Saturday, August 7, 2010

Medical View Of The Condition Of The Iowa Troops At St. Louis

(By. D. L. McGugin, M.D., Surgeon and Medical Inspector, Benton Barracks.)

BENTON BARRACKS, Feb. 2, 1862.

EDITOR OF GAZETTE:– Dear Sir:– A commanding officer of the 14th Regt. Of Iowa Infantry handed me a copy of your paper in which there is an editorial article, highly, and no doubt, justly commendatory of a lecture delivered by the Rev. gentlemen of the State Sanitary Board.

While I am gratified beyond measure by the display of interest in the part of the people, in the welfare of the soldiers, yet I am very sure that they are not fully advised as to the causes and their nature, which have produced so much affliction among the soldiery composing the regiments from our State. The Reverend lecturer may have adverted to them, and yet I am very well assured that to understand them fully it would require a much longer visit than any member of the Sanitary board favored us with.

In view of these facts and in order to afford all the satisfaction in my power to the people of Iowa, who have sent into the field so many brave soldiers to suffer and many of them to die, I will endeavor to do so by describing some of the circumstances and phenomena which have been the subject of investigation, and which I believe to lie at the bottom, as active predisposing agencies of the diseases and of giving power to their malignancy. The fatal termination of so many cases has been as much deplored here as their enumeration was startling to the good people of Iowa and elsewhere.

My position has given me advantages of general observation, while at the same time its responsibilities would tend to bestir me to investigation. From these considerations it becomes me to state in detail the results of these inquiries and observations which is incumbent upon me, because it is due to the people, the friends of those who have fallen sacrifices, and to myself, because my sympathies and interests have been intimately blended with the State.

First then in the list of causes and which exerted great power, was the unfortunate selection of this place for a cantonment. A just apology may be found for its projectors in the fact, that at first it was meant only for a small barracks – for a kind of encampment for those who were to be sent into the field and who were awaiting equipments and stores, before being sent into active service. It was made a school of instruction, for these that their time might be profitably occupied in perfecting their drill and discipline and no one dreamed that it would attain to its present magnitude and proportions, being that of the largest encampment on the continent.

The ground on which it is located is flat – a kind of basin, and when dry is certainly a beautiful parade ground. The soil is black loam, composed of vegetable matters partially decomposed. It is surrounded on the southwest side by numerous basins or lakes of water, and from this direction the winds generally prevail. From the surfaces and surrounding of these, evaporations take place, so great a degree that this whole cantonment has been overhung until 10 o’clock A.M., with a misty fog or vapor, rendering the atmosphere murky, damp, cold, and chilling. That it might be made a better parade ground, on which to display their forces on dress parade, drill and inspection, the surface which was rendered somewhat uneven by the existence of numerous little tumuli, regarded by some as Indian mounds, was leveled down and made even. Every intelligent observer has observed the unfortunate results which usually flow from upturning, for the first time a large prairie. Malarious diseases will occur to those living upon or contiguous to it in autumn, and during the winter pneumonias of a low, lingering type. I might refer to facts connected with the spread of cholera, and to numerous other circumstances, but it is not necessary, as it is so well known as to become an undoubted fact. This surface was still more thoroughly and frequently exposed and disturbed by the tread of so many horses, by the construction of drains and culverts, of streets, avenues and numerous buildings.

In the winter season, in a climate like this, where the humidity is not frozen as fast as it rises, and therefore the air kept pure and clear as in the far North, so much moisture evolved must prove highly detrimental to health and vigor of constitution even under the most favorable circumstances, and with all the means of comfort and capacities for protection.

Again:– The vast aggregation of human beings upon a plot of ground, not more than three square miles, to the number at one time of near twenty thousand souls within this area, beside half that number of horses.

Had I time I would show the great consumption of atmospheric air by each individual, by which that element is deprived of its healthful properties. Not this only but at every expiration there is a large amount of poisonous matter thrown off. Beside this, there are exhalations from the skin, of a large amount of impurities, which contribute to the unhealthiness of the air. The vital elements of the atmospheric air in large cities are stolen away and their place supplied by that which is deleterious, and hence in these densely populated cities there is more sickness and a physical degradation when compared to the physical vigor displayed in the rural districts. It is true that conjoined with this are the habits of life – the indulgence in luxurious ease, and the unrestrained and unlicensed gratification of the animal appetites.

