Civil War Hospital Ship

The U.S.S. Red Rover, a captured Confederate vessel, was refitted as a hospital ship.

Evolution of Civil War Nursing

The evolution of the nursing profession in America was accelerated by the Civil War.

The Practice of Surgery

Amputations were the most common surgery performed during the Civil War.

Army Medical Museum and Library

Surgeon-General William Hammond established The Army Medical Museum in 1862. It was the first federal medical research facility.

Civil War Amputation Kit

Many Civil War surgical instruments had handles of bone, wood or ivory. They were never sterilized.

Showing posts with label Mental Health. Show all posts
Showing posts with label Mental Health. Show all posts

Wednesday, May 3, 2017

Civil War Alcohol Abuse: Forty-rod, Blue Ruin & Oh Be Joyful

By David A. Norris, 9-20-15

With a plethora of colorful nicknames, alcohol was widely abused in both Union and Confederate armies during the Civil War.

Union General Benjamin Butler was baffled. Every night a picket guard went to an outpost 1½ miles from Fort Monroe, Virginia. The soldiers departed for their shift perfectly sober, yet when they returned to the post the next morning they caused trouble “on account of being drunk.”

Investigations failed to reveal the source of their whiskey. Searches of canteens and gear turned up nothing suspicious. But there was one odd thing about the detachment: someone in Butler’s command noticed that the men always held their muskets straight up in a peculiar manner. The mystery unraveled when their muskets were examined. “Every gun barrel,” wrote Butler, “was found to be filled with whiskey.”

Excessive drinking was a constant problem in both armies during the Civil War. “No one evil agent so much obstructs this army as the degrading vice of drunkenness,” wrote Union Maj. Gen. George B. McClellan in February 1862. “It is the cause of by far the greatest part of the disorders which are examined by court-martial.” The complete abolition of alcohol, he believed, “would be worth fifty thousand men to the armies of the United States.” And across the Mason-Dixon Line, the Norfolk Day-Book complained that Confederate enlisted men and officers in the vicinity were drinking whiskey “in quantities which would astonish the nerves of a cast-iron lamp-post, and of a quality which would destroy the digestive organs of an ostrich.”

Whiskey the Drink of Choice for Most Soldiers
Many if not most soldiers were already well acquainted with alcohol from the antebellum era. Whiskey was far and away the most popular drink in 1861. Often made from corn instead of grain, it was distilled at countless locations across the country. Popular nondistilled drinks included cider and beer. Cider, made from apples, was more common, but beer was quickly growing in favor, its rise fueled by the steady German immigration into Northern states.

With a plethora of colorful nicknames, alcohol was widely abused in both Union and Confederate armies during the Civil War.

Low-grade whiskey carried with it the threat of poisoning the drinker, so makers might start with clear alcohol, water it down, and then doctor the mixture to simulate the color and flavor of the real thing. Chewing tobacco, for example, helped approximate the amber tint of whiskey or brandy. Harsher ingredients added the bite that drinkers expected in their whiskey. An 1860 inspection of liquor samples in Cincinnati found whiskey containing sulfuric acid, red pepper, caustic, soda, potassium, and strychnine. It was no wonder that “rotgut” was the most prevalent nickname for cheap liquor during the era.

Countering the growth of alcohol consumption was the temperance movement, which sought to make all forms of alcoholic beverages illegal. Maine enacted a prohibition law in 1851. Several other states or territories passed dry laws in the following years. In most cases, these laws were repealed or overturned within a short time. Per capita consumption peaked in 1830 at an equivalent of 7.1 gallons of alcohol annually. A swift decline followed, with the annual per capita figure dropping to 2.53 gallons by 1860.

“Spirit Rations” Abolished
Alcohol still had an official presence in the U.S. Army in 1861. A daily spirit ration for American soldiers had been abolished in 1832, but officers were permitted to issue special servings of whiskey to relieve fatigue and exposure. Soldiers, naturally, had countless sneaky ways to obtain whiskey. While diligent officers could restrict the flow of whiskey into camp, soldiers could still drink when they received a pass to leave camp. In the Confederate Army, the phrase “running the blockade” meant slipping in and out of camp for illicit purposes, usually involving alcohol.

On February 27, 1862, the Confederate Congress passed a law allowing President Jefferson Davis to suspend habeas corpus and declare martial law in areas threatened by the enemy. Immediately, martial law was declared in Portsmouth and Norfolk, Virginia, followed by Richmond on March 1. Richmond came under control of the provost guards commanded by Brig. Gen. John H. Winder, who prohibited the manufacture of liquor and closed the city’s saloons. By then liquor sales had caused so much trouble and crime among Confederate soldiers and civilian that many in Richmond welcomed martial law. Winder also barred rail shipments of whiskey into the Confederate capital. Apothecaries were allowed to dispense liquor only with a doctor’s prescription.

Martial law did not stop the distribution of whiskey, but merely drove it underground. There were still countless cases of drunk and disorderly behavior, as well as arrests for illegal sales of alcohol. Corruption flourished among the provost guards, some of whom forged prescriptions for alcohol. After obtaining the liquor, they then arrested the apothecaries who had dispensed it, thus adding insult to injury.

A ‘Creature Comfort’ Care Package From Home
A great deal of whiskey was sent to army camps on both sides by well-meaning relatives back home. It was a common practice, especially among the Union soldiers, for families to send their loved ones packages of fresh, canned, or smoked food and other small creature comforts. Commanding officers quickly realized that a great deal of whiskey was also being smuggled into camp inside these care packages. General Butler later testified before Congress that a search of an Adams Express Company depot yielded 150 different packages of liquor in crates and boxes on their way to his command.

Every parcel intended for a soldier had to be opened and inspected by officers of his regiment or brigade. Union Private John D. Billings, in his classic memoir Hardtack and Coffee, recalled, “There was many a growl uttered by men who lost their little pint or quart bottle of some choice stimulating beverage, which had been confiscated from a box as contraband of war.” Billings noted some ingenious ways that innocent-looking gifts concealed whiskey. One favorite ruse was hiding a bottle of whiskey inside a well-roasted turkey. Whiskey bottles also came into Billings’ camp in tin cans of small cakes or in loaves of bread with holes cut in the bottom.

Smuggling whiskey in legitimate-looking containers with false labels was a common practice. A helpful sutler showed Butler several little bottles that supposedly contained hair oil packaged by a New York City firm. Instead, each bottle contained half a pint of whiskey, with a little olive oil on top. The bottles were sold wholesale at eight cents each, but soldiers paid 25 cents for them in camp. The distributor claimed to have sold thousands of such bottles at Fort Monroe.

Alcohol Restrictions Lead to Officer Impersonation
In February 1863, the Union guard boat Jacob Bell searched the supply schooner Mail at Alexandria, Virginia. Aboard the schooner were 428 dozen cans labeled “milk drink” packaged by Numsen, Carroll & Company, a Baltimore firm. Upon closer inspection, Lt. Cmdr. E.P. McCrea learned that the milk drink was actually “villainous eggnog.” Commodore Andrew Harwood noted that the cans were not soldered in the usual way. The top and bottom had been heated with a resinous substance and the edges bent over so that the cover at either end could be removed to convert the can into a drinking cup. Harwood issued orders to the Potomac Flotilla to seize any vessel caught smuggling alcohol.

Sutlers were in a good position to profit from liquor sales. Regulations prohibited them from selling liquor to enlisted personnel, but many of the officially licensed merchants evaded the rules. Sutlers could openly stock whiskey because they were still allowed to sell it to officers. Brassy enlisted men frequently borrowed a pair of officers’ shoulder straps and purchased whiskey in the shops. Others stole bottles from sutler huts, wagons, or tents.

With a plethora of colorful nicknames, alcohol was widely abused in both Union and Confederate armies during the Civil War.

Impersonating an officer was only one of the many ways that Union and Confederate soldiers managed to get around the rules restricting their drinking. Assignment to guard duty also provided opportunities for mischief. In eastern North Carolina in April 1862, several men in the 51st Pennsylvania were ordered to guard the commissary tent in which a newly arrived shipment of whiskey barrels was stored. One night the guards took the barrels off their muskets. After unscrewing the breech plugs, each soldier had a long iron straw, which he inserted into the bung-hole of a whiskey cask and sucked himself into intoxication.

Among the busiest routes for smuggling alcohol to the Union Army was the Long Bridge, which crossed the Potomac River, linking Washington, D.C., to Virginia. On November 23, 1863, all contraband liquor seized on the bridge was turned over to the Army Medical Museum, located not far from the Washington end of the bridge. At the time, tissue specimens saved for the museum were wrapped in cloth and preserved in a keg of alcohol or whiskey. Each specimen was identified by a small wooden block, with a description written on it in pencil so that the alcohol would not dissolve the writing. Confiscated liquor was distilled again by the museum into uniform grade 70 percent alcohol, which was deemed perfect for preserving specimens.

Liquor Smuggling Gets More Sophisticated
Surgeon John H. Brinton recalled that ground around the museum was piled high with “kegs, bottles, demijohns, and cases, to say nothing of an infinite variety of tins, made so as to fit unperceived on the body, and thus permit the wearer to smuggle alcohol into camp.” Another medical officer, Acting Assistant Surgeon Ralph S.L. Walsh, marveled at the ingenuity of liquor smugglers. Goods confiscated for the museum, ranging from blackberry wine to straight alcohol, were packed in many peculiar vessels. Frequently women were arrested with belts under their skirts to which were fastened tin cans holding between a quart and a gallon of whiskey. In a number of cases the women sported false breasts, each holding a quart or more of contraband liquor. Guards seized so much alcohol at Long Bridge during the war that the Army Medical Museum had enough alcohol for its specimens until 1876.

