiit -
200. 73
18. 50
.19
.16
.03
348. 93
278. 33
21.40
.30
.28
.08
Tertian Intermit tent _ _- . __. ,-
Quartciu Intermittent . ---
Total sininle Intermittent - - _
1
387.62
6.U
.38
1.39
648. 66
13.82
.66
4.14
393. 76
128. 58
1.77
1.59
662.48
167. 10
4.80
5.23
Remittent Fever 1 -
522. 31
(a) 26. 15
3.36
(«)1.95
829. 58 10. 03
Typho-malarial F'e\'er _ - - - -
41.04
6.79
Total Malarial Kevei'H _ .-._ ._- __.
(.0 544.72
(o)5.04
870. 62
16.82
(a) As the aDtiual rates of typho-malarial fever atnon^ the white troops are derived from the statistics of four years while the rates of the totality
of the malarial fevers cover five aurt one-sixth years of observation, the latter dilVer somewhat from the sum i»f the rates of the purely malarial and
t3'pho-.nalarial fevers.
The greater prevalence of all forms of malarial fever among the colored troops is as
well shown in the various items of this table as in the totals of 544.72 cases per thousand
of mean strength among the white, and 870.62 among the colored men. These figures
are as 100 to 160. The greater mortality among the negroes is equally well shown, and is
especially marked in the more serious forms, giving an average annual total of 16.82
deaths per thousand of strength as compared with 5.04 among the white troops; figures
whicl) are in the ratio of 334 to 100. As has already been seen,* the deaths formed 1.00
per cent, of the cases in the white and 2.02 per cent, in the colored regiments.
These statistics indicate that the colored race exhibited a greater susceptibility to
the malarial poison than was shown by the white commands, or that the colored troops
•Tables XXII and XXIII, pp. 79 and 80, supra.
AMONG THK V. ?. FORGES. 85
were exposed to influences of a more deleterious nature.'^' It would, however, be injudi-
cious to attach weight to a comparison of the annual averages given in Table XXVf
as bearing on the relative liability of the white and the colored troops to the malarial
influence. Large numbers of the white troops served in departments which were com-
iiarativelv salubrious, and the influence of their records is felt in diminishiuii; the average
annual rate for the white commands as a whole. The black men, on the contrary, were
agaregated in malarious districts. Those servincj in the Atlantic region were mainly
distributed in the Departments of the South, of North Carolina and of Virginia, and tliosc
on duty in the Central region held fortresses along the Mississippi bottom and in the
Department of the Gulf. Manifestly, in making a comparison to determine relative preva-
lence, locality must be taken into consideration. The records do not enter with sufficient
minuteness into the conditions of service of the white and the colored commands to enable
their relative susceptibility to be determined. In fact the question was seldom touched
upon by our medical officers. The writer is aware that the officers on duty at the Fitdd
Hospital for colored troops at City Point, Va., were of the opinion that although the
colored people under similar conditions of exposure might be less liable to seizure than the
whites, tliey were assuredly much less able to resist the febrile influence when the attack
was developed. Surgeon John Fish, 17th regiment Corps d'Afrique, appears to have enter-
tained the belief that the negro was as liable to Jiialarial attacks as the white soldier.f
The 17th re^inu'Ut Curjis (VAtVitiuf was rt'cruitcd at Jintoii Kou^c aiul tirst luustcivd August 10, I«t)3. Its
stren^tli at that time wuh 510 ineu. We left Baton Koiige on steamer for Port Hudson, Septenihcr IS, iHCy'A, and have
l)een ou dnty here over sinee. Tlie most fVejinent diseases have lieen diarrlnea and dysentery, intermittent lever,
typhoid fever, seurvy, pneumonia and rheumatism.
I had supposed the bhiek man to be peculiarly exempt from diseases due to malarial intlueuees; hut I should
not expect to have encountered a greater number of cases of intermittent fever in a body of white troops equalling
(»nr8 in number than we have actually had. — Port Hudson^ La., Feb. 25, 18t>4.
* Some writers hare clainied for the negro race an immunity from malarial disease. Thus FEKGUsoS in his article Oil the Nature and History
tif the Marsh Poison, Trans. Royal Society, Kdinbiirgh, Vol. IX. says : — '" The adaptation of the ne^ro t<» live in the unwholesome localities of the
lorrid xone, that prove so fatal to Europeans, is most happy and singular. From peculiarity of idiosyncrasy lie appears to be proof aj^ainst fevew; for
to him marsh iiiia.'imata are in fact no poison, and hence his incalculable value as a soldier, for field service in the West Indies. TJie warm, m()ist, l()W,
and leeward situations, where these i>ernicious exhalations are generated and concentrated, prove to him congenial in every respect- Me delights in
them, for he there enjoys life and health, as much as his feelings are abhorrent to the currents of wind that sweep the iiKuintain tops; where alone the
whites finil security against endemic fevers. One of the most obvious peculiarities of the negro as compared with the European is his thick oily skin,
mnk tt> a degree ; and from this circumstance the theorist, when he speculates upon the mode of reception of the marsh poison into the c<)nslituti(m,
whether by lungs, stomach, or skin, may draw a plausible conjecture in favor of the hist."
t Dr. E. AXUKKWS, in a letter published in the Chicago Med. Examiner, Vol. Ill, ]8t>2, p. 481, — speaks of the prevalence of intermittent and
'remittent fevers among the troops near Memphis, Tennessee, during the summer of 186"2, and remarks that he constantly observes these fevers among the
negroes, whose powers of resistance he conceives to have been greatly over-estimated. See also an interesting paper by Dr. .Sa\F0KI) H. Huxt — The
ytgro as a Soldier, The Quarterly Jour, of Psychological Medicine, Vol. I, 1863. p. 161 H seq. These fevers were, moreover, exceedingly common
among the colored people who received medical assistance frtuu ihe Kreedman's bureau. In an article entitled Uemarks concerning some of the diseases
prevailing among the freed peopU in the District of Columbia (Bureau Refugees, Freedmen and Abandoned Lands), American Journal of the Medical
Sciences, 18fi6. p. 366, Dr. R. UkvbL'RN, Surgeon V. S. Volunteers, cites the occurrence among these colored people of 2,776 eases of remittent and inter-
mittent fevers in a total of 7,949 cases of sickness and wounds, or about 35 per cent, of the whole, as a sufficient answer to and refutation of the statement
fio often reiterated id our text-bofiks. that the negroes are not subject to, and do not sulVer from, malarial disease. *' Now it may be that in Africa, and
in the West Indies they do not suffer to the same extent as unacclimated whites do. but they certainly are not exempt from these diseases in this c<tuntry ;
and as far as our own opinion goes, we are strongly inclined to the belief that this socalletl exemption has no foundation in fact and is unworthy of cre-
dence.'' The only testimony in favor of any supposed immunity of the colored troops from tliese diseases during any . :ir; of the war is contained in a
report by Medical Inspector N. S. TowxeiiEXO, L'. S. A., cited in the American Med. Times, Vol. VII. 1863, p. 65. This report is on file in the oHlce of
Ihe Surgeon General and is dated May 19, 1863. It relates to an inspectii>n of Fi»rts St. Philip and Jackson, near the mouth of the Mifisissipjti river, and
I'ontains the following paragraph: "Of the troops at Ihe forts four-fifths are of the 13th Maine, and one-fifth Louisiana negroes. The comparative
fxemption of the latter fnun diseases of malarial origin is most marked. Of the entire white force 10.8 per cent, had intermittent or remittent fever, while
of the colored troops only . 8 per cent, suffered from those diseases. In respect to other dise^ises their liability appeared nearly equal." This statement
ii no doubt true so far as the time and place referred to are concerned, though it cannot be verified because in the report <it" sick and wounded at this post
for the month of May. 1863, by Surgeon Jas. M. Bates of the 13th Maine, the figures for the white and colored troops of the garrison, viz: eight com-
imnies of the I3th Maine and one battery of Louisiana heavy artillery, are unfortunately consolidated. But whatever may have been the cause of the
temi>omry condiii<m reiwrted. Ihe subse<iuent separate reports of the colored troops at this post show no such immunity from intennittent or remittent
fevers. In this connection reference may be made to the statement of A. G. Temaiu^T with regard to ti.c Negroes of Virginia," as cited by T. P.
.\TKJXS*)X — Rep'trt on the anatomical, physiological and pathological difference* hetv:een the white and the black races, etc., Trans, of Ihe Third Animal
session of the Med. Sirt;. of Virginia, held at Staunton. Nov.. 1873, Richmond, 1873, Appendix E, p. 112, "Cases of intra<;tahle intermittent are rarely
seen aamng them, and never of chronic enlargement of the spleen, or the quartan ague."
86
MALARIAL FEVEES
But this is an opinion based upon one-sided experience. To ascertain the fact, statis-
tics are required from white and colored commands camped or operating in the same locah-
ties at the same time. In their absence, the following table may be of interest as pre-
senting the rate of prevalence among the colored troops during the fourth and fifth years
of the war in juxtaposition with the rates prevailing among the whites during the same
period in the same departments or sections of the country.*
Table XXVII.
A Comparison of the Prevalence of Malarial Fevers among the White and the Colored Troops serving in
the same localities during the tioo years from July 1, 1863, to June 30, 1865, the figures given
being the average annual ratios per 1,000 of strength.
Whitb Tkoops.
Colored Troops.
'si
1^
Typho-
malarial.
Total
Malarial.
Remit-
tents.
liitermit-
teuts.
Typho-
malarial.
o rt
Department of Virginia
88
244
'l08
676
1,364
497
25 789
.. (a) (a) (a\ ..
Department of Nortli C'arolin.a
33
46
1,641
651
Department of the South
■
1
The above Depts. of the Atlantic Region
129
786
33
948
140
412
44
596 '
Department of the Gulf . .
147
144
779
542
1,107
24 950
16 j 702
18 1,291
1
..(a)..
..(«)..
..CO)..
..(0)..
Division of Mississippi and Department of
Tennessee
Department of Arkansas
166
The above Departments of the Central Region
Total in these sections of the Atlantic and
Central Regions
147
664
18 , 829
176 715
44
935
143
692
1
22 857
164 615
44
823
(a) The statistics of the Colored Troops having- been consolidated by regions, it is impossible now to distribute the cases among the several Departments.
From this table it appears that in those departments of the Atlantic region in which
white and colored troops served during the period stated, malarial fevers prevailed more
extensively among the white men, they having presented 948 cases per thousand of mean
strength annually as compared with 596 among the colored troops. In the departments
of the Central region, however, the colored men suffered more than the whites. The
aggregate rates in these various sections show the fevers as somewhat more prevalent
among tlie white troops — 857 per thousand annually as against 823 among the colored
men.
* The Murtality Tables of the Tenth IT. S. Census, 1880, do not furnish satis fact oi-j' information concerning the relative prevalence and fatality of
malarial fevers among- the white and colored i>opn]atii>n. The returns are known to be very incomplete. A comparison with the tleatli records of the leg^is-
tration offices of the States of Massachusetts and New Jersey sliowed a deficiency on the part of the census tables of 2tl.42 per cent, of the whole number
retuiTied by them in the former, and of 34.45 per cent, in the latter. State. This would not affect a calculatiim intended to give expression to the relative
frequency of death fi-om any specified cause in the two races were the deficiency equally distributed ; but it is recognized by Dr. BlLLINGS, p. 1706, Com-
pendium of the. Tenth Census of (he United States, 1880, that in the sections of country having the largest colored population the greatest deficiencies were
found, and that these were probably greater among the colored than among the wliite population. With tiie knowledge that the ratios for the colored
people were in all likelihood greater than is represented by the figures, the foIli>winer table may be examined:
AMONG THE U. 8. FORCES.