And again, these barrack buildings were also at first intended for temporary purposes, but have been from time to time added to until the camp has grown into its present immense proportions. The first nucleus being defective it was not altered and improved, but others of like structure and proportions were added, so as to preserve the type and symmetry. The laws and rules of health were not considered, and rather than change the plan and improve on the model, they grew on until they have extended to their present length. They are lightless almost, and as airless and gloomy within the apartments. Their floors are laid flat upon the carbonaceous loam or soil, and are actually lower then the surrounding surface in a large proportion of them, and therefore no currents of air are admitted beneath to drive out the poisonous breath uprising from the moist soil beneath, but is actually invited into these apartments by the partial vacui produced by a central stove heated up to red-heat by the soldiers, to protect themselves from the cold moist air obtruding itself through every cranny and crick in the floor. Those who huddle and crowd about these stoves will hold their places until compelled to yield to others and go back, with every pore of the skin pouring out its moisture, into the same distant corner to breathe the cold, damp, and poisonous air, and their perspiration suddenly arrested and the surface made cold. If it is evening and the “taps” sends them to bed they remain chilled through the night and wake up in the morning with a cough, sore throat, &c., &c. They might almost as well sleep in a cold, damp, dark cellar. Who so wanting in common intelligence cannot see that if these causes do not actually and immediately excite disease in some form, they would assuredly become potent predisposing agencies for future mischief.

This is still not all. These barracks were so laid off as to allow one apartment for a company of the usual number; but the troops came pouring in at one time so numerously that there was a clamorous demand for more room. To meet this unlooked for exigency two companies were crowded into one of these apartments in which there was no surplus room after one had pre-occupied it. The laws of hygiene were outraged by this packing process, and regarding this as the climax of imprudence she commenced the work of thinning them out of this cruel aggregation and unfortunately for the work was but to promptly, and unfortunately for the men and the service, as thoroughly, performed. This crowding was neither foreseen nor originally intended, but was at the time the work of necessity, and it is but just to say that no one was especially to blame for it. Under the most favorable conditions and situations, man is but the creature of circumstances, and in no sense is this postulate so well comprehended and understood as in a time of war.

Experience has abundantly proved that infectious diseases seek crowded communities, and the more especially if filth be the concomitant of this backing, which in a large majority of instances is the case. Indeed, under such circumstances, some form of eruptions will be engendered, in my opinion – even those which will subsequently contact, actually to reproduce them in others. But should it be conveyed into communities where cleanliness has not been observed, and where the people have been laboring under such predisposing agencies as the want of pure air and light, an infectious malady, when once introduced; will run like fire in the dry grass of the prairies. Under such circumstances, the measles, which had been lurking in some of the regiments during six months, made its advent into those regiments which has but recently come into the barracks, and soon spread with rapidity, and soon the hospitals, which are established in connection with the barracks, were full to overflowing, and the cases presented a character for malignancy which I had never before observed in any epidemic visitation in a practice of thirty-six years.

You will pardon me while I go a step or two farther, and endeavor to explain to the reader a fact or two in the nature of this disease, so that he can better understand why it was followed by the untoward and fatal results in so many cases. From what has been said, he would infer that any form of disease, which would be introduced among those exposed to the predisposing causes above enumerated, would assume a formidable character. He would also infer that of whatever character or type it would assume a low form, because all the circumstances preceding were calculated to reduce the stamina forces. Every one knows that in measles the skin is changed from a healthy to a diseased state; but every one does not know that the skin continues into the cavity of the mouth and lining it, and even into the stomach and bowels and the air passage of the lungs. As found here it is modified from that which covers the exterior body, and is called the mucus membrane. Now, in measles the skin is not alone affected, but it also attacks these mucous linings; and hence the constant hoarse and distressing cough on the one hand, and the irritation of the stomach and very often of the bowels on the other. I have seen cases of dysentery of a most distressing character in these hospitals, as one of the sequels of measles. Any one looking at the abundant eruption upon the skin, and refleet that these mucous membranes are in a like condition of inflammation and vascular congestion, will not wonder at these distressing symptoms and phenomena. Now, the outer skin, in a few days of this eruptive state, would begin to scale off or desquamate like bran. This is the derma, or outer skin. This old dead skin has been replaced by the new, which has been formed and which has displaced the old. That which has been so recently formed is tender, and highly sensitive to impressions from cold applied, and the circulation thus recently established is feeble and easily interrupted.

Pneumonia, (lung fever) followed in a large majority of the cases of measles, and for reasons, which will be very readily perceived. The circulation in the skin furnishes a large amount of blood, and this is necessary to the performance of its functions. If it be not in the skin it is still in the body somewhere and this somewhere is just where it ought not to be – perhaps encroaching upon some vital organ. It is most likely to take the direction to some organ already in a state of irritation at the time. If the liver or kidneys, or stomach, or lungs, or brain – any one of these is in a state of disease already, it will be invited in that direction, by the irritation then and there existing. Now because the lungs are compelled to carry on the office of function of respiration, the very air they breathe coming in contact with the mucous lining of the pulmonary air passages perpetuates the irritation there, and when cold is applied to the surface so as to drive the circulation inward, it is invited to the lungs and hence we have had pulmonary diseases to follow more frequently then any other form of disease.