In many camps sutlers were allowed to sell patent medicines. Often these remedies were nothing more than liquor flavored and tinted with herbal concoctions. Countless posters and newspapers touted the healing power of bitters, liquor strongly flavored with herbs. Some medicinal bitters were served as drinks in saloons. The highly advertised Drake’s Plantation Bitters, which blended herbs with St. Croix rum, was enormously popular at sutler tents.

“Snake Smuggling”?
Lieutenant Luther Tracy Townshend, the adjutant of the 16th Vermont, was also the president of the regimental temperance society. Once, in the absence of the regiment’s sutler, it fell to Townshend to order a shipment of necessities and luxuries for the troops. Some of the men persuaded Townshend to order several cases of Hostetter’s Bitters to help soldiers who were suffering from chills. The merchandise soon arrived in their camp in Louisiana. As Townshend reported, “Some of the men, who were more chilly than the others, took overdoses and in consequence became staggeringly drunk.” Only then did the mortified adjutant learn that Hostetter’s Bitters was almost pure whiskey.

An exception to the ban on sutler sales of alcohol to enlisted personnel existed in some German units of the Union Army. Brig. Gen. Louis Blenker, for one, ordered sutlers to sell beer to the soldiers of his brigade, who were predominantly German immigrants, to keep up their morale. His orders caused resentment among non-German units, although this was mollified by sutlers selling beer to soldiers outside the brigade.

Perhaps the most creative dodge was used by a soldier of the 11th Ohio, who killed a snake and, in the words of a marveling comrade, “carefully dissecting the varmint obtained a long, white cartilage, which he carefully cleaned and coiled up. Proceeding to the hospital, he politely requested a small quantity of spirits in which to preserve the curiosity (which he represented as a tape worm). The surgeon not only agreed, but complimented the man highly for the interest he manifested in natural science!”

Whiskey abuse was not confined to land-based armies. Both Union and Confederate navies faced abuses of their own. In the 18th century the British Royal Navy routinely issued a ration of spirits, usually rum, to enlisted personnel. Originally the ration was eight ounces of distilled spirits per day. Naval rum was diluted with water, resulting in the traditional drink called grog. The practice was associated with Admiral Edward Vernon, a famed officer of the mid-1700s whose service nickname was “Old Grog” because he wore a coat made of grogham cloth. (Laurence Washington, George Washington’s older brother, served with Vernon. When Laurence died, George inherited his plantation Mount Vernon, which had been named for the admiral.)

Alcohol Smuggling in the Continental Navy
The Continental Navy, as well as the early U.S. Navy, adopted the British ration of half a pint of grog per day. Before the War of 1812, imported rum from Britain’s Caribbean colonies was dropped in favor of American-made whiskey. Despite the switch, sailors and the general public continued calling the naval ration grog. On land, lower class saloons were called grog-shops or groggeries. Aboard ship, the crew’s barrels of whiskey and the officers’ private stores of liquors and wines were kept locked up in the “spirit room.” At the captain’s discretion, extra rations of spirits were doled out before and after action, or even during a battle. During the long fight with CSS Virginia, the crew of USS Monitor was braced by a special issue of two ounces of whiskey per crewman.

With a plethora of colorful nicknames, alcohol was widely abused in both Union and Confederate armies during the Civil War.

Captains also issued extra liquor as a reward for hard work such as the tedious and backbreaking job of loading coal aboard steam warships. Confederate sailors outfitting Sea King, which was secretly being converted at sea into CSS Shenandoah, received a serving of grog every two hours. Mariners saw the spirit ration as well-deserved compensation for their long months of hard work and isolation at sea. With some reason, temperance advocates saw it instead as a severe problem and focused considerable effort on luring sailors away from the bottle. In 1832 reformers persuaded Congress to cut the naval ration to one gill, or four ounces, daily. Sailors under the age of 21 and anyone who chose not to draw a spirit ration received instead a small cash commutation, which had risen to five cents a day by 1861.

After reducing the naval grog ration, Congress debated but did not act further on the temperance movement’s demands for tighter restrictions. A chance to end the grog ration arose again when Southern members of Congress left the nation’s capital after the beginning of the war. Northern representatives and senators were more sympathetic to the temperance cause, and with Southern seats now vacant, there were enough Northern votes to abolish the naval spirit rations. A July 14, 1862, act of Congress set August 31 of that same year as the last day for the grog ration. A correspondent aboard an unnamed vessel wrote to the Philadelphia Press that Congress had made a great mistake. He warned that ending the spirit ration would drive all the old seamen out of the service. Aboard the receiving ship North Carolina in New York City harbor, the men met the restriction with muttered growls, but no signs of incipient mutiny were readily apparent.

Kegs Auctioned Off & Turned In To Medical Staff
Spirit kegs remained under lock and key until naval vessels returned to port. About 3,000 kegs were auctioned off and others were turned over to the naval medical service for hospital use. Excess whiskey in the North Atlantic Blockading Squadron was stored aboard the aptly named ship Brandywine. As compensation for the loss of the spirit ration, the Navy added five cents per day to sailors’ pay, a raise of between 8 and 10 percent. Despite the banning of grog, there was still some alcohol aboard Union naval vessels. “Distilled spirituous liquors” were allowed on board ship as medical stores. And officers, trusted by Congress more than common sailors, were still allowed to have private stores of liquors and wines.

Grog was served in the Confederate Navy as well. Rebel tars were entitled to one gill of spirits or half a pint of wine per day. As in the Union Navy, a small cash commutation was paid to sailors not taking their spirit ration. Confederate Navy officials had considerable trouble obtaining enough spirituous liquor for rations and hospital use. Naval requirements clashed with state regulations that reserved corn and grain for food rather than distillation of spirits. Eventually a distillery was set up in Augusta, Georgia, to produce whiskey for naval use. Despite the trouble in obtaining liquor, the Confederate Navy never got around to banning its spirit ration, and it remained on the books until the war ended in 1865.

Illicit alcohol resulted in a number of embarrassing incidents at sea. Midshipman James Morris Morgan, in his memoir Recollections of a Rebel Reefer, wrote about an alcohol-fueled riot on the cruiser CSS Georgia in October 1863. Sailors slipped into a coal bunker and bored through a thin bulkhead separating the coal from the spirit room. Then they drilled a hole into the head of a barrel of liquor and inserted a lead pipe. The pilfered grog was distributed among the crew, said Morgan, “and soon there was a battle royal going on the berth deck which the master-at-arms was unable to stop.” Georgia’s first lieutenant went below and induced most of the men to give themselves up for punishment. One holdout defied the officers, but Morgan tackled him and the master-at-arms handcuffed him. Several crewmen were placed in irons and sentenced to a spell in the brig on bread and water.

Whiskey As Spoils of War
The British blockade-running schooner Sting Ray, under the command of a Captain McCloskey, was captured in the Gulf of Mexico by USS Kineo on May 22, 1864. An acting ensign with a prize crew of seven men took charge of the vessel and followed in Kineo’s wake. McCloskey produced a stash of whiskey and offered it to the prize crew. By the time Acting Ensign Paul Borner realized what had happened his men were so drunk that they were unable to get back on deck without assistance.

Borner locked the hatch to keep the men from getting any more whiskey, but McCloskey and his crew jumped Borner, took his pistol, and reclaimed the ship. Union sailor William Morgan fell overboard, and McCloskey tossed a spar into the sea as an improvised life preserver. Another man jumped into a ship’s boat, cut the painter, and escaped. The Confederates followed Kineo for a time before changing course and making a dash for shore. Seeing Sting Ray change course, Lt. Cmdr. John Watters of Kineo opened fire with a 20-pounder gun. McCloskey managed to beach the vessel after dodging several Union shells. Borner and five of his sailors were captured by the 13th Texas. Only two of Borner’s crew avoided capture and were picked up later by Kineo. Morgan, according to Watters, was “in a beastly state of intoxication, crazy drunk and howling.”

Doctors at the time incorrectly believed that alcohol was a stimulant, so they prescribed it to treat sick or wounded soldiers. Some drugs were soluble in alcohol, and patients received them in doses with whiskey or brandy. One treatment for diphtheria was a dose of brandy mixed with ammonia. Alcohol itself was seen as having curative powers for some illnesses. Laudanum, a mixture of alcohol and opium, was a widely prescribed painkiller. Ether was made by distilling alcohol and sulfuric acid, called “spirits of nitre.” A purer form of alcohol called alcohol fortius was used to make ether and to dissolve various compounds.

A Prized Commodity in Medical Treatment
Whiskey or brandy, either alone or mixed with other ingredients, were routinely used to treat patients suffering from wounds or illnesses. Usually whiskey was prescribed in frequent but small doses, perhaps one ounce or one tablespoon every few hours. Sometimes it was administered by itself, but it might also be mixed in eggnog or milk punch. One example concerned the case of Private Augustus C. Falls of the 1st New York Heavy Artillery. Falls was admitted to Douglas Hospital in Washington with diarrhea on August 5, 1864. A surgeon prescribed 11/2 ounces of whiskey each day at dinner. Three days later the dosage was raised to two ounces of whiskey three times a day. On September 29, the dosage was again increased to three ounces of whiskey every four hours. Despite the special treatment, Falls died on October 5.