87
The statistics do not furnish the necessary data for determining the relative mortality
among white and colored commands operating in the same departments.
V
1'OPUI.ATIOX.
il
ll
ce'3
OS
if
flnnip 2
(f Census Tables Middle \tlantic Const
(Wliile
3,857,003
518, 633
1,284
338
33
46
( Colored
C White ....
4, 990, 587
72-t, nw!
791
374
16
51
( C.lcireil . . . .
C Wliile
rtroun 1 1 of Census Tables. .Suutlieni Interior Plateau <
(Colored
l,iai,0'.l6
1,972,449
1,410
1,784
I
The second ffixiup comprises Delaware, the District of Columbia and parts of New York, Kew Jersey, Maryland and Virfifinia; the eighth includes
parts of New York. Pennsylvania, Virginia and North Carolina; and the eleventh, parts of South Carolina, Georgia, Alabama, Mississippi and Tennessee.
.Aecurding to this tabulation lite colored race is more liable to death from malarial fevers in these sections of the United States; but that this does not
depend on distinctions ff mee seems indicated by the fuel that although in the mure malarious regions the death-rate of both races is increased, the relative
increase is uuieh greater among the whites. l*ntil proved otherwise it may be assumed that the higher death.rate among the negroes is due to greater
ex|t<«ures.
The mortality figures returned by the health oifioers of certain cities have been tabulated below as bearing on the point nt issue. These figures
having tieen obtained by a regular system of registration, based in most instances on the requirement of burial permits, are probably very nearly accurate ;
anti as they represent deaths which occurred within certain restricted limits of territory, they may be considered as possessing better qualifications for a
comi*arative inquiry than the figures of the census reports;
Cinni>ari3on n/ the Dta(h~Tate from Hutnrial Disease among the Whitt and Colored population of certain cities of the United States, from data taken
from lite Cnnsotidated Mortality Report of the National Board of Health for the year 1881. Bulletin of the Board, Vol. Ill, pp. 334-327.
CiTilis AND Towns.
District of Columbia
Norfolk, Virginia
Richmond. Virginia
Lynchburg, Virginia
Pelereburg, Virginia
Wilmington, Nonh Carolina
Charleston, >South Carolina .
A ugusta, (ieorgia
.\tlanta, Georgia
.Savannah, Georgia
Mobile, .Alabama
iSelma, Alabama
CulumL.'S, Mississippi
Natchez, Mississippi -
Vicksbnrg, Mississippi
New Orleans, Louisiana
.Shreveport, Louisiana
Raton Rouge, Louisiana....
Galveston, Texas
San .-Vntonio, Texas
Nashville, Tennessee
Memphis, Tennessee
■St. Louis. Missouri
I
POPUIJkTIOX.
Deaths from
i:il:trial disease.
White.
120,000
11,933
35,756
7,484
10,000
8, 893
22, 712
12,3fi4
31, 086
15, 007
16,837
3, 345
3,760
3,421
5, 975
158, 379
3,739
2,917
16,900
17, 525
27,004
18,622
338,233
Colored.
White. Colored.
60,000
10,033
28, 047
8,475
12,000
10,468
27, 287
I
10. 659 ;
16, 335 !
15, 674 I
14, 368
4,184
2,470
3,637
5,839
57, 761
7,278
4,300
5,353
3,036
16, 457
14, 971
22,390
360,932
9
6
5
30
19
8
1
2
19
2:)7
16
13
11
20
345
84
21
10
4
7
13
9
5
3
24
11
1
20
119
27
7
15
27
42
460
Katio of deaths per
100,000 of living.
While. Colored.
05.0
142.5
30.8
36.7
30.0
87.0
.19.6
48. S
3a 7
199.9
112. 8
339.1
36.3
58.5
318.0
149.6
428.0
171.4
59.3
68.5
40.7
107.4
105.1
ioa4
140.0
209.3
35.7
47.2
.58. 3
134.3
33
46.9
18.3
153. 1
70.7
525. 8
81.0
27.5
343 5
206.0
371.0
162.8
93.4
65.9
91.1
180.3
ie&4
isao
88
MALARIAL FF.VERS
It is not possible, in view of these figures, to decide whether the negro is less sus-
ceptible to the malarial influence than the white race; but the assertion may be allowed,
In twenty-three United States cities which contain a notable coiored population, the death-rate from malarial fever among- the white people in 1881
was in nine cities larger than that of the colored people; but the excess in the other direction was so g-reat in the remaining' fourteen cities that in a total
population of eee.SlU white and 300,922 colored, the deaths were 100 in every 100.000 of the former and 133 in every 100.000 t.f the latter. It is probable
that local conditions were involved in the production of the various death-rates given in-this table : for although in some towns that are notably malarious,
as Shreveport, Louisiana, and in others that are not so, as Atlanta, Georgia, the death-rate among the colored people was less than among the whites; in
some that are notably malarious, as Selina, Alabama, and Vicksburg. Mississippi, and in others that are not so. as Richmond and Lynchburg. Virginia.
the death rate among the colored people was greater than among the whites. The only inference that may with propriety be drawn from these municipal
statistics is that which has been reached in the text frora a comparison of the figures relating to malarial fevers in the whitt- and colored commands during
the war: that the colored race suffers greatly from these fevers, but whether to greater or less extent than the white race, cannot be determined in
the absence of a thorough knowledge of the surroundings and exposure. Manifestly, since in any of these cities the colored people may or may not have
been aggregated in unhealthy lucalities, nothing can be said of their relative liability to malarial fevers until a comparison is made of the prevalence of
these fevers in the two races in certain wards or sections of the city having the same medical topography.
Our army experience since the war jiresents statistics which ought to be of more value in this connection than those heretofore adduced. Certain
posts have been occupied by a mixed garrison nf white and colored troops. The two commands have been similarly quartered, clothed and rationed ;
they have performed the same guard, fatigue, escitrt and scouting duties, and have necessarily been exposed to the same malarious influences. More-
over, the same medical autluirity has supervised the recnrd of the sickness of both races. The facts tabulated below may therefore be accepted as
obtained under conditions which permit the relative liability of the white and colored races to be as satisfactorily tested as if they had been specially
arranged for the experimeu*. I'nfurtunately, however, owing to the small number of posts garrisoned by mixed commands, the strength represented is small.
Table exhibiting the Prevaltrice of Ptriodic Fevers at difftrent Posts in the Department of Texas.
Fort Bliss. Texas.
Fort Bliss, Texas -
Tro<ips.
Fort Brown, Texas .
Fort Clark, Texas.
Fort Mcintosh, Texas .
Fort Mcintosh, Texas .
Fort McKavett. Texas
Fort McKavett, Texas.
Fort Ringgold, Texas .
Fort Ringgold, Te.xas ..
Fort Ringgold, Texas .
Fort Ringgold, Texas .
-.- 1
White...
Colored .
White...
Colored .
White...
Colored .
White...
Colored .
White ..
Colored .
White...
Colored .
White ..
( I Colored .
White...
Colored .
White...
Colored .
White...
Colored .
White...
Colored .
White...
Colored .
1878-9
1879-80
1879-80
187i;-7
1877-8
1876-7
Total White ..
Total Colored .
54
26
340
56
2.i()
1-20
98
9»
65
1S7
263
59
164
30
199
74
155
"8
126
119
107
166
1,887
1,016
3
1
30
3
21
12
10
19
'1
5
16
11
14
4
91'
5
14
3
31
3J
7
22
14
4
1
10
1
1
113
24
18
4
g
10
11
12
106
47
358
134
10
1
5
48
6
06.
16
11
14
4
113
G
35
8
35
37
12
26
29
3
29
1
151
27
41
17
22
30
15
18
512
188
.^t4
"So
is--
B c B.
266.6
21i.r.
2.'i9. :i
I0S.9
332. 4
107.1
136.7
66.6
357.1
373.7
184.6
189.8
110.3
50.8
176.8
33.3
758.8
364.9
264.5
217.9
174.6
252.1
■]40.2
108.4
271.3
185.0
At Forts Bliss, Brown, Clark aud McKavett, Texas, there was a greater prevalence among: the white troops : at Fort Mcintosh the white and
colored troops suffered at about the same rate ; while at Fort Ringgold, in the year 1878-9. there were more malarial cases among the colored than amt)ng
the white soldiers. But in dealing with such small numbers as are represented at each of these posts the records of a single garrison do nut have much
value, as they may be affected by unknowu local conditions. The totals tabulated show a less degree of prevalence among the colored troops, the annual
rate per thousand among them being 18.0, 0, while among the white troops it was 271. 3.
AMONG THE U. P. KORCKS.
89
that the colored troops did not sufllr in a marked degree as compared with the white men,
although it is not unlikely, from the then generally accepted belief in their partial immunity,
that they wore often stationed in localities that would have proved specially dangerous to
white men. It is probable, therefore, that if strictly comparaljle figures were obtained thcv
would show the black man to be less susceptible to malarial attacks than the white soldier.
Seasonal variations in Prevalence. — The following table shows the monthly rates of
malarial cases among the white troops, and permits a comparison to be made between ihi-
i-att>s among the troops operating in tlie several regions.
Looking tlrst at the totals in the army, the purely malarial fevei-s (the intermittents
antl remittents) are seen to have a distinct maximum and minimum of prevalence in
each year. These seasonal variations will be more readily followed liy a reference to
the diagram facing page 90. The maximum in the year ending June 30, 1862, was
attained in the months of September and October, 1861, when the monthly ratios were
61.3 and 60.7 respectively, and the minimum in January, February and j\Iarch, 1862,
when the ratios were respectively 18.8, 18.2 and 17.0. Tn October of 1862 the maxi-
mum, 62.6, was again reached, after which the fevers subsided rapidly, and comparatively
few cases occurred during the months of January, February, Marcli and April, 1863, the
ratios for these being 29.4. 26.8, 28.6 and 29.3. A steady increase in the number of
cases reached its maximum in .August and September, with ratios of 88.5 and 80.7 per
thousand of strength. The fall to the minimum in January and Februarj^ 1864, was as
Table XXVIII.
Showing the Seasonal Variations in the Prevalence of Malarial Fevers among the White Troops in tlie
several 7-egions during the years of the War and the year following tlie War, expressed in monthly
7'atios per 1,000 of mean strength.
YEAR ENT)ING JUNE 30, 1862.
Disease.
Eegiok.
1861.
1862.
<
:£
5
3
S
a
S
1
an
5
§
i
<
3
%
■<
i
a
a
1
■<
s4
<
S
Ed
Intennitt^nl (iiirliidin^ Conge.<;tive) Fever . .
Atlantic ...
Central....