Under this twofold power, namely, intropulsion from the skin and the strong attraction on the part of the irritation upon the air tubes, the momentum of rush is great for it is usually sudden, as it is terrible. In ordinary pneumonia, as every medical man knows, one tube of a lung only is diseased, and this the lower one on the side affected. The other lobe or lobes of that side and the other entire lung are left to carry on respiration, and thereby life is perpetuated until the disease is controlled, or it subsides. But in the epidemic of measles as it prevailed in this cantonment, those that relapsed and were sent to the hospitals, very often came in with all the lobes of one side congested and sometimes both lungs. Of course these cases very soon became asphyxiated unless the general circulation was speedily restored. The more mild forms at the beginning would linger on and sink into a low state of depression, and because of the physical degradation arising out of their mode of life prior to the attack of measles, it was very difficult to sustain the vital powers until the morbid state would pass away. Many of these cases would be complicated with erysipalatous inflammations, and so frequently did I observe this upon my daily round among the hospitals, that I became satisfied that a majority of the cases of pneumonitis following measles showed that the character of the inflammation was strictly of that type. The low form of the inflammation, the character of the discharge throw from the lungs and then the supervention of erysipelas upon the skin usually confined to the face, where circumstances which arrested my attention. If the vital forces had not been too far expended, the appearance of erysipelas upon the surface was usually hailed as a harbinger of good, by coming to the relief by transference to the surface of the disease upon the lungs. In this view I was sustained by Prof. Johnson of St. Louis, a very eminent and worthy gentleman.

There was still a more formidable disease than even the pneumonia which very often followed measles and which was Capillary Bronchitis. It was of this disease that the 12th Iowa infantry lost a most valuable officer and worthy gentleman, Capt. Tupper, of Decorah. I was called to see him, in consultation with his surgeon, two days before his death, and found that his was a case of this character. The disease in question consists in the blacking, with thick, tenacious mucus, of the fine, indeed the finest air tubes of the lungs. They are called capillary brochis because not larger than a hair (capillus), and these communicate directly with the air cells. Now, if the air does not reach to these cells, the blood is not revivified or aerated, and as the way to these cells, or in a large majority of them, is closed because these fine, hair-like tubes are blocked up, the oxygen does not reach the blood, nor can the poisonous material which is in the blood when it is sent to the lungs, and which here escapes, be allowed to do so, for the very reason that the oxygen cannot enter. It is in the residual air in the cells, but is re-absorbed into the system to add to the poison rapidly accumulating. Hence, there is a death like lividity of the countenance, intensely upon the lips and about the eyes; the tongue, and even the gums, become of that death blue aspect. The hands and the feet are blue and mottled, and, in extreme cases it extends to the knee. The breathing is most labored, and in the language must expressive, of my friend, Surgeon Andrews of the 3d Michigan cavalry, they become “tight” – a term which misled me at first, but it was so expressive of the condition of the respiration when he used it, that I preferred it. It is distressing to witness the efforts made to breathe, and the various positions they assume, if they have strength to do so. These cases prove fatal in one or two days, or they may live a fortnight, depending upon the number of the air tubes blocked up, for the gravity of the case mainly depended upon this. The surface was cool, unnaturally so, the pulse from 110 to 140 – stupor and great exhaustion. In some cases there was free expectoration of bubbling mucus, which was also highly tenacious; in a majority of cases, however, there was very little discharged. The sheet-anchor was in the use of alcoholic stimulants and tonics, with stimulating expectorants. Nauseating expectorants were contra-indicated because too depressing to the little of life left. It is difficult, nay, almost impossible, to contend against a disease when, as one of its consequences, and increasing as it progressed, the system is continually generating its own poison and accumulating materials for its own destruction. The air cannot get behind those barriers to free admission into the cells, and therefore these obstructions not expelled by expectoration. Examinations of those cases of the diphrite variety in children exhibit shreds or filaments which entirely fill up these fine air tubes, and are moulded and fashioned into their size and form.

Again: the measles leave other consequences in their train. Ophthalmia some times succeeds to it, and there is also the inflammation and suppuration of the glands of the ear, accompanied, in all cases, with dullness of hearing, and in some instances, complete deafness. A chronic disease of the larynx, or vocal-box, remains for some time so that the patient cannot raise his voice in a tone above that of a whisper. - As one of the Medical Board for the examination of those who may apply for discharges from the service, I have seen and examined numerous cases of those different affections in soldiers claiming disability. – There were very many cases of enlargement of the glands about the neck and beneath the jaw.

(Concluded to-morrow.)

– Published in The Davenport Daily Gazette, Davenport, Iowa, Thursday Morning, February 13, 1862, p. 2

NOTE: This is the first of a two part article. For its second part, please click HERE.

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