With a plethora of colorful nicknames, alcohol was widely abused in both Union and Confederate armies during the Civil War.

One of the few effective drugs of the era, quinine, could prevent malaria or ease symptoms for patients who already had the disease. Soldiers often balked at taking their malaria medicine, though, because of its markedly bitter taste. To cajole soldiers into taking quinine, some surgeons mixed it with whiskey. This created the opposite problem; some soldiers enjoyed the quinine-whiskey dose so much that they sneaked through the line for a second prescription. While stationed at New Bern, North Carolina, the men of the 44th Massachusetts found that their medical officers took precautions to limit the soldiers to one dose each. Instead of serving quinine in whiskey, the drug came blended with medical alcohol, water, and cayenne pepper. “No soldier,” wrote a veteran of the regiment, “is known to have acquired a dangerous hankering for the mixture.”

Guilty on Charges of Drunkenness
Southern medical officers struggled to obtain sufficient quantities of medicinal alcohol. Surgeon General Samuel P. Moore established distilleries in Montgomery, Columbia, Salisbury, and Macon to produce medicinal alcohol. Volunteer committees gathered food, clothing, medicines, and creature comforts from civilians and shipped them to military hospitals. On November 22, 1861, the Charleston Mercury highlighted the first quarterly report of the city’s Ladies’ Christian Association. Among numerous shipments sent by the association to hospitals in Virginia were 34 boxes or crates of alcoholic beverages, including wine, brandy, blackberry brandy, claret, Madeira, port, whiskey, ale, bay rum, and additional alcohol in the form of medicines and bitters.

Drunkenness could be overlooked if it occurred when a soldier was off duty and did not compound his offense with other crimes. Court-martial of officers charged with drunkenness was handled differently from those of enlisted men. Officers found guilty could be cashiered with forfeiture of pay. In addition to dismissal, a Confederate law of 1862 allowed a public reprimand of officers convicted of drunkenness. An officer dismissed from the Confederate service could also be conscripted back into the ranks as an enlisted man. Enlisted personnel found guilty of drunkenness usually faced some form of confinement, corporal punishment, or public shaming. Penalties varied depending on the degree of the soldier’s offense and the policies of his commanding officer. Common punishments for drunken enlisted men included confinement in a guard tent or guardhouse, wearing a barrel with a placard noting that the culprit was a drunk, extra duty, or a spell carrying a log or marching with a knapsack filled with rocks.

Generals were not immune from abusing alcohol. Indeed, their vast responsibilities encouraged such abuse. Most notoriously, rumors of alcoholism dogged Union General Ulysses S. Grant. After Grant’s capture of Vicksburg, several gentlemen warned President Lincoln that Grant drank to excess. Lincoln was said to have asked what sort of whiskey Grant drank, because “if it makes him win victories like this Vicksburg, I will send a demijohn of the same kind to every general in the army.”

Generals Just As Guilty As Their Soldiers
A serious instance of generals drinking on duty contributed to the Union defeat at the Battle of the Crater on July 30, 1864. After successfully detonating a huge explosion in a tunnel dug under the Confederate lines outside Petersburg, Union forces moved in to exploit the break in the Rebel defenses. Brig. Gens. James H. Ledlie and Edward Ferrero remained behind the lines drinking liquor in a bombproof while their neglected divisions floundered without guidance from their commanders. The attack, which had the potential of taking Petersburg and shortening the war, bogged down, and the Union regiments were devastated by Confederate counterattacks. After investigations into their drinking and dereliction of duty, Ledlie was allowed to resign from the army, but Ferrero escaped serious penalty. He even managed to be brevetted to major general before the end of the war.

Offenses were not limited to line officers. Confederate hospital matron Phoebe Yates Pember wrote of one case in which a drunken surgeon treated a patient whose ankle had been crushed by a train. After the injuries were set and bandaged, the soldier remained in excruciating pain and his condition worsened. Checking the patient, Pember found that the bandaged leg was perfectly healthy, while the other leg was “swollen, inflamed, and purple.” The attending surgeon had been so drunk that he set the wrong leg. Fever set in and the patient died at the hospital.

Plagued with food shortages, inflation, and transportation problems, Southern soldiers and civilians dealt with severe shortages of alcohol caused by state legislatures restricting the use of grain, corn and foodstuffs for distilled liquor. Private distilling took a blow after the Federal capture of Chattanooga in September 1863 and advancing Union forces captured copper mines desperately needed by the South. Not only did their loss crimp production of brass artillery pieces, it also threatened the manufacture of percussion caps and artillery friction primers. The Confederate Ordnance Bureau confiscated scores of copper whiskey stills in western North Carolina. Metal from the stills went into many of the South’s percussion caps made during the remainder of the war.

Persimmon Brandy & Other Homemade Recipes
Southern blockade runners brought wine, whiskey, brandy and other potables from Europe. Less popular than wine and brandy, but still showing up in blockade runner holds, were rum, gin, Scotch whisky, champagne, ale, porter, and schnapps. Occasionally one might even find imported cut glass decanters to serve the imported liquors. Pure alcohol, intended as medical supplies, also passed through the blockade. Blockade-run liquor was beyond the financial means of most Confederates, forcing many people to turn to home-made substitutes. Despite wartime laws, some corn and grain found their way into whiskey. When these standard ingredients were not available, distillers turned to sweet potatoes, rice, sorghum seeds, and persimmons.

On October 21, 1863, the Charleston Courier published a recipe for persimmon brandy. Mashed by a pestle or simply with one’s hands, persimmons were mixed with warm water and left to ferment for five or six days. Then the mash was ready for distillation. In thrifty fashion, the writer suggested saving the persimmon seeds. They could be used for buttons, or parched and mixed with dried sweet potatoes to make a coffee substitute. Beer and wine were simpler to make at home than whiskey, as they needed no distilling apparatus. Newspapers published numerous recipes for persimmon beer. Wine and brandy were made from any kind of available fruit, including peaches, pears, cherries, blackberries, plums, and even watermelons.

With a plethora of colorful nicknames, alcohol was widely abused in both Union and Confederate armies during the Civil War.

F.P. Porcher’s 1863 work Resources of Southern Fields and Forests listed uses for hundreds of plants that grew in the Confederacy. He gave recipes for making beer from corn, persimmons, and boiled sassafras shoots. Blackberries could also be used to make wine, and with the addition of spices and whiskey, a healthy cordial could be concocted. Porcher also mentioned dozens of medicines that could be prepared from native herbs added to whiskey, wine, or brandy. Another way of coping with the lack of alcohol was to make a joke of it. By early 1864, “starvation parties” were becoming a fad in Richmond. Attendees wore the best finery they could manage. Unlike antebellum parties, there were no imported wines or liquors. The fine punchbowls and glassware remaining from the days before the war held only water from the James River.

Robert E. Lee once remarked that it was not possible to have an army without music. He might just as well have said that it was not possible to have an army without whiskey. Whether serving as an innocent aid to relaxation, medication to treat wounds or disease, or a lure to the evils of vice and desertion, whiskey and other types of alcoholic beverages were firmly rooted in the armies of the 1860s. The many creative ways alcohol found its way to soldiers and sailors, and the methods used to control its influence, are intertwined with the story of battles, generals, regiments, and ships of war.

Offenses were not limited to line officers. Confederate hospital matron Phoebe Yates Pember wrote of one case in which a drunken surgeon treated a patient whose ankle had been crushed by a train. After the injuries were set and bandaged, the soldier remained in excruciating pain and his condition worsened. Checking the patient, Pember found that the bandaged leg was perfectly healthy, while the other leg was “swollen, inflamed, and purple.” The attending surgeon had been so drunk that he set the wrong leg. Fever set in and the patient died at the hospital.

For Some, Private Distilling Filled the Gap
Plagued with food shortages, inflation, and transportation problems, Southern soldiers and civilians dealt with severe shortages of alcohol caused by state legislatures restricting the use of grain, corn and foodstuffs for distilled liquor. Private distilling took a blow after the Federal capture of Chattanooga in September 1863 and advancing Union forces captured copper mines desperately needed by the South. Not only did their loss crimp production of brass artillery pieces, it also threatened the manufacture of percussion caps and artillery friction primers. The Confederate Ordnance Bureau confiscated scores of copper whiskey stills in western North Carolina. Metal from the stills went into many of the South’s percussion caps made during the remainder of the war.

Southern blockade runners brought wine, whiskey, brandy and other potables from Europe. Less popular than wine and brandy, but still showing up in blockade runner holds, were rum, gin, Scotch whisky, champagne, ale, porter, and schnapps. Occasionally one might even find imported cut glass decanters to serve the imported liquors. Pure alcohol, intended as medical supplies, also passed through the blockade. Blockade-run liquor was beyond the financial means of most Confederates, forcing many people to turn to home-made substitutes. Despite wartime laws, some corn and grain found their way into whiskey. When these standard ingredients were not available, distillers turned to sweet potatoes, rice, sorghum seeds, and persimmons.