Pacific
10.2
38.9
8.2
27.6
W.O
30.6
:i9.4
56.9
18.2
-
34.6
65.5
21.7
22.2
41.7
20.1
14.2
30.7
13.9
7.9
21.9
7.2
8.5
17.2
10.1
6.9
19.1
8.8
12.3
26.7
10.0
15.S
27.6
8.9
15.8
27.1
13.0
19.1. 9
379.9
161.8
22.2
35.9
43.2
44.2
28.4
19.6
11.7
111 -
ti. :
10.0
1.8
18.9
21.2
21.2
260.8
;. J
Atlantic . . .
Central....
Pacific ...
2.8
, I)
7.3
9.9
31.6
.4
15.9
26.3
1.3
16.0
18.4
7.4
13.7
18.6
ai
9.3
las
4.S
5.7
11.3
1.3
8.5
15.8
1:1.7
1 7
14.2
17.9
8.9
15.9
124.4
182.1
55.0
9.5
4.3
lae
Keinittent in all the reruns
14.3
18.1
16.5
14.9
las
7.1
7.4
6.5
10.4
■20.8
39.3
18.5
15.8
143,2
Intennitteiit ami Kemitteiit
Atlantic. ..
Central
Pacific
13.1
52.4
9.1
37.5
98.5
21.0
55.2
8a2
19.5
50.6
83.9
29.1
3.5.9
GO. 3
23.2
23.5
44.0
18.5
13.5
3a2
8.4
15.1
27.2
11.9
12.2
28.7
13.1
31.0
43.4
10.6
30.1
45.0
21.9
320.3
562.0
216.9
Total Malarial in all the regions
29.4
50.2
f.1.3
m.7
1
43.3
30.1
18.8
18.2
17.0
29.3
37.0
37.1
404.0
Med. Hlst., Pt. 111—12
90
MALARIAL FEVERS
YEAR ENDING JUNE 30, 1863.
Disease.
Region.
186S.
1863.
ti
H
><
d
•-a
i
O
s
S
a*
CO
a
a -
i
o
1
<
sa
<
S
S
^
<
s
Intermittent (including Congestive) Fever . .
Atlantic . . .
Central
Pacific
20.4
32.3
12.5
21.4
36.8
17.4
24.4
56.3
17.6
30.8
61.2
11.4
19.4
46.0
11.1
12.9
33.9
8.0
11.3
28.5
8.2
8.6
26.9
6.0
9.2
29.2
7.3
1».4
28.6
8.2
15.3
29.1
7.7
18.8
44.0
9.8
191.2
440.8
124.5
Intermittent in all the regions
25.4
2a 8
39.3
46.3
33.2
23.1
19.9
17.9
19.5
20.3
2ao
34.3
319.8
Atlantic - - .
Central....
Pacific
21.4
19.0
2.4
16.1
18.1
6.6
13.4
18.4
1.5.0
16.7
16.3
7.0
10.5
12.6
5.7
8.0
10.3
2.7
8.0
11.2
1.5
6.6
11. a
.7
6.7
11.6
1.8
6.8
10.9
4.0
8.5
12.2
a 6
9.0
14.9
a2
12a 3
138.3
sae
19.9
16.9
15.8
16.3
11.5
9.1
9.5
8.9
9.1
9.0
10.5
12.5
140.4
Intermittent and Remittent
Atlantic . - .
Central
Pacific
41.8
51.3
14.9
37.5
54.9
24.0
37.8
74.7
32.6
47.5
77.5
1&4
89.9
58.6
16.8
20.9
44.2
10.7
19.3
39.7
9.7
15.2
38.1
6.7
15.9
40.8
9.1
17.2
39.5
12.2
23.8
41.3
11.3
27.8
58.9
lao
314.5
599.1
178.1
460.2
Total in all the regions
45.3
4^7
55.1
62.6
3.4
3.2
2.2
44.7
32.2
29.4
26.8
28.6
29.3
3a 5
46.8
Atlantic . . .
Central....
Pacific
6.1
4.8
2.0
4.1
4.5
2.3
3.3
a2
1.6
3.8
2.3
.9
as
1.9
a4
4.2
2.8
.2
2.9
a 9
.8
2.7
a3
.7
2.5
2.6
1.3
2.7
2.1
.7
a 5
2.0
2.2
42.3
34.8
18.0
5.4
4.3.
3.2
as
ao
2.9
a4
a4
ao
•
2.6
2.3
2.6
38.0
Intermittent, Remittent and Typho-malarial
Atlantic . . .
Central
Pacific
47.9
56.1
16.9
41.6
59.4
26.3
41.1
77.9
34.2
50.9
80.7
20.6
3a 7
60.9
17.7
24.7
46.1
14.1
2a5
42.5
9.9
18.1
42.0
7.5
18.6
44.1
9.8
19.7
42.1
las
26.5
4a 4
IS.O
31 3
60.9
15.2
356.8
633.9
196.1
498.2
All the regions
50.7
.50.0
58.3
65.9
47.7
33.1
32.8
30.2
31.6
31.9
35.8
49.4
YEAK ENDINOf JUNE 30, 1864.
BiSBiSE.
Region.
1863.
1864.
><
K
P.
1-3
1
§
o
H
B
>
o
i
Ed
Q
as
<
"5
•*
a
S
1
S
<
<
s
f-a
Intermittent (including Congestive) Fever. .
Atlantic . . .
27.6
44.7
52.0
47.8
38.8
23.5
19.4
17.1
21.0
24.2
22.2
24.5
359.7
Central
66.3
84.6
74.7
58.2
42.6
30.4
28.6
27.4
32.1
33.8
34.8
37.6
541.0
Pacific
ia8
15.7
23.3
25.1
15.7
10.7
8.0
7.4
10.4
10.6
11.8
11.6
161.8
51.6
69.0
65.3
54.0
40.8
27.7
25.1
23.4
27.7
29.7
30.1
32.7
470.0
99.8
Remittent Fever
Atlantic . . .
11.2
17.6
15.3
12.3
7.7
4.8
as
a7
4.6
5.5
5.1
10.7
Central...
19.3
91.0
15.7
10.0
7.1
4.9
5.0
5.5
6.3
7.7
9.8
las
12a 6
Pacific ....
5.0
5.1
6.8
11.3
11.6
a 6
2.7
.9
2.2
ao
5.4
5.6
61.4
16.2
19.5
15.4
10.4
7.4
4.9
4.6
4.8
5.6
6.8
8.2
12.4
114.1
Atlantic . . .
Central....
38.8
8.J.6
62.3
105.6
67.3
90.4
60.1
68.2
46.5
49.7
28.3
35.3
2aa
33. B
20.8
32.9
23.6
38.4
29.7
41.5
37.3
44.6
35.2
51.1
459.5
664.6
Pacific
18:8
20.8
32.1
36.4
27.3
14.3
10.7
8.3
12.fi
ia6
17.2
17.2
223.2
584.1
67.8
88.5
80.7
64.4
48.2
32.6
29.7
28.2
33.3
36.5
38.3
45.1
T3-pl]0-nialanal Fever
Atlantic . . .
4.4
4.2
ao
2.8
1.8
1.2
1.3
.7
.7
.9
1.2
ai
24.6
Central
2.9
a2
1.9
1.4
1.2
.8
.6
.5
.7
.7
1.0
1.3
16.1
Pacific
.8
.2
.3
.1
.4
.2
.2
.4
.1
.1
.2
.1
ao
18.9
a 4
a 5
2.3
1.9
1.4
1.0
29.5
.8
.6
.7
.7
1.0
i.O
Intermittent, Remitteut and Typho-malarial
Atlantic . . .
4a 2
66.5
70.3
62.9
48.3
24.5
21.5
26.3
30.6
28.5
38.3
484.1
Central
88.5
108.8
92.3
69.6
50.9
36.1
34.2
3a4
39.1
42.2
45.6
52.6
680.7
Pacific ....
19.6
21.0
32.4
36.3
27.7
14.5
10.9
8.7
12.7
ia7
17.4
17.3
226.2
71.2
92.0
eao
66.3
49.6
3a6
30.5
28.8
34.0
37.2
39.3
47.1
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AMONG THK U. S. FORCES.
YEAK ENDING JUNE 30, 1865.
91
Disease.
Region.
1864.
1-.,.,
<
■ g
3
i
c
a
s
X
(0
1
51.0
53 3
16,4
3
a
cd
E>
g
39.1
36.8
11.4
37.2
9.4
8.4
1.8
8.7
a
a
a
24.6
32.5
8.5
28.8
6.7
7.9
1.2
7.3
31.3
40.4
9.7
36.1
1.6
1.1
.3
1.3
<
3
1
16.6
36.3
9.6
a
<
s
b
<!
20.0
33 6
114
26. S
6.7
ao
3.4
7.3
26.9
34.1
12.0
39.4
bi
28.0
38.1
17.3
33.9
Intermiltent (inoludiiiK' Congestive) l-Vver. .
AllBntio...
Central
PHOiDc ....
33.6
5a 8
8.0
41.3
62.4
14.9
5a8
52.9
62.8
12.9
1&6
29.7
9.2
19.6
31.3
9.2
V>. 6
6.8
8.2
2.6
7.5
26.4
39.5
11.8
3a 1
1.5
1.0
359,3
49.5, 8
142,8
429.5
4a 9
.57.9
16.0
15.5'
as
15.5
51.6
13 7
10.8
8.3
12.0
24.7
6.8
7.6
2.6
7.2
25.4
37.3
11.8
21.6
Reinitteat Fever
Atlantic ..
Central
Pacific ....
17.4
18.5
5.4
17.4
22.8
8.6
20.6
58.7
85.2
aas
74.4
6.6
2.3
.1
5.8
7.1
1.9
6.4
7.6
9.8
as
9.H
11.7
4.1
119.3
137.3
46,9
127.8
17.8
8.7
10.7
Atlantic...
Central
Pacific ....
50.0
71.3
ia4
61.7
68.9
78.3
16.7
"•"
4.8
1.7
.4
64.7
64.1
24. 7
63 6
48 5
44,2
la^
45,9
2.9
.7
.5
22.4
33 4
11.5
28.0
1.3
.4
26.7
41.6
15.8
34.1
34.5
43 9
15,8
38,1
1.7
.S
37.9
49.8
21.4
43 6
478 6
633 1
1B9.7
31.9
1.4
.8
.4
1.1
557,3
Atlantic...
Central
7.6
a. 1
4.0
1.2
1. 1
2.4
1.4
1.2
.1
1,6
1,4
34.4
14.9
2.6
4.2
as
65.3
87.5
aa6
78,2
2.9
1.6
.8
1.2
1.2
1.2
1.5
22.9
513
648.0
193 3
Intermittent, Remittent iiiul Typho-nialarial
Atlantic . . .
Central
Pacific
57.6
TO. 4
13.4
7a 7
80.0
17.1
76.3
68.7
65.3
25,8
_
66.0
51,4
44.9
13 7
47.5
32.9
41.5
9.9
37.4
36. 8
38.1
12.2
-23 7
33 8
11.5
27.9
40.5
11.8
28.1
42.8
15.9
36.2
44.7
15.8
39.5
51.3
31.4
45.1
65.9
33
28 8
34.3
580.3
YEAR ENDING JUNE 30, 18G6.
DISEASE.
Recion.
1865.
1866.