From: warfarehistorynetwork.com

Suffering Veterans - The American Civil War and PTSD

By Emma Walton

Much has been written about the lives and deeds of Civil War soldiers, but little has been said about their mental state. This is in part because the practice of psychiatry was not established by the cessation of hostilities, and attitudes to mental illness were then very different to those we hold today. However, there is significant evidence of disturbed behavior from Civil War veterans to support a theory that many were irreversibly damaged by their experiences during the war. Many undoubtedly suffered from what is today referred to as 'Post-Traumatic Stress Disorder'

The History of PTSD

Post-Traumatic Stress Disorder (PTSD) is a term covering a range of symptoms and behaviors which can be traced back to mental and emotional damage caused by traumatic experiences. These symptoms include, but are not limited to, an increase in aggression, an inability to connect with the world, flashbacks to the traumatic events, sudden and seemingly unprovoked violence, panic attacks, hallucinations, great stress, depression, shaking, ‘hysterical’ physical symptoms (i.e. apparent bodily problems induced by the mind rather than any more physical cause), substance abuse, mood swings, and suicide. The condition was first properly recognized during the First World War, when hundreds if not thousands of soldiers suffered irreparable emotional damage by what was then termed ‘shell shock’. However, it has almost certainly existed ever since human consciousness first developed – and has featured in the battle accounts of many ancient cultures. Ancient Egyptian hieroglyphs have been found which depict the stories of soldiers suffering from battle-induced mental trauma, while the Ancient Greek historian Heroditus eloquently records the tales of several fighters which most modern medical professionals would not hesitate to diagnose with PTSD. In one, a young man is afflicted with blindness for which there is no apparent physical cause after witnessing his fellow soldier shot down by an arrow next to him. In another, a soldier is withdrawn from the front lines due to incessant trembling. He leads a listless, haunted life – which he ultimately takes. Clearly, therefore, PTSD has been affecting humans for millennia, making it a fairly certain bet that many of those who participated in the American Civil War would have been affected in like manner.

Haunted By Their Experiences

PTSD can be brought on by any traumatic event – childhood abuse is a common cause – but its strongest causative correlation comes with wartime events. Given that civil wars are among the most mentally and emotionally distressing of combat situations, it should come as little surprise to find that a great many accounts record ex-soldiers who were thoroughly unable to reintegrate with peaceful life. Many found that they simply could not cope with civilian existence and opted out of society. The years following the Civil War saw an increase in vagrancy, with veterans making up the vast majority of these new wanderers. Some attributed this to a lack of economic opportunity for ex-soldiers, but others acknowledged that most of these people had been rendered mentally and emotionally incapable of taking any opportunities offered to them. In his book ‘To Appomattox and Beyond’, Larry Logue speaks of a veteran named ‘Len’. Len took up a nomadic lifestyle, drifting from place to place, and completely unable to speak of his experiences. When taken in by the police, he seemed unable to remember any personal details – but perusal of his effects and a little detective work revealed that this apparently deranged hobo had once been a prosperous man, happily settled into family life and with a contracted lawyer to boot. His experiences during the war had damaged him beyond repair. If he ever returned to his family, he swiftly absented himself from them, driven to the roads by the horrors within his own head. Many others did likewise.

Inadequate Treatment

Those who did return to their families often fared little better. It takes a strong and loving family indeed to cope with a PTSD sufferer. Logue tells of Polly McColley, who wrote letters about her son, whom she described as ‘Out of his mind’ when he returned from the war. Many recognized that their loved ones were ill, and called in the professionals – but with little effect. Post-Traumatic Stress Disorder would not be recognized as a condition for several decades, and treatments would take even longer to arrive. Nowadays, although there is still no definitive ‘cure’ for the condition, avenues do exist which can be of great help to sufferers. Treatment centers like The Refuge have a much greater understanding of the condition and how to treat those suffering from it. Not so after the Civil War. Those who seemed depressed were diagnosed with ‘melancholy’ or ‘nostalgia’, and their families were advised to raise their spirits. Others were simply passed as physically sound and told they needed to ‘pull their socks up’. The protests of wives and parents that their sons and husbands were ‘not themselves’ or ‘being strange’ were considered too nebulous to act upon, and frequently dismissed as feminine silliness or oversensitivity. Besides which, the violence which commonly accompanies PTSD was rarely spoken of in a domestic context – and not considered a great problem even when it was. Where behavior was clearly disturbed, disturbing, or dangerous, sufferers would be throw into lunatic asylums - where they received treatment which was often brutal and very rarely (if ever) effective. Those who evaded this often acquired lengthy criminal records, and many ended up in jail.

The 'Old Soldier' Problem

Old soldiers have always been something of an awkwardness for peacetime society – which frequently wishes to brush the horrors and atrocities of wartime beneath the carpet and forget about them. Veterans expecting a hero’s welcome when they return home after the cessation of hostilities are thus more often than not disappointed. A pervasive disillusionment has been observed to take hold of many veteran populations after major armed conflicts – and this phenomenon was attributed to the general surliness, disengagement, and ‘oddness’ of many post-Civil War veterans. However, the behavior of many would now be recognized as far too extreme to stem from simple discontentment with society. That they had experienced wartime horrors, and been mentally scarred by them, seems a near certainty. While the war brought out a great deal of heroism and produced legends which would last generations, it also continued to deal out human suffering long after the killing had ended. The mental torment of those soldiers who returned with PTSD should not be forgotten. The condition continues to affect combatants to this day – although, thankfully, diagnostic procedures now exist to spot and attempt to remedy it in vulnerable soldiers.

From: nycivilwar.us


Tuesday, April 25, 2017

Mental Health

By Barbara Floyd, University Archivist, University of Toledo

In early 19th century America, care for the mentally ill was almost non-existent: the afflicted were usually relegated to prisons, almshouses, or inadequate supervision by families. Treatment, if provided, paralleled other medical treatments of the time, including bloodletting and purgatives. However, in a wave of concern for the oppressed, some took action. Among these, Dorothea Dix was the leading crusader for the establishment of state-supported mental asylums. Through her efforts, the first state hospitals for the insane were built in New Jersey and Pennsylvania. She and other reformers sought humane, individualized care with the rich and the poor housed together to insure high standards for all. The movement was generated by social reform, but throughout the century, mental illness was probed and analyzed, and "cures" prescribed by both the scientific and lay communities.

"Moral treatment" was the predominating philosophy to cure the insane. This system was developed
in late 18th century Europe, and by Benjamin Rush in the United States. It challenged the demonic explanations for insanity and emphasized the role of environment in determining character: improper external conditions could induce derangement. The "moral treatment" system was optimistic that an appropriate environment could facilitate cure, especially for those with acute (not chronic) afflictions.

Essential to this theory was a physiological basis for mental disorder: insanity was caused by brain damage. The brain's surface was soft and malleable and physically altered by outward influence. This idea was closely related to phrenology which assigned specific faculties to sections of the brain.

The notion that mental illness resulted from physical impairment was rarely challenged, but the nature and treatment of ailments were continually debated. To find physical evidence for mental deficiencies, autopsies were performed on mental patients to discover lesions or other abnormalities. Although progress was made in the diagnosis of somatic diseases like tumors or syphilitic derangement, these efforts were frustrating and subjective. Also controversial was the fate of the chronically versus acutely ill: the differences between them, whether they should be housed together, and whether the chronically ill should be treated at all.

Superintendents of early mental institutions were well educated, although not necessarily in medicine, and active in the community. Thirteen heads of institutions, called "alienists," formed the Association of Medical Superintendents, and began the American Journal of Insanity. Asylums were built in rural areas to remove patients from their home environments and to provide fresh air in a bucolic setting. Patients were offered exercise, work, education, and religious instruction. Most alienists did not dispense drugs, but stressed healthy, clean living. They lived near patients, invited the public in for programs, and promoted the view that the insane were not monsters but rather "unfortunate fellow beings." Focusing on societal causes, alienists believed mental health problems could be avoided, especially in the young: children's brains were softer, vulnerable, and more prone to influence.

After the Civil War, faith in "moral treatment" declined because the curability rate had been overestimated, the cost of facilities was high, the government curtailed funds, and the public became disillusioned with "experts" and their failed promises. Repeated failures also frustrated practitioners who responded with an increased use of physical restraint. An influx of immigrants caused overcrowding and a loss of fee-paying private patients. As the medical field was slow to become interested in the care of the mentally ill, there was a lack of trained personnel. The original, more idealistic practitioners were gone, and new managers, many of whom were political appointees, were less inspired and qualified. These alienists became self-protective and isolated from the public. They also feared that "moral treatment" was responsible for the rise in spiritualist movements, considered fanatical and dangerous, and they further tightened the reins of custodial care.

Between 1850 and 1880, viewpoints reverted back to pre-asylum assessments, with the added element of heredity: mental illness resulted from a weak family and vice committed by ancestors. This led to a fatalistic view of cures, and a new wave of books detailing the dangers of bad habits such as alcoholism and masturbation. Influenced by Social Darwinism, practitioners believed mental illness could be eliminated through eugenics. Although there were scientific advances, particularly in neurology, the tendency was to classify ailments rather than investigate through observation. Drugs such as chloroform, bromides, and ether were increasingly used to subdue patients.

By the 1880s, asylum conditions had deteriorated significantly, and neurologists began to vie for control of institutions. They opposed superintendents and questioned the validity of the asylum itself, promoting the clinic instead. In 1880 they formed the National Association of the Insane and the Prevention of Insanity. A public interest in reform ensued with exaggerated stories of asylum abuse appearing in newspapers. By 1884 the neurologists and superintendents were forced into an uneasy truce resulting in medical standards for superintendents, greater control over asylums, oversight commissions, psychopathic hospitals for the acute, out-patient care, and research. Medical education began to include the study of insanity. The word "asylum" was replaced by "hospital" to reduce the stigma of mental illness.

Neurologists made some sound contributions to the field, but they also promoted dubious treatments such as static electricity and the "rest cure." Eventually, neurologists formed two camps: those who focused on somatic cases, and those who embraced psychological theories as medically respectable.

To remove the chronically ill from overcrowded asylums and in a general effort to promote non-restraint, alternative care facilities such as the tent treatment, the free air system, and the cottage system were attempted in the latter part of the century. The Toledo (Ohio) State Hospital was the first mental health institution in the country to be designed exclusively on the cottage system. In spite of such reform efforts, the dominance of Social Darwinism condemned the chronically ill as genetically inferior. It was not until the final years of the century that Sigmund Freud's theories about the unconscious crept into the professional arena.

Beard, George M. A Practical Treatise on Nervous Exhaustion (Neurasthenia). New York: E. B. Treat, 1889. MCO

Buckham, Thomas R. Insanity Considered in its Medico-Legal Relations. Philadelphia: J. B. Lippincott & Co., 1883. MCO

Deslandes, Leopold. A Treatise on the Diseases Produced by Onanism, Masturbation, Self-Pollution, and Other Excesses. Boston: Otis, Broaders, and Company, 1838.

Fowler, O. S. Hereditary Descent: Its Laws and Facts Applied to Human Improvement. New York: Fowler and Wells, 1853.

Gilman, Charlotte Perkins. "The Yellow Wallpaper." In New England Magazine, Vol. 5, September 1891-February 1892.

Hammond, William A. A Treatise on Diseases of the Nervous System. New York: D. Appleton and Company, 1873. MCO

Laurie, J. The Parent's Guide: Containing the Diseases of Infancy and Childhood and their Homeopathic Treatment. Philadelphia: Rademacher & Sheek, 1854.

Mott, Mrs. The Ladies' Medical Oracle; or Mrs. Mott's Advice to Young Females, Wives, and Mothers. Boston: Samuel N. Dickinson, 1834.

Packard, Elizabeth. Prisoner's Hidden Life: Or Insane Asylums Unveiled. Chicago: J. N. Clarke, 1871.

Ranney, Ambrose L. Lectures on Nervous Diseases: From the Standpoint of Cerebral and Spinal Localization, and the Later Methods Employed in the Diagnosis and Treatment of These Affections. Philadelphia: F. A. Davis, 1890. MCO

Shannon, Bishop Samuel. Nature's Secrets Revealed. Scientific Knowledge of the Laws of Sex Life and Heredity; or Eugenics. Marietta, Ohio: S. A. Mullikin Company, 1914.

Walker, Alexander. Intermarriage: Or the Mode in Which, and the Causes Why, Beauty, Health and Intellect, Result from Certain Unions, and Deformity, Disease and Insanity, from Others. New York: J. H. G. Langley, 1839.

Image 1:  Many authors warned of the dangers of masturbation in the 19th century, including Leopold Deslandes in A Treatise on the Diseases Produced by Onanism, Masturbation, Self-Pollution, and other Excesses, published in 1838.

Image 2:  Title page from Alexander Walker's Intermarriage: Or the Mode in Which, and the Causes Why, Beauty, Health, and Intellect Result from Certain Unions, and Deformity, Disease and Insanity from Others, published in 1839.

Image 3:   The Indianapolis Hospital for the Insane, ca. 1854.

From: utoledo.edu


Tuesday, April 18, 2017

Nostalgia and Malingering in the Military During the Civil War (excerpt)

By Donald Lee Anderson, Godfrey Tryggve Anderson

In lieu of an abstract, here is a brief excerpt of the content:

The American Civil War witnessed a revival of nostalgia, a mental disorder that had created problems for armies for centuries. It is not within the scope of this study to trace the origins of nostalgia in detail. If we were to attempt this we might begin in early biblical times and consider the words of the psalmist: "By the waters of Babylon, there we sat down, yea, we wept, when we remembered Zion".

As early as 1569, a Swiss officer reported that one of his cadets had succumbed to homesickness. References to this problem can also be found in the first half of the seventeenth century. In 1688 Johannes Hofer, a medical student in Germany, wrote a dissertation on the subject. He was the first to use the term "nostalgia" and to identify it as a disease. He described the symptoms as anorexia, insomnia , slow fever, irritability, anxiety, and a general wasting away of the organism. Hofer pointed out that separation from the homeland was the basis of this ailment and that an "afflicted imagination" was an important cause of this malady. In the course of his description of this "wasting disease" he used such expressions as "nervous fluid" and "the animal spirits".

During the seventeenth and eighteenth centuries, this malady attracted the attention of German physicians. Prominent also in the consideration of nostalgia were the Swiss, who seemed to have particular problems with this malady. It was believed, incorrectly, that those from the vicinity of Bern were especially susceptible to homesickness when they left their native habitat. However, at various times people of Scotland, Wales, Ireland, Lapland, and almost every country showed symptoms of this problem. Beginning at about the time of the French Revolution and extending into the nineteenth century, the French physicians became very concerned with problems of nostalgia in their military ranks. Nostalgia was of epidemic proportions in the French army of the Rhine in 1793.

The official records of noninfectious diseases in the federal army during the American Civil War reveal 5,213 cases of nostalgia and 58 deaths from this malady among white troops from May 1861 to June 30, 1866. The record for "colored troops" reveals 334 cases of nostalgia and 16 deaths. The number of cases of nostalgia is relatively small when compared with such diseases as rheumatism and typhoid, yet the cases which were labeled nostalgia posed a perplexing problem in some areas for the army during the entire duration of the war.

During the early years of the conflict the number of cases of nostalgia among Northern troops increased. In the year that ended June 30, 1863, 2,057 cases and 12 deaths were reported. The next year the number of cases decreased by 800, and the last year of the war the number of cases dropped markedly, although deaths continued to increase slowly but steadily. The year following the war brought a drastic drop to less than 200 cases. The decline after 1863 was due in part to the type of men being taken into the service and the more realistic view of the duration of the war at this time. It was generally felt that nostalgia was most prevalent among the young recruits, and partly for this reason the surgeon general favored increasing the age for induction from 18 to 20 years. Early in 1863, the assistant surgeon general, Dr. Dewitt C. Peters, described nostalgia as found in the military at this time: "... a species of melancholy, or mild type of insanity, caused by disappointment and a continuous longing for the home . . . and is daily met with in its worst form in our military hospitals and prisons, and is especially marked in young subjects".

From: Perspectives in Biology and Medicine
Volume 28, Number 1, Autumn 1984
pp. 156-166 | 10.1353/pbm.1984.0021

From: muse.jhu.edu

History of PTSD in Veterans: Civil War to DSM-5

By Matthew J. Friedman, MD, PhD, Senior Advisor and former Executive Director, National Center for PTSD

Exposure to traumatic experiences has always been a part of the human condition. Attacks by saber tooth tigers or twenty-first century terrorists have likely led to similar psychological responses in survivors of such violence. Literary accounts offer the first descriptions of what we now call posttraumatic stress disorder (PTSD). For example, authors including Homer (The Iliad), William Shakespeare (Henry IV), and Charles Dickens (A Tale of Two Cities) wrote about traumatic experiences and the symptoms that followed such events.

The PTSD diagnosis has filled an important gap in psychiatry in that its cause was the result of an event the individual suffered, rather than a personal weakness. PTSD became a diagnosis with influence from a number of social movements, such as Veteran, feminist, and Holocaust survivor advocacy groups. Research about Veterans returning from combat was a critical piece to the creation of the diagnosis. War takes a physical and emotional toll on Servicemembers, families, and their communities. So, the history of what is now known as PTSD often references combat history.

Early attempts at a medical diagnosis
Accounts of psychological symptoms following military trauma date back to ancient times. The American Civil War (1861-1865) and the Franco-Prussian War (1870-1871) mark the start of formal medical attempts to address the problems of military Veterans exposed to combat. European descriptions of the psychological impact of railroad accidents also added to early understanding of trauma-related conditions.

Nostalgia, Soldier's Heart, and Railway Spine
Prior to U.S. military efforts, Austrian physician Josef Leopold (1761) wrote about "nostalgia" among soldiers. Among those who were exposed to military trauma, some reported missing home, feeling sad, sleep problems, and anxiety. This description of PTSD-like symptoms was a model of psychological injury that existed into the Civil War.

A second model of this condition suggested a physical injury as the cause of symptoms. "Soldier's heart" or "irritable heart" was marked by a rapid pulse, anxiety, and trouble breathing. U.S. doctor Jacob Mendez Da Costa studied Civil War soldiers with these "cardiac" symptoms and described it as overstimulation of the heart's nervous system, or "Da Costa's Syndrome." Soldiers were often returned to battle after receiving drugs to control symptoms.

The thought that physical injury led to PTSD-like symptoms was supported by European reports of "railway spine." As rail travel became more common, so did railway accidents. Injured passengers who died had autopsies that suggested injury to the central nervous system. Of note, Charles Dickens was involved in a rail accident in 1865 and wrote about symptoms of sleeplessness and anxiety as a result of the trauma.

Shell Shock
In 1919, President Wilson proclaimed November 11th as the first observance of Armistice Day, the day World War I ended. At that time, some symptoms of present-day PTSD were known as "shell shock" because they were seen as a reaction to the explosion of artillery shells. Symptoms included panic and sleep problems, among others. Shell shock was first thought to be the result of hidden damage to the brain caused by the impact of the big guns. Thinking changed when more soldiers who had not been near explosions had similar symptoms. "War neuroses" was also a name given to the condition during this time.