•<
><
§
g
■3
D
3
<
a
a
a
O
a
a
S
1
i
a
•-a
X
•<
3
el
a
ta
b
c
o
as
<
S
<
i
•-3
Inteimittent {including Congestive) Fever . .
Atlantic...
Centra! ....
Pacific ....
45.9
6a 4
18.8
66.5
91.3
2.3.9
88.0
96.1
42.7
92.7
90.3
41.4
6.3.3
73.0
37.5
39.0
40.9
22.8
18 5
31.7
12.9
16.8
25.4
7.4
20.4
29.5
12.0
28 4
35.2
18.7
33.3
29.2
18.1
34.7
42,2
31,7
658.7
808. 9
385.0
693 4
Intermittent in all tlie regions
54.7
78. 2
88.1
85.6
6a 9
37.0
33:6
18.9
22,3
24,9
27.9
34,7
Atlantic . .
Central....
Pacific ....
13 4
19.3
a 4
16.7
26.1
a 5
21.8
21.7
5.
16.0
19.3
1 7
1C.4
108.7
109.6
46.1
6.5
8.2
4.6
5.1
ai
2.4
a 5
2.2
2.1
4.1
2.5
ai
a 9
a 2
4,5
4.4
2.5
5.1
6.2
2.6
8,7
11.5
2.3
144.8
197.2
39.0
Kemitlent in all tbe regions ^
16.3
21.3
20.3
109.8
117.8
47.7
6.8
69.8
81.3
40.7
4.6
3.9
ai
as
4.0
!i.O
8.3
159.7
Atlantic...
Central ....
Pacific ....
59.3
82.7
22. 2
71.11
83 3
117.4
27.4
43 6
46.0
25.9
30.9
35.2
1.5.1
26.5
18 9
29.5
9.9
2a 5
3a 4
15.3
32,9
29,6
31,3
38.4
35 4
30.7
43 4
5a 7
34.0
803, 5
1,006.1
324.0
Total in all the regions
99.5
108.3
102.0
70.7
41.6
23.0
35.8
28.9
32.9
4a
853.1
Atlantic . . .
Central....
Pacific...
1.4
4.5
.6
1.7
1.7
.1
1.6
1.0
1.7
I.l
.5
.9
.2
.2
.3
.1
.1
.3
.05
, 1
.1
.1
.2
1.2
.5
lao
32.5
1,5
1
Typho-nial.irial io all tlie regions
ai
1.6
i.r
1.2
.6
.2
43 8
46.3
26.0
.1
.1
.02
.05
.1 1 -7
16.6
Intermittent, Remitleatanil Typlio.malariEl
Atlantic . . .
Central ....
Pacific
60.7
87.2
38.8
84.9
119.1
27.5
111.4
118.8
47.7
110.4
110.7
46.1
70.3
82.1
40.9
20.9
35.3
15.1
19.2
29.5
9,9
2a5
3a 4
15.2
32,9
29,6
21,3
38.5
35.5
30.8
4a 6
.54.9
24.5
816.5
1,028.6
325.5
74.1
101.1
109.4
103 2
71.3
41.8
26.6
22.1
25.82
28.95
sao
4a 7
869.7
92 MALARIAL FEVERS
rapid and equable as the antecedent increase, the ratios for these months, 29.7 and 28.2,
being very similar to those of the preceding year. The maximum was again reached, 74.4
and 73.4, in August and September, and the subsequent minimum, 28.0, in February, 1865.
During the year succeeding the war the highest figures, 99.5, 108.3 and 102.0 were reached
in August, September and October; the fall to the minimum, 22.0, in the following Feb-
ruarv being as sudden as was the rise which preceded it.
The intermittents had similar waves of prevalence; in fact, the contour of the general
malarial waves was mainly due to the preponderance of fevers of this type. But remit-
tents also followed the same general course, having their maximum in July, August or
September, — 18.1 per thousand strength in September, 1861 ; 19.9 in July, 1862, and 19.5,
20.6 and 21.3 in August of the three following years. The minima corresponded with
January, February and March, and often included December on the one hand and April on
the other; thus the average monthly ratio for these five months was 8.4 in the year 1861-2;
9.1 in 1862-3; 5.3 in 1863-4; 7.1 in 1864-5; and 3.6 in 1865-6.
It is noticeable that only in the year ending June 30, 1862, was there a distinctly
marked occurrence of vernal fevers, as notable among the remittents as among the inter-
mittents, but in both cases this vernal rise culminating in May, was separated from the
autumnal increase not by a diminution in the number of febrile cases in June, but only by
the failure of that month to show an increase corresponding with that of May on the one
hand or July on the other. A tendency to a stasis in the advance of the febrile wave
occurred also in April or May of the other years, and was most defined among the inter-
mittents in 1864.
The great prevalence in the autumn of 1863, and again in 1865, must be considered
due to the meteorological conditions of those years favoring the evolution of the disease-
])oison or to the operations of the troops carrying them into more dangerous localities.
But these high waves were composed largely of recurrences; for the corresponding winter
seasons were not characterized by that increased prevalence which would have resulted from
the relapses occurring in a larger body of men subject to attack under the influence of
chill, fatigue and other so-called predisposing causes. The ratios of the winter months
may be regarded as giving expression to the relative numbers of men under the influence
of the malarial poison in each year, for there are not wanting reports such as that of Surgeon
J. M. Bates, 13th Maine Volunteers, to establish the principle that winter attacks were
generally recurrences.
Every case of intermittent fever has occurred in those who were afiected with the disease during last summer
and fall. The attacks have shown a very general tendency to recur every seventh, fourteenth, or twenty-first day.
Two conipanies that came from Ship Island, Mississippi, about the middle of February, have as yet given no indica-
tion of the disease, showing that the malarial influence is not sutticiently strong at this season of the year to induce
the disease in those not previously affected. — Forts Jaclcson if- St. Fhilip, La., March, 1864.
In view of this principle, it may be recognized as a fact that in October, 1862, our
armies became as fully saturated with the malarial poison as in any of the after years;
for while the minimum in March of that year was as low as 17.0 per thousand of strength,
the succeeding minimum, which was considerably higher, did not differ much from those
which followed it.
Typho-malarial fevers, which are included in the table and on the diagram, were most
prevalent in the year ending June 30, 1863, diminishing gradually in the after vears. The
waves of prevalence were abrupt, culminating in July and falling gradually during the
autumn months.
AMONG THE U. S. FORCES.
93
But the study of these seasonal variations lor the several years may he niudi facilitated
hy their consolidation into the average figures of Table XXIX and the corresponding linos
of the diagram facing page 94.
T.\BLE XXIX.
Average monthhj number of Cases of the several varieties <f Malarial Fever amon</ the White Troojisfrom
July i, 186 1, to June SO, 1860, e.vpresseil <^^• rutins jier 1,000 of mean strength.
IJl.SEASILS.
1
a
a
u
£
s
'A
a
<
y,
<
a ,
•<
D
K
<
11.00
10. oo
1.07
<
12.00
11.00
1.14
13.00
12.00
1.01
16.00
13.00
i..-,n
30. :i\
.45
30. 98
12.61
^ —
^ —
204. 00
1 1
171.00 1
1H,8.'
393. 82
6. 24
400. Oil
130.89 [
530.95
26.15
, 5.57. 10
aaoo
laoo
1.93
29.00
24.00
2.22
30.00
23.00
2.72
27.00
ai.oo
2.39
19.00
16.00
1.79
13.00
11.00
1.18
10.00
9.00
1.31
10.00
8.00
1.10
Qiiurtiiii liitermilteiil
Tula] iiimpio Iiiterinittt-Mils
41.92
.82
.'-W.22
.94
55.72
.89
50.39
.70
36.79
.47
25.18
.42
20.31
.39
19.10
.32
23. 07
.32
24. 14
.37
26.01
.39
Total Intennittenls
Reinilteut Fever
42.74
17.18
56.16
19.23
56.61
16.11
51.09
13.55
37.26
9.96
25.60
7.56
20.70
7.10
19.42
6.79
22.39
7. 2ti
24. 51
8.07
32.58
1.50
26.40
10.17
Tutal pure Malariul Fevers. . .
Typho-nialarial Fever (a)
59.92
4.07
75.39
3.52
72.72
2.64
64.64
2.45
47.22
1.98
33.16
1.71
27.80
1.85
26.21
1.66
29.65
1.65
36.57
1 . .'.1
43.59
2. 04
45. «l
Tidal Malarial K»'vers
63.99
78.91
75.36
67.09
49.20
34.87
29.65
27.87
31.30
34.08
38.08
(a) From July 1, 1862, to June 3P, 1866.
From these the purely malarial fevers, and the intermittents which constituted so
large a proportion of them, are seen to have attained their maximum in August and Sej)-
teniher. They decreased rapidly during October and November, and slowly thereafter to
their minimum in February. Their increase was slow and equable from March to June,
ami without any vernal wave other than that involved in the gradual formation of the
autumnal increase. During July the cases occurred with greater frequency, leading to the
maximum in August.
The remittents prevailed as a single annual wave, rising in !\larcli. culniiiiatiiig in
August, and falling, more abruptly at first but more equably than the intcrmiitents, to a
minimum during the winter months.
It is noticeable also that the autumnal increase affected the intermittents and the
remittents alike, i. e., both of these types of fever contributed to the annual maximum of
malarial fevers the same percentage of increase on their respective minima. Thus in the
intermittents the difference between the minimum, 19.42, and the maximum, 56.61, is 37 19,
an increase of nearly two hundred per cent, on the minimum; while the difference between
the minimum, 6.79, and the maximum, 19.23, of the remittents is 12.44, also an increase of
nearly two hundred per cent, on the minimum.
The seasonal cui've of typho-malarial prevalence rose abruptly in June to its maxi-
mum in July, fell gradually during August, Septemlier and October, and thereafter remained
at about the same level until the next June rise.
A similar table constructed from the statistics of the colored troops shows the maxi-
mum of the purely malarial fevers as having been reached in August, September and
94
MALARIAL FEVEES
October, after wliich the fall was rapid to the minimuin in February. A notable increase
in May, with a less marked rise in June, gives a suggestion of a vernal wave as well among
the remittents as among the interraittents. The remittents, as in the case of the white
troops, decreased in the autumn before a corresponding decrease occurred in the number of
the accompanying agues.
The typho-malarial curve differed from that of the remittents in falling less rapidly
during September and October.
Table XXX.
Avei-age monthly number of Cases of the several varieties of Malarial Fever among the Colored Troops
from July 1, 1S63, to June SO, 1866, expressed in ratios per 1,000 of strength.
DlSEASEB.
o
1-5
i
<
a
s
CO
OCTOBEH.