During World War I, treatment was varied. Soldiers often received only a few days' rest before returning to the war zone. For those with severe or chronic symptoms, treatments focused on daily activity to increase functioning, in hopes of returning them to productive civilian lives. In European hospitals, "hydrotherapy" (water) or "electrotherapy" (shock) were used along with hypnosis.
Battle Fatigue or Combat Stress Reaction (CSR)

In World War II, the shell shock diagnosis was replaced by Combat Stress Reaction (CSR), also known as "battle fatigue." With long surges common in World War II, soldiers became battle weary and exhausted. Some American military leaders, such as Lieutenant Gen. George S. Patton, did not believe "battle fatigue" was real. A good account of CSR can be found in Stephen Crane's Red Badge of Courage, which describes the acute reaction of a new Union Army recruit when faced with the first barrage of Confederate artillery.

Up to half of World War II military discharges were said to be the result of combat exhaustion. CSR was treated using "PIE" (Proximity, Immediacy, Expectancy) principles. PIE required treating casualties without delay and making sure sufferers expected complete recovery so that they could return to combat after rest. The benefits of military unit relationships and support became a focus of both preventing stress and promoting recovery.

Development of the PTSD diagnosis
In 1952, the American Psychiatric Association (APA) produced the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which included "gross stress reaction." This diagnosis was proposed for people who were relatively normal, but had symptoms from traumatic events such as disaster or combat. A problem was that this diagnosis assumed that reactions to trauma would resolve relatively quickly. If symptoms were still present after six months, another diagnosis had to be made.

Despite growing evidence that trauma exposure was associated with psychiatric problems, this diagnosis was eliminated in the second edition of DSM (1968). DSM-II included "adjustment reaction to adult life" which was clearly insufficient to capture a PTSD-like condition. This diagnosis was limited to three examples of trauma: unwanted pregnancy with suicidal thoughts, fear linked to military combat, and Ganser syndrome (marked by incorrect answers to questions) in prisoners who face a death sentence.

In 1980, APA added PTSD to DSM-III, which stemmed from research involving returning Vietnam War Veterans, Holocaust survivors, sexual trauma victims, and others. Links between the trauma of war and post-military civilian life were established.

The DSM-III criteria for PTSD were revised in DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), and DSM-5 (2013) to reflect continuing research. One important finding, which was not clear at first, is that PTSD is relatively common. Recent data shows about 4 of every 100 American men (or 4%) and 10 out every 100 American women (or 10%) will be diagnosed with PTSD in their lifetime.

An important change in DSM-5, is that PTSD is no longer an Anxiety Disorder. PTSD is sometimes associated with other mood states (for example, depression) and with angry or reckless behavior rather than anxiety. So, PTSD is now in a new category, Trauma- and Stressor-Related Disorders. PTSD includes four different types of symptoms: reliving the traumatic event (also called re-experiencing or intrusion); avoiding situations that are reminders of the event; negative changes in beliefs and feelings; and feeling keyed up (also called hyperarousal or over-reactive to situations). Most people experience some of these symptoms after a traumatic event, so PTSD is not diagnosed unless all four types of symptoms last for at least a month and cause significant distress or problems with day-to-day functioning.

Today VA operates more than 200 specialized programs for the treatment of PTSD. In Fiscal Year (FY) 2013, more than a half million Veterans diagnosed with PTSD received treatment at VA medical centers and clinics.

VA is committed to provide the most effective, evidence-based care for PTSD. It has created programs to ensure VA clinicians receive training in state-of-the-art treatments for PTSD. At of the end of FY 2013, VA had trained more than 5000 of its clinicians to use Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE), which are cited by the Institute of Medicine Committee on Treatment of PTSD as proven to be effective treatments for PTSD.

VA's National Center for PTSD was created in 1989 by an act of Congress, and celebrated its 25th anniversary on August 29, 2014. We continue to be at the forefront of progress in the scientific understanding and treatment of PTSD. In addition to improving upon existing treatments, we are researching effective new treatments. We are also developing new educational products such as our What is PTSD? whiteboard video. For more information on the National Center for PTSD, please visit our About Us section of the website.

Sources
Portions of this fact sheet originally appeared in a Veterans Day observance post on VA's blog, VAntage Point (November 7, 2013). For more information about the history of the PTSD diagnosis, see PTSD History and Overview in the "Professional Section" of our website.

From: ptsd.va.gov

Thursday, April 6, 2017

PTSD and the Civil War

By Sarah Handley-Cousins, 8-13-14

Daniel Folsom, a tinsmith from northern New York, enlisted in the Union Army just days after the fall of Fort Sumter. His exemplary service through years of long marches and hard battles led to two promotions, but during the Battle of Fredericksburg in late 1862, something changed. Folsom seemed uneasy. He was still troubled months later when the regiment mustered out. He returned home, opened his own tin shop and tried to focus on work.

As time passed, Folsom’s motivation to work waned. He neglected the tin shop and wandered, aimless, around the village. In July 1863, when the first men in his neighborhood were called by the draft, Folsom snapped. Terrified that he would be sent back to the Army, he became sleepless and manic, and then fell into a severe depression. When he attempted suicide, his family had him committed to the State Lunatic Asylum in Utica. In the asylum, the young veteran grappled with his paranoia and guilt. At times, he begged the attendants to kill him.

Eventually, Folsom slowly began to improve. “I am not injoying myself much at presen,” he wrote to his sister in the spring of 1864. Still, he assured her, he had recovered, and implored her to persuade their father to retrieve him from the asylum. Folsom was especially concerned about finding work. It seemed to him that the longer he was institutionalized, the less likely it would be for him to succeed in business. “I should like to get out of this city [and] go into business iff I stay here any longer the world will be a blank,” he wrote. “I really think there is a chance for me yet.”

Folsom was not alone: Tens of thousands of veterans damaged by the war had to learn how to live and work with their wounded bodies. In much the same way, Folsom had to adapt to life with a wounded mind. His illness – what today we would likely call post-traumatic stress disorder – had damaged his reputation, but he might be able to prove himself through clean living and dedication.

Folsom’s difficulty was compounded by a stigma that held that mental illness was a personal failing and should be kept secret. That stigma has proved difficult to kill. Even today, the case files of the men and women treated in New York State’s asylums during the 19th century are restricted in the name of patient privacy. Thus, the names of the soldiers in this article have been replaced with pseudonyms, and other identifying markers have been removed.

The psychological implications of the Civil War have been long debated by historians. Statistically speaking, insanity was not a major cause of discharge for the Union Army. “The Medical and Surgical History of the War of the Rebellion,” an official report by the War Department, lists only 853 discharges by reason of insanity during the war years, accounting for less than 1 percent of total discharges. Terms used to describe mental illness during the 19th century, however, such as neuralgia, nostalgia, headache and sunstroke, were counted separately, which suggests the possibility of a higher number. Of course, officers wanted to maintain as strong a fighting force as possible, so soldiers could be discharged for insanity only if their commanding officers, in addition to medical staff members, agreed that their symptoms were obvious and disruptive. Only the most disturbed soldiers, therefore, received discharges. Moreover, after the autumn of 1863, soldiers could be discharged for insanity only after the physicians at the Government Hospital for the Insane in Washington examined them and declared them too insane for duty.

There are no statistics that can tell us how many soldiers experienced moments of panic and helplessness, or how many feared they might be losing control. There is also nothing to teach us about the experiences of most of the soldiers after they were discharged. Asylum records, like those of Daniel Folsom, allow us a glimpse into the lives of such veterans and to see the ways the traumas of war affected their ability to navigate the day-to-day obligations of their lives.

Folsom, as it turns out, was fortunate – as he indicated to his sister, he did still have a chance. As a postscript to his letter, he made a promise: “I shall try and be a man.” His way of keeping his word was by re-enlisting in the Union Army upon his release, hoping to reaffirm his manhood through battle. He received a commission as a first lieutenant in a New York regiment. When the war ended, Folsom enjoyed success as a tinsmith. He even married and fathered six daughters.

For other soldiers, the distress of war had more sinister consequences. Many soldiers had difficulty letting go of the rage that had been vital in battle. When they returned home, this anger was sometimes channeled into domestic violence. Clinton Moore came home bitter and restless after he was discharged. He drank heavily, beat his wife and terrorized his neighbors. When the local constable came to arrest him, Moore hurled a stove down the stairs and wounded the officer in the head. The disgruntled constable, upon finally delivering Moore to Utica, described the former soldier as “3 parts ugly and 1 part crazy.”

Moore soon escaped. He returned home and spent the next several months menacing his family and neighbors before returning to Utica. After his return, Moore seemed ready for a change. He wrote to Dr. John P. Gray, the superintendent of the asylum, promising he would find honest work if he could only be released, even insisting that he would “let Licker alone entirely.” Unwilling to wait for the superintendent’s assent, Moore escaped again in late summer, and from that point disappears from historical record. Whether he was able to change or find work is unknown.

Some soldiers were entirely undone by the war. Andrew Hamilton returned home a changed man in June 1864. He had survived the horrors of Chancellorsville and Lookout Mountain and bouts with camp diseases. He had survived prison and hundreds of miles of marching, but when he got home, though his body seemed strong, his mind was altered. He raved about the war. He had insomnia and refused to eat. Hoping for a cure, his family committed Hamilton to the asylum at Utica.