-A
1
<
<
i
o
<
s -
1
'A
<
Kg
34.00
25.00
1.93
41.00
32.00
2.26
50.00
36.00
2.97
49.00
39.00
2.95
33.00
30.00
1.98
25.00
20.00
1.04
20.00
18.00
1.14
17.00
16.00
1.24
J 9. 00
14.00
.91
17.00
16.00
1.53
21.00
15.00
2.01
20.00
18.0ft
1.50
349.00
278.00
21.39
Total simple Intennittents
60.93
1.56
75.26
1.57
88.97
1.93
90.95
1.99
64.98
.94
46.04
1.17
39.14
.85
34.24
.72
33.91
.93
34.53
.45
38.01
.88
39.50
.83
648.39
13.83
Total
62. 49
23.20
76.83
23.08
90.90
21.61
92.94
17.51
65.92
12.10
47.21
8.57
39.99
7.77
34.96
7.46
34.84
8.51
34.98
9.05
38.89
13.61
40.33
15.08
662.22
167. 10
829.32
41.06
Total pure Malarial Fevers . . -
85.69
6.34
99.91
6.87
112.51
6.11
110.45
4.44
78.02
1.90
55.78
1.66
47.76
1.97
42.42
1.56
43.35
2.13
44.03
1.96
52.50
2.95
55.41
3.29
Total Malarial Fevers
92.03
106.78
118. 62
114.89
79.92
57.44
49.73
43.98
45.48
45.99
55.45
58.70
870.38
Seasonal Variations in Mortality. — This has been illustrated by the plate facing page
20, on which are delineated the monthly variations in the level of the malarial death-rate
in juxtaposition with the corresponding variations in the mortality from certain of the
more fatal classes of disease and from diseases in general. The autumnal prominences
are clearly defined, particularly in the last three years, the culminating points being in
August in 1863 and 1864, when 1.14 and .94 per thousand are reached, and in September,
1865, when a rate of 1.18 is shown. The autumn waves in 1861 and 1862 do not have
so, distinct a culmination. These death-rates will be found to correspond precisely with
the variations in the line of prevalence in the diagram facing page 90; whence it may be
inferred that in general these fevers caused death within the month of the attack.
Influence of Pi.egion on Prevalence. — Table XXVIII, already presented, shows the
seasonal variations in prevalence as affected by the climatic and other influences of the
region in which the white troops operated during the several years of the war. The mala-
rial fevers were more frequent in the Central than in the Atlantic region, while in the
Pacific region the ratio of cases was much smaller than in either of the others. During
the year succeeding the war the increased prevalence of these fevers affected the troops in
all the regions. In the Central and Atlantic regions this was due to the occupation of
southern and malarious territory ; in the Pacific region it was owing in part to the estab-
Di(t(/ranis shinsnmi flic .hyr<n/r ^In/iiiiiJ Curves n/' Pi-cviiJnicr
of the Mai ai'ial Ferns (inuuiii Ihr While (iml iJie. Colored Troojis diirijia
the liar, in Moii/hlv Rales jier Thousand of iHlrenqth .
'Ihliil jtoi'f niiiJiuhd /t\ y/:s
Iii/rrnidtna.s
indfr Troe>p.s.
1 1 i ^1-1 i-^.i'S^ I'll 1
11411^
114
1 12'
112
11(1;
1 Ul
i lOM '
_10Hj
1U« .
IOC. 1
KMf
104
10 2*-
102
loo
lOo
88
98
96 1
96
94
94
92
H 90 II
92
00
! 8« i
88
HO
80J
84
84
82
82
80
80
7B !
78
76 }
7B
74,
74
72^
^-
I
k
72
7(1
\
70
68
1 68
GGi I r
1
66
6-CT^
n.lJI
627 p
; iM' '
60 I t
hi-^
1 '"':
38 : I
: ." 8 .
36 ! f\
. .
,'(. 1
34 /I \
'' "L;l
52 1 / 1 /
52
50 /
1
50
48
;/
1
48
46
1
1
46
44 !
'
1
44
" 42T ■""
B
\
42
40 '
/
I
40
38 ;
/
\
38
30
,T4I
J
1
36
/
, I
34
32]
>
\ '
32
;)0 I
/
1(
V
30
. 28 iy
/
\
\
28
26'^^
/
1
N
26
2 4
y
\
24
22
y
s
22
20
/
20
18
/
/
s
IB
16
y
\
16
14
/
\
14
le
V
12
^''i
^
s
10
s'
^
/
\
8
6f
"^
6
4
4
2
/L
*"■
— -
^
1^-.
g_
- \ r- t
■
1 Ii4tli--|-t5^i-i5 j
Hrnuttcnl.'i .
lypho iniiliiricd
^
niofcd TrdOft
,v.
^k^^:\%M%kk\%
114
1
1 14
112
1 12
110
N
no
108
I
108
106
I
106
104
/ F
104
103
/ 1
loa
10
L(- "c
100
H8
/- I
98
36
1
1
96
84
1
1
94
92
1
, \
92
!10
V\ '
' \
9
HS
l\.
1 I
88
86
.- \ / i / Ll
86
84
/ 11
8 4
82
I . .11
82
80
1 1 1
8<)
78
1 W -
78
76
It U -
76
74
I \
74
72
1
72
70
1 : '
7()
68
/ ■
68
66
1 / '
66
6 4
/ /
64
62
1
62
60
60
38
S8
36
36
34
J
i
04
52
f
\
32
60
/
\
*
50
48
/
; I
'
48
46
/
>v 461
44
42
^
\ 44
" ■ N 42
40
40
;1K
^\
' ' ■ 38
36
Vl 36
a 4
■^
^^ 34
32
32
30
^■^ 30
28
28
26
■ ■ ' 2Gj
24
r-^
24
22
i
■^v. 22
20
■■ i \ / \
2(1
18
1 1 / '^ ■
18
16
\
,_10
14
^ J
\
14
12
jf 1
>
121
10
y^' . : 1
s.
10
8^
>«»
8
pi
•^
,^-.
4
/
'^
4j
2
^^
^
\
si
-
^-*» ^
—
1
||4tlt-f=^5^||^ J!
96
MALARIAL FEVERS
PACIFIC REGION.
Diseases.
■-5
1
<
s
g
o
o
33
'A
s
a
8.9
i-
•A
<
'-a
<
<
•A
Annual
AVKKAGE.
H. 8
11.9
17.2
1.15
13.8
5.6
4.9
6 7
9.4
Tertian Inteniiitlent
4.6
5.0
6.6
7.8
. S.5
3.8
S.8
3.6
4.0
4.6
4.6
4.3
55.5 1
Quartan Intermittent
.9
.9
.7
.6
.6
.4
.9
.4
1.0
.8
.3
1.2
8.6
C'on^'estive Intermittent
. 2
.:!
._o
.1
.a
.1
.1
.1
.1
.3
.2
2.6
^4.8
-M. 1
20.0
13.3
9.4
8.0
9.8
13.2
15.0
178.2
Bemittent
3.S
5.7
6.6
7.6
5.0
3.0
3.1
1.6
2.8
3.7
5.1
4.6
50.6 ,
Total pure Malarial
16.3
24.2
31.4
31.7
S5.0
16.3
11.5
9.6
13.6
15.9
17.0
19.6
228.8 ;
Tyjtho malarial -
--
.,;
f
.0
■'
.3
.2
.5
.■i.8
Total Malarial
17.0
24.7
31.8
33.4
25.4
17.0
U.5
9.9
12.7
16.2
17.1
20.1
233.7 j
DiAGKAM allowing the Seasonal Prevalence of the
Malarial Ferern in the Atlantic," Cenlrali and
PacificX Bet/ions.
100
100
i 8
9a
9 i
96
n
9*
52
+
Si
9
'
9
8 i
88
a
j
36
8*
/
[
at
8 2
/
\
82
80
/
\
80
78
/
\
7S
-'6
/
\
76
7t
/
\
74
72
72
70
70
68
6 S
66
\
6S
6'^
\
64
62.
\
62
60
/
*
\
(a
si
s
\
58
56
]
56
64
■ ^f
52
/
\
bJ
50
/
\
60
48
/
\
48
46
/
\
46
44
/
\
44
42
\
42
40
/
40
38
y
s
Js
36
/
\
J6
34
/
\
34
32
31
30
^,
1 — 1
30
28
/
^
28
26
/
*
26
24
f
^
34
22
/
y
\
2i
lU
/
/
*v
20
) 8
^
V
s.
/
^
\i
1 6
■s
'
16
14
/
^
14
1 2
V
t 2
1
/
'
s
10
i
'
a
6
6
4
4
i
1
The concurrence of an elevated temperature
and liigli ratios from malarial fevers, so well
marked in the seasonal variations in prevalence, is
noted also in the geographical distribution of the
cases. Table XXXII, which follows, exhibits an
increased prevalence in the departments of the
southern part of the Atlantic coast, as compared
with those on the northern part of that coast. The
increase from an annual rate of 144 cases per thou-
sand of strength in the Department of the East,
through the Middle and other coast departments, to
1,035 in Xorth Carolina and 930 in the Department
of the Gulf, shows in a general way the connection
of these fevers with temperature as affected by lati-
tude. In the interior their increased prevalence in
the river towns, as compared with the higher ground
constituting the water-shed, may be seen in the 538
cases in the Department of the Missouri, the 8(35
cases in the Department of Tennessee and the 1,287
cases in the Department of Arkansas, as against
227 in Western Virginia and 265 in the Depart-
ment of the Ohio; while the country bordering the
great lakes gave 526, as against 238 in the north-
west.
In compiling this table it was found that the
highest malarial sick-rate for any one year was
presented by the Department of North Carolina, in
which during the year 1863-4 there were recorded
23.848 cases in a strength of 10,226 men, or 2,353
cases per thousand.
AMONG THE U. S. FORCES.
97
Table XXXTI.
Shotcing the Prevalence of Malarial Fevers in the Departments on the Eastern and Southern Coasts of the
United States, end in thos-e of the high and low grounds of the Central Region, expressed in annual
raliosper 1,000 of stnngth, ra/cntated from the statistics of the four years ending June 30, 1865.
Department of tbe East
Jliddle Department
Department of Virginia
Department of the Sonth
Department of North Carolina.
Department of the (inlf
Ids
172
503
396
828
7:iK
32
81
110
131
179
148
Department of W'est Virginia ...
Department of the Northwest...
Department of the Ohio
Department of the Cumberland .
Northern Department
Department of Missouri
Department of Tennessee
lit)
I. ".(I
187
•Xi
390
1)61
Department of Arkansas 1, 103
71
82
66
135
126
V.W
181
166
Typho-
malarial.
Total
Malarial
Fevers.
I
11
37
31
28
44
10
6
12
15
14
12
23
18
114
2&I
650
5.'i8
1,035
930
227
238
265
456
526
538
865
1,287
But while the seasonal wave was made up of a proportionate increase of the inter-
mittent and romittent cases, the increase in the number of malarial cases, which coincided
with lower latitudes and lower grounds in the same latitudes, was largely composed of inter-
mittent cases. It is evident that the 32 remittents in the Department of the East do not
bear the same relation to the 108 intermittents of that command that the 166 remittents
of the Department of Arkansas bear to its 1,103 intermittents. Although remittents
increased in their absolute number with an increase in the total of malarial cases, their
number as a percentage of that total became diminished in the more malarious localities.
This is readily gathered from Table XXXIII, in which the various types of fever that
occurred in each department are tabulated as percentages of the total number of its mala-
rial cases.
At first sight it appears as if no relationship existed between the prevalence of the
remittents and intermittents; for of the two departments, the East and New Mexico, which
had less than 200 cases of malarial fevers annually per thousand of strength, the one had
7-T per cent, of intermittents and 22 of remittents, while the other had 61 per cent, of the
former and 35 of the latter. But if an examination is made of the figures from such
departments as the South, the Missouri, the Northern Department and Part I of the Mis-
sissippi Division, which had an annual rate of from 500 to 600 malarial cases per
thousand of strength, the intermittents will be found to have constituted from 71 to 73 per
cent, of the total and the remittents from 23 to 25 per cent. It is noteworthy also, that
Mjii>. Hist., Pt. UI— 13
98
MALAFJAL FKVERS
these figures agree with the averages iVoni the army as a whole, for with 539 malarial cases
annually per thousand of strength in all tlie departments the i)ercentage of intermittents
was 71.71 and that of the remittents 24.01.
Table XXXIII.
IShoiciiKj — 1, The relcdive prevalence of the Malarial Fevers among the White Troops in the several Depart-
ments and Rcgionx during (he four yeais ending June 30, 180.'), expressed as ratios per IpOO of
strength; ^, The relative frfijaenci/ of the forms of these Fevers, expressed in percentages of the total
number of cases; and 3, The relative frequeney of the varieties of Intermittent Fever, expressed as
pereentuges of the total number of Intermittent cases.
144
264
284
32'J
390
315
288
650
1,035
559
423
238
526
227
.538
265
4Sfi
865
.595
457
1,287
930
648
195
212
DtrAliTMENTS ASH REGIOX.S.
Department of the East
Mirt'Ilf* Dei'.Trtment
Depiirtineiit i>t the .Slienaudoab
Middle Military division
Departnifnt of ^\'ashil|f^t^^n
Army of tlie Potomac
Department of Ihe Kappahannuel; .
De}tartment of Viro;iniu - -
Department of North Carolina . .
Department of the South
.Atlantic; Kf-yion
Department of tin; Northwest
Northern Department
Department ot \Ve.st \'ir^inia
Dejiartnient <»f the Missouri
Department of the Ohio - -
Department of the Cumberland
Department of the Tennessee - - -
Military Division of the Mississippi, Part I -
Military Division uf the Mississippi, Part II
Department of Arkansas
Department of the Gnlf
Central Rofji.m
Department of New Mexico
De])artnient of the Pacific - . .
Pacific Region
Total in the Regions .
6,330
12, 275
4, .560
15, 297
40, 349
138, 494
4,075
67,249
64, 389
36, 175
75.07
65.04
69.99
64.64
62.51
52.73
53.50
77.43
80.00
70, 82
e
a;
K
22.29
30.56
30. 06
30. 13
26.15
38.43
46.50
16.90
17.21
23. .50
389, 193
4,
20,
14,
54,
22,
107,
211,
65,
40,
7,3,
115,
2,987
5,052
8,039
1, 126, 294
li;>.u4 ] 27.71
63.07
34.. 59
73.35
24.03
64.19
31.22
72.54
25.31
70.44
25. 07
67.03
21). 75
76.43
20.68
73.46
2;!. 44
70.43
27.20
8,5.74
12.85
79.38
1.5.87
60.73
77.16
35.15
20.70
2.64
4.47
- (n) .-
5.23
11.34
8.84
. <a) ..
5.68
2.79
5.68
6.65
2.34
2.62 \
4.59
2.15
4.49
3.22
2.69
3.10
2.37
1.41
4.74
3.03
4.12
2.14
4,752
7,984
3,189
9,889
25, 224
73, 031
2,180
52,068
51,512
25, 619
255, 448
2,967
14, 732
9,035
39, 239
15, 9.50
72, ISO
161, 445
47,756
28, 775
62, 999
91, 517
546, 544
1,814
3,898
5,712
807,704
45.27
58.20
64.36
52. 89
47.34
51.50
43.53
51.33
58.75
47.73
52.26
61.61
50.55
50.08
48.79
52.08
52.13
.51.74
52.53
50.37
49.21
44.23
50.03
60.73
49.77
.37.04
33.68
43.67
47.29
41.27
47.16
43.48
:i8.07
45.56
42.27
33.27
42.37
46. 00
42.72
42.23
41.02
41.36
41.15
44.92
43.26
49. 0(1
43.18
59.81 I 33.78
50.85 42.77
O
4.48
3.31
1.38
2. 52
4.34
4.83
6.05
3.85
2.44
4.77
3.94
4.04
5.38
2.78
6.34
4.16
5.19
5.13
4.93
3.84
6,14
5.10
5.19
7.72
5.44
.48
1.45
.60
.92
1.04
2.40
3.26
l.M
.74
1.94
1.54
1.08
1.70
1.14
2.15
1.54
1.65
1.77
1.39
.88
1.39
1.66
1.62
{(i) These departments became niei-ged in others before the introduction of the term tifphn-maUirial.
■*
If, however, the specially malarious localities are examined, it will be found, as indi-
cated in the presentation of Table XXXII, that the remittent fevers did not form so large
AMONG THK V. S. KORCES. 99
a percentage of the total as in tlic (Irpartmcuts wlicrc tlie malarial influence was manifestly
not so extensively prevalent. Tims, in the Department of Arkansas scarcely 13 per cent.
of remittents occurred in 1,287 malarial cases annually per thousand of strength, in the
Gulf deinirtment 16 per cent, in 930, in North Carolina 17 per cent, in 1,035 and in Ten-
nessee 21 per cent, in 8G5; in the whole of ihe Central region 22 per cent, in OlS, and in
the whole of the Atlantic region 28 per cent, in 422.
In other departments, as the East, New Mexico, etc., where, with similar totals giving
expression to the malarial influence, the remittents and intermittents were not similarly
distributed, it is pi'obable that the jiercentages of each may have been largely determined
by the existence of those conditions which are recognized as predisposing causes. The
highest proportion of remittents occurred in the .\i-mies of the Potomac and llappahannock.
Predisposing causes such as fatigue, exposure to weather changes, loss of sleep, improper
food, impure water, etc., were undoubtedly at their maximum among the actively engasxed
troops of those commands.
The typho-malarial cases, while more frequent in a malarious locality than in one
comparatively free from malarial disease, do not ajipear to have exhil)ited any fixed rela-
tionship to the malarial fevers. Thus, the Department of Arkansas had the lowest per-
centage of typlio-raalarial cases, although presenting thi' highest annual total of malarial
fevers, and the Department of Washington and Army of the Potomac gave by far the
highest ]:>ercentage of typho-malarial cases, although they were below the average as
regards the prevalence of malarial disease.
The statements of medical authors as to the relative frequency of the types uf inter-
mittents are somewhat at variance. Thus, Brow.n''' represents the tertian as most fre-
quently met with, the quartan standing next, and the quotidian as in some degree rarer
than the latter. CoPLANnf also gives the tertian the greatest, and the regular quotidian
the least, prevalence. Climate and season have no doubt an influence on the production
of these varieties. HertzJ says that in temperate climates the tertian occurs most fre-
quently, and that the short types approaching the continued form prevail in the tropics and
in the teiiq^erate climates during the hot season. Indian experience appears to sustain this
view. Si'LLlVAN§ gives the order of frequency as quotidian, tertian and quartan. Maillot
and E. Collin II have published statistics of prevalence among the French troops in Algeria
which show a similar order of frequencv. Onr own statistics give the following percentages:
Quotidians 50.85, tertians 42.77, quartans 4.79 and congestive attacks 1.59.
On the assumption that the short types are most common in hot weather and in hot
climates, quartan agues ought to be most frequent where the total of malarial disease is
smallest. But the table just presented shows similar p<'icentages of this type of fever in
the Department of the East and in that of the Boutli. in the Northern Department and in
that of the Gulf, while the Department of Arkansas had many quartans and the Depart-
ment of the Cumberland comparatively few. The tertians were more frequent than the
tpiotidians in the Department of the East; but the same statement holds good with regard
• JOSKni Browx in the Cyclopxdia of Practical ilrdicitte, Phila., Pa., 1845, Vol. II, p. 206.
f A IHcliotiary o/ Practical Medicine, by J.\MI-;s Cori,AM>. London, 1858. Vol. 1. p. 9:J5.
: Hertz in Zirmssen's Ci/clopxdia , Amor. Traiisl.. New York, 1f7.'i, Vol. II. p. VJi't.
5 Endemic Piseases nf Tropical Climate.t. by JOIIX .SLLI.lv.vx. M. D., London. 1877, p. rW.
II F. C. M.VILI.OT— 7Voi( </m Fifrres IntermitUntes, Paris. 18»' — ffives, on p. 414, u table showing the occurrence in Iho military hospitals at Bone of
'-'.3:t8 clearly dcGned inlennittents, of which 1 ..WS were <|Uutidians. 7:i0 tertians and l!fi <niarlans. E. Coi.l.lX— in his Rerlierchrs sur U.n affections de la rate,
published in Reeueil dc Mfmoiies de .M6>lecine, etc.. 2' Sferie, T. IV. Paris. 1S4S — states, p. 116, that of 6,63(i cases observed at Philippeville in Algeria,
3,523 were quotidians, 9l(i tertians, 58 quartans, 31K1 erratic of variable type and 1,836 remittents.
100 MALARIAL FEVEKS
to the Department of the Gulf. A closer inspection of the data from which this table was
made up gives greater prominence to the irregularity in this respect. While the nature of
the disease-poison is no doubt the main factor in determining the type of the disease, it is
probable that predisposing conditions exercise a strong influence on the resulting fever.
Congestive fever constituted .48 per cent, of the interraittents in the Department of the
East; .60 in the Shenandoah; .92 in the Middle Military Division, and .98 in the Depart-
ment of the Pacific, in each of which the malarial total was comparatively small: 1.66 in
the Department of the Gulf, and 1.39 in Arkansas, in which the totals were large; but it
constituted only .74 per cent, in the highly malarious Department of North Carolina, and
1.93 in the comparatively healthy territories of the Department of New Mexico. Since,
however, the highest proportionate number of congestive cases was found in the Army of
the Potomac, 2.40 per cent., and in the Department of the' Rappahannock, 3.26 per cent.,
it may be assumed, as in the case of the remittents, that these pernicious fcers were largely
due to the fatigues, exposures and deprivations incident to active operations.
Tlie distribution of the malarial fevers during the war, presented in numbers in the
last two tables, has also been illustrated by the tinted map which faces this page. It is
impossible to show on a single map of this, or perhaps of any size, the many changes
wliicli the exigencies of the moment necessitated in the boundaries of the various military
departments. For this reason no attempt has been made to secure such official accuracy
in their outlines as would be required were the map intended as an illustration of a mili-
tarv study. Nor is this needful, for the depth of tint indicating the prevalence oi ,cJ
fevers in a given department was determined not by the malarial character of the depart-
ment as a whole, but only by that of the part, oftentimes a small one, occupied by the
Union forces. The lines and circles of solid color show in what parts of the various depart-
ments our armies operated during the years of the war, — red, yellow, blue and green res-
pectively representing the portions held during the years ending June 30, 1862, '63, '64
and '65. In certain of the home departments, as the Northern Department and those of
the East and Northwest, no lines of position are given, as the troops serving in these
'military commands were scattered generally over the country at recruiting depots and
camps of instruction, etc.