Attendants confined the frantic young man to a “Utica crib,” a bedlike wooden cage used to restrain and ostensibly calm patients. But Hamilton could not be soothed. He beat against the bars until his arms and legs were bruised. He shouted orders to phantom soldiers and drove teams of invisible horses. By mid-July, at only 23 years old, Hamilton was dead.

During the dark days of war, soldiers fantasized about their return home, imagining it would be the moment their troubles would end. Daniel Folsom certainly did. “I thought I had got through the hardest of my life when I got through solgerin’,” he wrote his sister. But for Folsom, and the many other soldiers who bore the psychic scars of war, their troubles had only just begun.

Sources: Jeffrey Allen Smith and B. Christopher Frueh, “Minds at War,” New York Times Disunion, March 20, 2013; Eric Dean, “Shook Over Hell: Post-Traumatic Stress, Vietnam and the Civil War”; Joseph K. Barnes, “The Medical and Surgical History of the War of the Rebellion”; New York State Archives, “Utica State Hospital Patient Case Files, 1843-1898;” Ancestry.com and genealogical records of the Church of Jesus Christ of Latter-day Saints; 1880 United States Federal Census.

Image: Civil War veterans in 1884, with William T. Sherman in the front row centerCredit Library of Congress

Sarah Handley-Cousins is a graduate student in history at the University at Buffalo.

Correction: August 13, 2014
This article originally misstated the name of the school where the author is a graduate student. It is the University at Buffalo, not the University of Buffalo.

From: opinionator.blogs.nytimes.com

Tuesday, March 28, 2017

Home, Sweet Home

By Susan J. Matt, 4-19-12

In October 1861 Alfred Lewis Castleman, a surgeon in the Fifth Regiment of the Wisconsin Volunteers, described the first death in his regiment. It was not from battle. “The poor fellow died of Nostalgia (home-sickness), raving to the last breath about wife and children,” he wrote. “Deaths from this cause are very frequent in the army.”

While today “nostalgia” is used to describe the longing for a lost time, the word originally signified acute homesickness, a condition widely regarded as a dangerous and often deadly illness. Doctors maintained that it could kill, either by worsening existing maladies or by causing its own physical symptoms, which included heart palpitations, lesions, damage to internal organs, “hectic fever,” bowel problems and incontinence.

A Civil War veteran described nostalgia’s effects in 1866, noting how it “fastens upon the breast of its prey, and sucks, vampyre-like, the breath of his nostrils. Many a heroic spirit after braving death at the cannon’s mouth … has at length succumbed unresistingly to this vampyre, Nostalgia.” During the Civil War, with close to three million men away from home and therefore potential victim to its ravages, Americans both on the battlefield and on the home front worried about nostalgia.

Homesickness was widespread in both the Confederate and Union armies, as thousands of surviving journals and letters testify. Many men came from rural areas and were away from farm and family for the first time. Added to this sense of displacement was the fear that they might be killed in battle and never see their loved ones again.

An 1861 letter from Richard Simpson, a soldier in the Third South Carolina Volunteers, to his aunt was typical. “We are now in the land of danger, far, far from home,” he wrote. Simpson had been away from home before, but, he confided: “I never wished to be back as bad in my life. How memory recalls every little spot, and how vividly every little scene flashes before my mind. Oh! If there is one place dear to me it is home sweet home. How many joys cluster there. To join once more the family circle (I mean you all) and talk of times gone by would be more to me than all else besides.”

While Simpson’s homesickness was intense, it was not debilitating. For thousands of other men, the emotion sapped their strength and left them ill. When it became this serious, doctors deemed it nostalgia. Union records offer a good picture of its consequences: over the course of the war’s first year, the Surgeon General reported, there were 572 cases of nostalgia among troops. Those numbers rose in subsequent years, peaking in the year ending in June 1863, after the draft had begun. That year more than 2,000 men were listed as suffering from nostalgia; 12 succumbed to it. The year with the most fatalities was 1865, when 24 men died of the disease. In all, between 1861 and 1866, 5,537 Union soldiers suffered homesickness acutely enough to come to a doctor’s attention, and 74 died of it.

Given the deadly risks believed to accompany the condition, soldiers of all ranks monitored their own mental health as well as that of their comrades. Union Gen. Joseph Shields wrote in 1862 that soldiers, “if not allowed to go home and see their families … droop and die. … I have watched this.” In August 1864, Gen. Benjamin Butler worried that this might happen to him, writing his wife, “You make me so homesick. I shall have nostalgia like a Swiss soldier.” Men lower in the ranks harbored the same fears. Cyrus Boyd of the 15th Iowa Infantry wrote in 1863, somewhat hyperbolically, “More men die of homesickness than all other diseases — and when a man gives up and lies down he is a goner. Keep the mind occupied with something new and keep going all the time except when asleep.”

In light of such fears, soldiers and physicians looked for possible causes of and cures for nostalgia. What sparked the emotion? And how could it be assuaged? Some pointed to the letters that soldiers received from home. If they didn’t receive enough letters, they might grow lonely and sad and begin a descent into nostalgia. On the other hand, if they received too many letters, they also might dwell overmuch on the family scenes they were missing.

Doctors also theorized that music might carry a soldier’s mind back to his family. As a result, some units took steps to prohibit particularly moving melodies. S. Millett Thompson, of the 13th New Hampshire Volunteer Infantry, reported that “the bands are forbidden to play pathetic or plaintive tunes, such as Home, Sweet Home… Auld Lang Syne, etc., lest they serve to dispirit, and unnerve our suffering men.” Such a rule was not frivolous, as Numa Barned, a Union soldier forced to listen to new “homesick recruits” playing “Home, Sweet Home,” confided. “I don’t like to hear it for it makes me feel queer,” he wrote.

If music could spark homesickness, so could holidays. Thanksgiving and Christmas were always difficult days for men far from home. The Sabbath likewise was a day for remembering other routines and identities that war had forced soldiers to abandon.

Doctors also contended that within the Army, homesickness was more visible among some populations than others, although they reached no consensus about which populations those actually were. Some pointed to young recruits, venturing far from home for the first time. Others claimed that middle-aged men, long accustomed to the comforts of domestic life, missed them most acutely. Some believed farm boys were more likely to be homesick than city dwellers, while others maintained that New Englanders were particularly tender-hearted and therefore vulnerable.

Doctors sometimes went beyond these demographic profiles and attributed homesickness to character flaws. J. Theodore Calhoun, the assistant surgeon of the Union Army, believed nostalgics needed to be rendered “more manly,” while Dr. John Taylor of the Third Missouri Cavalry contended that they were indolent hypochondriacs who were probably prone to other vices as well. Taylor told nostalgic soldiers that their “disease was a moral turpitude,” and “was looked upon with contempt – that gonorrhea and syphilis were not more detestable.”

The association of nostalgia with venereal disease was not accidental. Some doctors, like Roberts Bartholow, believed that a strong libido and the tendency to masturbate predisposed soldiers to homesickness, pointing the finger at “those given to solitary vice or the victims of spematorrhea.” Supposedly, soldiers who lived in a dream world and who fantasized about home or sex, or both, became disconnected from their actual surroundings, and wished for different circumstances. Other vices associated with nostalgia were drinking, gambling and tobacco use.

If the precise causes of nostalgia were open to debate, so too were its cures. Some suggested that vigorous physical exercise might cure men of their yearnings for the family hearth; others put faith in the idea that once they faced battle, men would feel more committed to the cause and less tied to home.

Many, however, worried about the risks of nostalgia and took extreme measures to treat it. Physicians sometimes suggested hospitalization, but if cases turned critical, they often sent men home to cure them. A medical manual suggested that in nostalgia’s early stages, “a furlough … will often suffice to restore the moral vigor of the young soldier. But when it has long resisted treatment, and gone so far as to produce sensible external lesions … or structural changes in large organs, a discharge must unquestionably, be granted.”

To modern Americans who are accustomed to leaving home and who harbor few fears of dying of nostalgia, such diagnoses and cures seem strange, even laughable. But they reveal much about 19th-century values. The widely shared conviction that homesickness could kill reflected the deep moral and emotional significance that these Americans attached to home. Even more, their concerns about homesickness and nostalgia remind us that while today we celebrate restless mobility and see it as a central part of our national identity, earlier generations did not, and instead found mobility to be profoundly painful and unnatural.

Sources: Alfred Lewis Castleman, “The Army of the Potomac”; “The Prisoner of War in Texas,” Beadle’s Monthly, Jan. 1866; Guy R. Everson and Edward H. Simpson Jr., eds., “‘Far, Far From Home’: The Wartime Letters of Dick and Tally Simpson”; United States Surgeon General’s Office, “The Medical and Surgical History of the War of the Rebellion (1861-65)”; Donald Lee Anderson and George Tryggve Anderson, “Nostalgia and Malingering in the Military During the Civil War,” in “Perspectives in Biology and Medicine”; Bell Irvin Wiley, “The Life of Billy Yank”; Private and Official Correspondence of Gen. Benjamin F. Butler, During the Period of the Civil War in Five Volumes, Vol. 5; Mildred Throne, ed., “The Civil War Diary of Cyrus F. Boyd Fifteenth Iowa Infantry, 1861-1863”; “Nostalgia, as a Disease of Field Service,” Medical and Surgical Reporter, 1864; S. Millett Thompson, “Thirteenth Regiment of New Hampshire Volunteer Infantry in the War of the Rebellion, 1861-1865”; Frances Clarke, “So Lonesome I Could Die: Nostalgia and Debates Over Emotional Control in the Civil War North,” Journal of Social History; Reid Mitchell, “The Vacant Chair”; Roberts Bartholow, “A Manual of Instructions for Enlisting and Discharging Soldiers”; John Ordronaux, “Manual of Instructions for Military Surgeons on the Examination of Recruits and Discharge of Soldiers.”