The Departments of the Rappahannock and Shenandoah and the Middle Military
Division are not represented on the map. The first two temporarily formed independent
commands in the section of country which was for most of the time known as the Depart-
ment of the Potomac, and the last, during the latter part of the war, included West Vir-
ginia and the Valley of the Shenandoah. Nor does the Military Division of the Mississippi
appear on the map. Part I of this Division included, during the last year of the war, the
country composing the Departments of the Ohio, Cumberland, and Tennessee and such
parts of the neighboring States as were occupied by the army under General Thomas ; while
Part II comprised the territory passed over by General Sherman's army in its march through
Georgia to the Atlantic Coast, and thence northward to Washington, D. C.
The map shows in a general way the greater frequency of the malarial fevers in the
southern portions of the Atlantic and Central regions. Apparent exceptions were due to
easily explained circumstances. Thus, in the Atlantic region the troops in the Department
of the South suffered less than those of the North Carolina command, because the greater*
portion of the former occupied dui'ing most of the war comparatively healthy sites on coast
AMONG THE U. S. FORCES. 101
islatnls. Hacl the fortune of war carried them into the more malarious districts, they would
undoubtedly luive had an experience similar to that of the rebel troops that held those dis-
tricts.* Thus, also, in the Central region the deptli of color expressive of prevalence is
greater in the Department of Arkansas than in that of the Gulf, on account of the occupa-
tion by the troops of the unhealthy bottom lands in the former section of the country.
It would be interesting in this connection to discuss the geographical distribution of
the malarial fevers among the civil population of the United States and the garrisons of
our military posts in times of peace. Information on the latter head will be found in
Fokry"s bookf and in the publications of the Surgeon General's Office. | As to the former,
the works of Drake and Hirsch § may be consulted. Both these writers have relied to
a considerable extent on the military statistics compiled by FoRRY and Coolidqe.
Tliroughout the .Vtlantic region malarial fevers were, during the war, most prevalent in
the swampy districts and lowlands adjoining the sea and bordering the water courses: they
became milder in the dryer and more elevated districts of the interior, and disappeared in
the highlands of the Appalachian chain and the mountainous districts of New England and
New York; but south of Pennsylvania the}^ were found in the river valleys at a consider-
able elevation.
In the Central region the malarial influence was most intense in the lowlands border-
ing the Gulf of Mexico and along the rivers that discharge into its waters; thence it
extended northward with diminisliing intensity to the vicinity of the great lakes, where it
again became markedly prevalent. On the East it penetrated toward tlie headwatei's of
the streams arising in the Appalachian range, and on the AVest it because gradually milder
towards the Rocky Mountains, finally disappearing on the lofty slopes of that system,
though still existing to some extent in its elevated valleys.
In the Pacific region the relative prevalence of the malarial influence corresponded
closely with tha,t which obtained in the Atlantic region on the same isothermal lines.
* Cum(>are the statements <>f thi* freqiieiK-y of the malarial fevers among the Confederate troops iii these very Jistricits, given in a subsequent part
«f Ibis chapter, p. U»,1, on the authority of Br. JOSEI'II JONKS. .See also the testimony of KDl.l.Oi'K, cited by J, V. POSKY — Hejxtrt on the Utpxyraph}/ mul
tpidtmic diftasfs of Ote State of Georgia, .Southern Med. and Sur^. Jour., Vol. XIV, 185^, p. 191 — with roftjard to the freedom from niiasmatio fevers of
those sea ishinds on the coast «if Oeorg-ia, which have "few or no brackish ponds or lagunes as compared with the opjxtsite main." For further remarks
ou the ineiliciil toj>og:niphy of this part of the Southeni States, see a reference to the report of the Confeilerate Surfifeon SamI'KI, I.or.ANj infra, ijago 171.
t Samiki. FoitKV— ry**; CUmatr of the I'liited Stales, '^d Edit., New York, 1842. See also, t)y the same author, Slati.ttical Ri-sforches elucidating
thf CHmate of the Uniteil States and its relation with diseases of Malarial origin, etc. The Anier. Juiir. of the Med. .Sci., N. .S., Vol. II, 1841. p. i;j,
aivil the Endrinic tiitiuences of the Umted States, in the same volume, p. '^*y3.
; See the Statistical Rejttirts on the SicL-riess ami Mortality in the. Army of the United States: the first. /rom January, 1819, to January, ie:i9,
Wasbtnglon. I?40. Edit, by FOKiiv ; the second,/mm Janvory, 183M. to January, 1855. Washington, 18rj<J, edited by It. H. Cooliuge^ the third, from
January. 1855, to January. Ititjll, Washington, IH60, edited by the same; also the two reports edited by Assistant .Surgeon (now Surgeon) J. S. ISlL-
LIXOS. V. S. A., viz: Circular So. 4, Surgeon General's Office, Washington, Dec. 5, 1870,—^ Report on Barracks awl Hospitals, with dtscriptions of
Military Posts, and Circular A'o. 8. Surge^in General's Office, Washington, May 1, lfl7.T — A Report on the Hygiene of the United States Army, with
description nf military posUc.
^ Uasiri. Drake— Oh the Principal Diseases of the Interior Valley of Xorth America, Cincinnati, 1850; also, the same work, Second series,
Philadelphia, 1854. A. Hin»vn—Handb. der historisch-geoyraphischen Pathologie. Erlangeu, 1860, Bd. I, S. 1 1 et .t<r(/. .See alsf., besides the several
essays riteil by Hirsch. the following: Oliver Wenhell HoL>tE.'j— ^'acfs and traditions resi>ecting the existence of indigenous intermittenl fe.ver in
y'ew England : being the Boylston Prize dissertation for the 3-ear 183fi. Boston, 1838. — An interesting (wiper, jjiving a good dt-al of evidence to show
that at various times during the previous teiitnry. and even earlier, inlerniitlent fever prevailed more extensively in New t^ngland than it did at Ihe time
it was written, or indeed for a number of years jtreviously. J. W. Wv.V^Tls— Medical facts and intfuiries resiterting the cause, nature, precention and
cure offerer in the Southern States, etc., Cahawba, Alabama, 18.;5. R. S. H0I>MES, late of the Medical Stalf, V. S. Army— 0** Malaria in connection
with Medical Topography. The St. Louis Med. and Surg. Jour., Vol. V. 1848, p. 519 — comiiares the topography of certain military posts in Florida,
Pnrtland and IIolti>n, Maine, Prairie du Chien on the Upper Mississippi, and certain ptiints in Mexico. E. D Vksskr— Southern Medical Reports, New
Orleans and New York, Vol. I, 184l», Vol. II, 1850. .JOHN F. Po&E\—R^j>ort upon the Tojtography and Epidemic Diseases of the Stale of Georgia,
Southern Med. and Surg. Jour, Vol. XIV, 1858, pp. lOfi and 191. J. C. Harris «.f Alat>ama — An Essay on the climate and fevers of the Southicestern,
Simthfrn Atlanticand Gulf States. The New Orleans.Iour. of Med., Vol. XXIII. 1870. p. 401 et seq.; also Charleston, S. C. lS7i». H. BliONSON— //iVory
nf intermittent fever in the Xew Haven region, with an attempt to distinguish the known from the unknown causes. Pn^ceeding.** of the Connecticut
Medical Society. 2d .Series. Vol. IV, 1872-5, p. 29. A. W. BaRROWs — On Malarial fever in New England. (President's Address.) Same pr..ceed-
ings, 1877. p. 22. See also the Reports on the Epidemics and Climatology of various States, made to the Section of Meteorology, Medical Topography
and Epidemic diseases, scattered through the volumes of Transactions of the American Medical Association prior to and including the year 1873: subse-
quently, many of the rejiorts to the section of State Medicine and Public Hygiene (organized in 1873J in the same Transactions.
102
MALARIAL FKVERS
In eacli of these regions the niahirial influence became in a general way more intense
towards the south; but local conditions everywhere exercised a controlling or modifying
power. Malarial fevers were less prevalent in well-drained rolling districts, elevated
plateaux and mountain slopes, while they increased in frequency and severity on low plains,
in moist river valleys and in swampy lands. In fact, their distribution during the war
corresponded intimately with that already outlined by FoRRY and Coolidge, and with the
indications of the mortality tables of the Census Reports* and of the deaths returned by
municipal boards to the National Board of Health.f
II.— MALARIAL FEVERS AMONG THE CONFEDERATE TROOPS.
Prevalence. — The consolidated monthly returns of the Confederate Army of the Poto-
mac, preserved bv Dr. T. H. Williams, have served for the computation of ratios indica-
ting the monthly prevalence of malarial fevers in that army from July, 1861, to March,
1862, inclusive. In the table on the following page these ratios are given in juxtaposition
•with those for the Federal Army of the Potomac during the same months.
These figures shuw that malarial fevers were even more prevalent in the Confederate
tliaii ill the Federal Army of the Potomac. The average monthly strength represented
by the Confederate sick reports was 49,394 men, among whom occurred the monthly ratio
of 38 malarial cases per thousand, while the average strength represented by the Federal
sick reports was 111,169 men, and the monthly ratio of malarial cases 28.
It is not possible to contrast statistically the mortality of tlie two armies from these
fevers during the period in question, as the Confederate returns give the number of deaths
only under the heading "total from all causes."
'' ill tills <-niiiiecli(iii the folluwing tjibl
ieaths IVoin iiialanal t'evt^rs per 11IU,UU0 livii
e liHS b
-Hii ('(inii.ilfil In. Ill tlic Sfatistii-s of tl
us:
p ('ens
IS years 187(1 anil 1880. The figures
tabulated represent
Atlantic Rehion.
1870.
1880.
Ckntkal Reoion.
1870.
1880.
Pacific RRGiqir.
1870.
1880.
8
18
18
6
121
11
15
15
15
20
29
3
4
1
y
4
.
-1
5
9
29
20
47
24
28
39
69
73
69
112
5
,0
l-J
22
27
17
20
4,')
■17
1
36
59
83
«
104
91
140
93
92
Utah
13
15
25
38
47
WhnI \'irs-iuia
Daki.la
l*alifuriij;i
[ Nevada
4
Connectu^iit 5
Maine. . , . - - . t,
Nebraska . -
Ohio
I J
14
14
21
2.j
31
■M
3.->
45
61
6G
76
77
91
114
115 ■
! . ^
7
Mic^higan
Keiitiifky ....
Indiana
Miniie-sola
Arizona
('cUirailo --.
New Ycirk 10
18
20
21
42
52
60
114
Florida
t See note on p. 87, supra.
AMONG TIIR CONFEDERATE TROOPS.
103
Tlie cases embraced in the reports of Dr. W'iij.i.vms consisted of 9,954 intermittents
and 6,827 remittents. Of the former, 5,713 were (juotidians, 3,769 tertians, 389 qnartans
and 83 congestive cases.
Table XXXTV.
A Comparimn of the Prevalence of IntermiUent and Remittent Fevers in the. Confederate and Federal
Armies of the Potomac from July J, 1861, to March 31, 1863.
CONFEDBBATF. AltMT.
U. S. Akmv.
Number of Cases.
Jul}-. ISiil
Aiifrnsl. leiil
Scl.tinilMT. isi;i
o<-t..i»r. im:i
November, ll^tjl .
l)tHfml>er, Iflil
JuiiiiKry. I'-'tlw
Kebruury, \&\'i. .