Susan J. Matt, the presidential distinguished professor of history at Weber State University, is the author of “Homesickness: An American History.”

Image: Thomas Nast’s depiction of a homesick soldier on Christmas Eve. Library of Congress

From: opinionator.blogs.nytimes.com

Minds at War

By Jeffrey Allen Smith and B. Christopher Frueh, 3-20-13

Any attempt to calculate the carnage of the Civil War, the number of sick, wounded, dismembered and dead, leaves one numb in the struggle to make sense of it all. The conditions and horrors faced by those who fought the war exacted a horrific toll.

One would assume that the physical price paid by the men who fought in the war would have a rough equivalent in the mental price, that the experience of that terrible war would have left countless survivors with horrible psychological scars. But that may not actually be the case: according to official Union war records, adverse psychological reactions to combat across a variety of categories never matched, or even approached, the shocking physical losses from the war.

Serving as the official medical record of the Union Army, “The Medical and Surgical History of the War of Rebellion, 1861-65” was a groundbreaking effort to systematically record the medical impact of one of the first “modern” wars while it was happening. Undertaken by the Army Medical Department, and using exclusively military and governmental records, the six-volume publication contained thousands of pages of medical case studies, pictures, graphs and statistics. With more than 100 separate tables charting some 150 “diseases,” ranging from serpent bite to gunshot wounds and dysentery to suicide, the study provided one of the first medical tallies of the impact of warfare on its combatants.

Looking over the exhaustive array of medical data found in “The Medical and Surgical History,” a subtle trend lies beneath the jaw-dropping numbers of physical wounds and maladies suffered by those who fought the war. Across a variety of potential psychological categories, the number of cases and deaths for both white and black troops was often well below 1 percent, surprisingly low even after adjusting for the possibility of underreporting.

In a paper we published in a peer-reviewed psychiatric/psychological journal, the highest annual rate of cases reported for any year of the Civil War for Union troops was .017 percent for insanity, .032 percent for “nostalgia” (or depression), .005 percent for concussion of the brain, .045 percent for delirium tremens, .034 percent for inebriation and .06 percent for chronic alcoholism. The data also revealed there were a total of 278 documented suicides over the four years of the war, fewer than the 349 military personnel who died by suicide in 2012 alone.

The excessive use of alcohol has historically been a common coping mechanism for troops under the stressors of combat. Yet the annual rate of reported inebriation and chronic alcoholism remained below 1 percent throughout the duration of the war, save for two interesting spikes. First, Union troops in the “Pacific Region” had in excess of a tenfold increase in rates of inebriation relative to their Atlantic and Central counterparts – probably more a function of boredom than combat stress. Second, all regions and racial groups reported a discernible spike in reported inebriation in the year following Appomattox, a perhaps understandable surge given the ending of the war.

Likewise, chronic alcoholism and delirium tremens mirrored these patterns, but with significantly fewer reported cases. While these numbers reflect what was socially considered drunkenness by 1860s standards, they also highlight that most troops were not outside that intangible norm, and when low levels of delirium tremens are taken into account, it further underscores how relatively few men had to “sober up” for duty.

Union Surgeon General Joseph K. Barnes acknowledged in the “The Medical and Surgical History” that “obviously troops stationed in the neighborhood of large cities furnished the greater number” of alcoholism cases, and he credited “the government and discipline of the camps” for keeping rates from getting out of hand. Of course, the adverse effects of combat have the power to do more than simply drive a person to drink.

For some Union troops, military service became a mental burden too great to bear. The psychological stressors of combat began to physically manifest themselves in reported cases of nostalgia and insanity. Psychologically naïve by modern standards, Civil War combatants and medical personnel struggled to identify and understand psychiatric disorders and behavior health problems that resulted from combat. For example, the term nostalgia, described as “a temporary feeling of depression… on account of discomfort, hardships and exposures” in the “The Medical and Surgical History,” was treated as “a camp disease of war” that proved “dangerous to their efficiency.” Some current examinations of the “disease” ascribe to it symptoms comparable to post-traumatic stress disorder.

Nevertheless, regardless of terminology, official cases in the Union Army of nostalgia and insanity were quite rare and they peaked during the first two years of the Civil War, and then dropped markedly over the duration of the conflict in many regions, with some exhibiting declines by half or more. The trend of early, elevated levels of diagnosed cases of nostalgia and insanity that diminished as the war went on was also evident in segregated colored units, even with official military incorporation not until 1863.

To be sure, accusations of malingering and an evolving understanding of these psychological reactions to combat probably resulted in a degree of underreporting. As with nostalgia and insanity, Civil War health professionals’ understanding of suicide was limited by the paucity of research on the topic.

With the French sociologist Émile Durkheim’s groundbreaking book “Suicide” still 30 years in the future, most Civil War doctors and nurses had few tools with which to interpret Union Army suicides. During the war annual suicide rates for white Union troops fluctuated between 8.74 and 14.54 per 100,000, while surging to 30.4 for 1865-1866. Serving in segregated units, African-American troops’ suicide rate ranged from 17.7 per 100,000 in 1863, to 0 in 1864 and 1.8 for 1865-1866. These figures appear consistent with some of Durkheim’s conclusions about suicide, including that whites had higher rates of suicide than blacks during the 19th century.

Looking deeper into these numbers in his 2011 paper “Felo De Se,” R. Gregory Lande noted seasonal variations in Union suicides, with rates spiking reliably every spring. However, as with any of these psychological variants tracked in the “The Medical and Surgical History,” a certain amount of caution must be taken, as the data is 150 years old, and the study’s strict reliance on government medical records undoubtedly led to some undercounting.

These statistical limitations were not lost on the compilers of the “The Medical and Surgical History,” for as was noted in its introduction, the publication “cannot be regarded as complete,” but while “most imperfect,” the data “embrace so large a proportion of the troops concerned that they cannot fail to serve fairly as a reliable basis for deductions with regard to the health of the whole army.”

The men who fought in the Civil War participated in a brutal modern war, as soldiers’ letters, photographs and newspaper articles bear testament. Yet often obscured by the ghastly casualty figures and recounts of battles won and lost were the personal struggles that the troops fought on a daily basis – an internal conflict constantly waged against the self-evident, understandable mental and physiological pressures of military service and combat.

Nevertheless, what should be made of the relatively low-recorded instances of psychological casualties in the Civil War? Was it a result of flawed data collection or analysis? Did Victorian or religious social pressures result in under reporting or unwillingness to recognize these invisible wounds?

While considering diagnoses of modern psychiatric conditions extrapolated from records kept 150 years ago during the Civil War is problematic at several levels, perhaps the larger take away message is a heartening one of human resiliency. The data seem to demonstrate that exposure to combat alone does not weaken the human psychological condition. Instead, as with most things in life, there are a multiplicity of factors that result in psychosocial casualties. One of the real tragedies of the conflict was not the sheer number of men who fought to win the Civil War, but the few who lost the war within. On the other hand, these data remind us there is good reason to be optimistic that the psychological consequences of war are not inevitably devastating to all those who serve.

Jeffrey Allen Smith is an assistant professor of history at the University of Hawaii, Hilo.

B. Christopher Frueh, a clinical psychologist and a professor of psychology at the University of Hawaii, Hilo, is a McNair scholar and directs the research programs at the Menninger Clinic in Houston.

From: opinionator.blogs.nytimes.com

Wednesday, February 22, 2017

A Case of Temporary Insanity

By Karen, 2-25-13

Daniel Sickles, although perhaps best known as a political Civil War general whose disobedience at Gettysburg got his troops killed, is also known for a scandal before the war in which he killed his wife’s lover.

Sickles was a former lawyer of the Tammany Hall political machine who had become a Democratic representative for New York in the House of Representatives. Sickles was a womanizer and had many affairs, most famously with courtesan Fanny White, whom he took with him on his travels to England. At age 33 he courted scandal by marrying Teresa Bagioli—who was 15 and pregnant.

In 1859, when his wife was 23, Sickles discovered that she had been having an affair with 40-year-old Philip Barton Key, a family friend who was also a US district attorney and the son of composer Francis Scott Key. Sickles had apparently been ignorant of the affair until he received an anonymous letter informing him of his wife’s actions. Sickles confronted his wife and she confessed.

The next day, February 27, he saw Key walking by the house, and Sickles ran out shouting, “Key, you scoundrel, you have dishonored my home—you must die!” Sickles cornered Key, assaulting him and shooting him multiple times. Finally, Sickles shot Key point blank in the chest, killing him.

As there had been multiple witnesses, there was no doubt of Sickles’s guilt, but when his case came to trial, his lawyer (Edwin Stanton, later Lincoln’s secretary of war) blamed temporary insanity—the first time that defense had been used in trial. The trial received much attention, and the public—as well as the jury—sided with Sickles, believing that his actions and insanity were totally justified given the situation, and he was acquitted.

Interestingly, public opinion stayed on Sickles side until a few months later, when he reconciled with his wife. Having completely vilified Teresa, the public couldn’t forgive Sickles for returning to her, and they turned against him. It seemed like his political career would never recover, but then the war started and Sickles became a Union general—giving him a chance to start over.

Image 1: Daniel Sickles shooting Philip Barton Key, 1859

Image 2: Teresa Sickles

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