.Miircli, 1862
M..nthlv
5U, .W5
K<,.T60
nt<,918
5.'),09n
56, 700
ra, 089
54,P10
ai, .iTO
49, 394
Sil9
1,1174
.1,739
1,864
1,405
1,148
687
65(1
488
1,106
330
1,716
1, 739
1,347
664
477
262
171
lai
759
629
3, 390
3,478
3,2n
2, 069
1,625
949
Ml
609
1,865
Ruliu per 1.000
strength.
Number «f Cases.
Katiu
sir
per 1,000
.■iiKlb.
29 17,709 165
67 ! Mjm ' 1,607
no ' 85.4(18 I 3,514
.54 j' 113.204
984
133,669 I 3.011
152,7.)9 I 2, 151
167,21.7 ;.17()
153, 3(a
126, 588
111,169 1,971
1,344
793
(»
584
1, 340
i,7.'.(;
1,922
1.474
982
1, 148
664
1,104
228
2, 191
4,854
5, 740
4, 9X1
3, (i25
2, 1.52
2, 492
1,457
3, 075
a*
a>
E
a
<£
9
4
32
11
41
16
35
16
23
14
14
10
7
(;
9
7
7
5
1-
ID
I
13
43 i
57
51
37
24
13
< 16
12
The consolidated monthly reports for certain general hospitals in Virginia during tlie
last fonr months of 1862 give, in a total of 34,890 admissions for disease, 3,095 admissions
for malarial fevers, distributed as- follows: Remittents 931, or 30 per cent, of the malarial
total. (jUotidians 623, tertians 1,309, quartans 215 and congestive cases 17. Unfortunately
the mortality from these cannot lie ascertained from the reports.
According fo Dr. Jones, the reports of sick and wounded for the years 1861 and 1862,
filed in the office of the Surgeon General of the Confederacy, exclusive of those from the
Trans-Mississippi department, gave a total of 819,286 cases of disease and injury, not
including gunshot wounds, while the cases of malarial fever numbered 1 15,115, or one case
of malarial fever in 7.1 of the cases constituting the total. The corresponding figures*
from the records of the United States troops give 1,709,416 cases of all diseases and injuries
exclusive of gunshot wounds, and 274,053 cases of malarial fever, or one case in every 6.2
of the total. These rates indicate that the proportion of malarial cases to the whole
number taken on sick report was greater among our men than among the Contederates.
But it would be unsafe to conclude from this that the ratio oi' the paroxysmal fevers to
strength was at all less with them than with us. Indeed, in the few instances in which it
has been possible to ascertain the ratios of cases to strength in certain portions ol the
Confederate armv. they have been fouud to be actually' greater than in the corresponding
parts of the United States forces. Among the statistics preserved by Dr. JoNES is a table
relating to the Confederate Army of Tennessee, the figures of which may be compared with
those of the Federal Army of the Tennessee for the Same year. The table covers fourteen
♦ See Table XIII, tupra. page 31.
104
MALAKIAL FEVERS
months, from April, 1862, to May, 1863, inclusive; but the mean strength for the first two
months is unfortunately not given. Dr. Jones remarks, also, that the returns for Julv,
September and October, 1862, are "incomplete." They represent, however, a sufficiently
large part of the force to give a fair notion of the prevalence of the disease under consid-
eration in the whole army. In the following table the malarial statistics of these armies
are contrasted :
Table XXXV.
A Comparison of the Prevalence of Intermittent and Remittent Fevers in the Confederate and the United
States Armies of the Tennessee from June 1, 1862, to 3Iay 31, 1863.
June, 1862
July,1863
August, 1862
September, 1862 .
October, 1862
November, 1862 .
December, 1862. .
January, 1863 ...
February, 1863 . .
March, 1863
April, 1863
May,1863
Monthly average .
COSFEOEBATE AKMY.
40, 675
10,658
30,025
9,311
15,082
33, 791
48,958
50,604
63,494
61,226
64,441
55, 121
40, 282
Number of Cases.
3,269
982
2,161
543
902
1,310
1,695
1,795
2,213
3,103
3,734
4,030
a, 144
2,487
927
1,593
97
2-30
268
398
491
613
908
1,418
1,498
911
5,756
1,909
3,7,54
640
1,132
1, .'>78
2,093
2,286
2,826
4,011
5,159
5,528
3,055
Ratio per 1,000
strength.
23
141
179
125
69
75
47
43
45
44
65
80
100
76
U. S. ARMV.
66,042
80,647
70, 997
82,972
111,891
136,503
13;), 119
143, 942
141,158
146,790
143, 367
140, 277
116, 475
Number of Cases.
2,541
3,045
3,245
5,898
7,338
6,783
4,643
4,771
4,566
5,076
4,695
3,911
4,709
1, 574
1,927
1,725
1, 702
1,669
1,643
1,405
1,891
1,715
1,919
1,736
1,565
1,706
4,115
4,972
4, 970
7,600
9, 007
8, 426
6,048
6,662
6, 2i!l
6, 995
6,431
5,476
6,415
Ratio per 1.000
strength.
40
15
In the case of these confronting armies, as in the case of the Confederate and Federal
Armies of the Potomac previously coutrasted,* the Confederates had actually a larger pro-
portion of cases than was reported bv the Federal Army. Other statistics published by
Dr. Jones point in the same direction. The rebel command serving in the river batteries
below the city of Savannah, Ga., reported from October, 1862, to December, 1863, inclusive,
a mean strength of 878 officers and men, with 3,313 malarial cases, of which 2,824 were
intermittents and 489 remittents. As this command occupied the low rice lands of the
Savannah river its experience may serve to indicate what our own troops in the Depart-
ment of the South would have suffered had they been advanced by the fortune of war
from the comparatively healthy coast islands to the lowlands of the main. Looking only
to the statistics of the year 1863, Dr. Jones's figures give 2,214 intermittents and 461
remittents, a total of 2,675 cases of malarial fever in a mean strength of 873 men. In
ratios per 1,000 of strength these are equivalent to 2,536 for the intermittents, 528 for the
remittents and 3,064 for all the malarial fevers. Among the United States troops in the
Department of the South the ratio of malarial cases for the year ending June 30, 1863,
* Page 103, supra.
AMONG THE CONFEDERATE TROOPS.
105
was luit 528, that of the intermittents being 359 and of the remittents 169; while for
the following year the malarial ratio was 594, the intermittent ratio being 492 and the
remittent 102.
Equally instructive is the contrast between our reports from the Department of the
South and those published by Jones as from the Confederate troops serving in the De])art-
ment of South Carolina, Georgia and Florida, from January, 1862, to July, 186)), inclusive.
The mean strength of the command during this period was 25,723 men, and the cases of
malarial fever 41,539, of which 35,925 were intermittents and 5,614 remittents. Con-
sidering only the figures for the fiscal year ending June 30, 1863, the following results are
obtained, which may be compared with the ratios just stated as from the Federal Depart-
ment of the South: Mean strength 26,185; number of intermittents 30,322, or 1,158 per
1,000 of strength; remittents 3,665, or 140 per 1,000; total of malarial fevers 33,987,
or 1,298 per 1,000.
Another table presented by Jones embodies the statistics of the Confederate troops in
and around Mobile, Ala., for the period from January, 1862, to Julv, 1863, inclusive:
Average strength 6,752; malarial cases 13,668, of which 10,500 were intermittents and
3,168 remittents. The figures for the year ending June 30, 1863, give a mean strength of
7,659, and a total of malarial fevers amounting to 10,878, of which 8,635 were agues
and 2,243 remittents. The ratios obtained from these numbers, respectively 1,420, 1,127
and 293 per 1,000 of mean strength, exceed those for the same year I'miu our Department
of the South, and even those for the same period from our more unhealthy Department
of the Gulf, which reported per i,0(M of strength 863 cases of malarial fever, 696 being
intermittents and 167 remittents. ^
The Army of the Valley of Virginia, during the ten months, January, 1862, to Octo-
ber, 1862, inclusive, had 3,885 malarial cases in an average strength of 15,582 men.
The figures for the first six months of this period may "lae contrasted with those of the
Federal troops in the Department of the Shenandoah. An equally trustworthy comparison
cannot be made for the remaining four months, because during that period the Federal
reports for the district in question have not been separately tabulated.*
• We may. however, contrast the figures furnished by Dr. JONES for the Confederate Army <if the Valley of Virginia during the months of .July.
August. September and October, I8fi2, with those of the Federal troops in the Middle Department for the same period : for on the breaking up of tlie
Department of the Sheuandikah the sicli reports of the troops which remained in it were consolidated with those from the Middle Department.
A Comparison of the J'revalence
of Intermittent and Remittent Fevers in the Confederate Army of the I
of the Atlantic Region for the period from July 1 to October 31
'alUyof
1862.
■irginia and the V. S. Middle Ihymrimmi
COXFEDEKATE ARMY.
V. S. Ahmv.
tii
S
Y,
15,589
15, 643
21,123
34, SIW
Number of Cases.
Ratio per 1,000
strength.
s
Y,
S
s
Number of Cases.
K»t
s
o per 1,000
trength.
a
9
1
0)
c
•E
o
1
®
1
'i
•c
1
1
•c
a
"a
s
o
1
"1
*
a
—
1
a
•c
s
1
July, lgC2
473
4:i4
348
239
305
127
■35\
712
739
475
983
31
28
16
19
15
19
6
10
46
47
22
29
12,357
9.135
19, 101
21,531
266
214
235
473
150
82
139
193
416
296
374
666
22
23
13
22
12
9
7
9
34
.12
20
31
August, 1862
Septt-inber, I8«2
October. 1862
21,639
472
255
727
29
12
34
15,531
297
141
4:i8
19
9
38
Med. Hist., Pt. Ill— 14
106
MALARIAL FEVERS
Table XXXVI.
A Comparison of the Prevalence of Intermittent and Remittent Fevers in the Confederate Army of Virginia
and the U. 8. Department of the Shenandoah from January 1, 1862, to June 30, 1862.
These statistical fragments indicate that malarial fevers were more prevalent among
the Confederate than among the Federal soldiers.
Murtahty. — For want of data on the rebel side it is not possible to determine the rela-
tive mortality from these fevers in the opposed armies; but, as bearing on the question, we
have Dr. Jones's statement that the records of the Surgeon General's Office for the years
1861 and 1862 gave 1,333 deaths in connection with 115,415 cases of paroxysmal fever
and 31,238 deaths from all causes excepting gunshot injuries. Table XIII, already pre-
sented, shows that these figures are equivalent to 43 deaths from malarial fever per
thousand deaths from all the included causes, and to a fatalitv rate of 1.15 per cent., or
one death in 86.2 cases, while the corresponding figures from the records (jf the U. S.
troops are equal to 160 deaths from -malarial fever per thousand deaths from all causes,
and to .95 per cent, of fatal cas'es, or one death in every 105.3 recorded attacks.
According to these figures the ratio of deatiis to the recorded cases was greater among
the rebel than among the northern troops; but there is no certainty that the recorded cases
m the two armies liore the same relation to the number of cases that actually ocmu'red. It
appears not unlikely that tins larger ratio of deaths to recorded cases may have originated
in a failure to report the lighter agues. The familiarity of the Southern people with
malarial disease suggests that many attacks which would have appeared on the sick reports,
had they occurred among Nor 
