The Pampered Louse

From: acws.co.uk

No one should attempt a collection of Confederate humour without including an account of the old-time "grayback" louse, or Pediculus Vestimenti. These tiny unforgiving creatures were so well known by all Civil War Soldiers, as to have become "legends in their own time." One infantry man summed up their ever-presence by declaring simply, that each louse should have had stamped on his or her back; "IFW", "In for the war."

There are hundreds of excellent primary sources that make mention of these devilish insects. One favourite which chronicles the "comings and goings" of this "depraved little pest," was recorded by Captain William ‘Buck’ Walton, Company B, 21st Texas cavalry. Here is his excerpted version:

Head Louse
I found that many of the men had been familiar with these varmints a long time - and become accustomed to their presence. So much so, that it was part of their amusement to catch big ones and bet on their fighting qualities. It is true that the grown bug, when taken from the bodies of different men - and placed together, will rush at one another like bulldogs, and fight to the death - or until one, being whipped and wounded, will scramble out of reach if his adversary. This I saw tested one day when a number of my men were gathered together, watching very intently such a fight. They had two "big fellows" on the top of a hat, smoothed out. There was considerable excitement, and the men had their Confederate money - and were flourishing it, as I have seen men do at a horserace. I walk up to see what was the matter and saw the whole fight. The bugs were just coming together - and they certainly were mad. The gladiators unarmed save with their natural weapons were joined in conflict. It was a battle royal. They stood up on their hind feet. They closed in grapple and would roll over and over. They seemed never to weary. The battle lasted five or six minutes. The blood was very perceptible on each one. Their legs were broken and there were wounds on their bodies - to such an extent that they were maimed - and neither could run from each other. The two warriors could do nothing, but lay on the field of battle and lingering die.

Actually some of the men would not molest a very fine specimen - but let him grow and fatten on his own blood until the thought he had the most robust "gladiator" in camp and then would draw him forth privately and try his powers on a smaller specimen, that he would borrow or steal from another man. When he had tested him and made him bold by whipping smaller fellows--his owner would challenge the field - having the champion--& offer to bet on him, like he owned a press that threw off Confederate money as wanted. Sometimes they made a run with their pampered louse, and became very flush. And then some man would find a still more pampered one and win all his money. Many are the ways that idle soldiers find to amuse themselves - but I really think this was one of the most unique ways that I saw in the army. I called on two boys for two of their champion "gladiators" - for a special purpose. They cheerfully gave them, and I took them & in a letter to my Captain’s wife Mrs. Wm. Rust at Burnet, Texas, enclosed them to her - to see what we could do in the army. They were received - and proved of the right gender - & before she was aware of it, she was in possession of a flourishing colony, which caused much washing and disinfecting before she could get rid of them.

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The Four Year Itch

By James M. Schmidt

“There were two things that stuck closer than a brother; that was the itch and body lice or greyback as they were politely called…I had a bad case of the itch… it became very bad; so much that my hands were swollen and my fingers stood apart. Sores and yellow blisters came between them and they ran corruption. I could scarcely touch anything, my hands were so sore.”-Pvt. Milton Asbury Ryan, Co. B, 14th Mississippi, CSA

In his recent article, “The ‘Army Itch’: A Dermatological Mystery of the American Civil War” (Journal of the American Academy of Dermatology, August 2006, Vol. 55, No. 2, pp. 302-8), Thomas G. Cropley, M.D., provides an excellent review of this chronic, painful, and epidemic skin condition that plagued Private Ryan and thousands of other soldiers, North and South. The article includes a chronology of the disease, extensive excerpts from the writings of period physicians who saw and treated the disease, and a description of the treatments used.

[Note that since the time this article first appeared in The Civil War News in October 2006, Dr. Cropley has authored another interesting article: "Dermatology and skin disease in the American Civil War," Dermatol Nurs, 2008 Feb;20(1):29-33.]

Dr. Cropley received his M.D. from the University of Virginia and completed his residency at Harvard University. (At this writing) he is currently Professor of Medicine at the University of Massachusetts Medical School and director of the school’s Dermatology Residency Program. In addition to his own clinical and teaching work, Dr. Cropley is also deputy editor of the Journal of the American Academy of Dermatology. Earlier this year at their annual meeting, the History of Dermatology Society awarded him its Samuel J. Zakon Award (First Prize) for his research and paper on army itch.

Dr. Cropley (who is named “Thomas” after Thomas J. “Stonewall” Jackson) has been interested in the Civil War for a long time and his interest in Civil War medicine is an outgrowth of his interest in medical history in general. “I grew up in West Virginia, very close to the battlefields of the 1861 Kanawha Valley campaign,” he told me. “My grandfather, an unreconstructed ‘Reb,’ used to take me out hunting for artifacts like Minie balls and the like.”Dr. Cropley also speaks a number of foreign languages (including Gaelic!) and plays the bagpipe competitively.

Army itch, referred to as “camp itch” in the Confederate army, was a disorder that baffled military physicians of the day. The “mystery” is that medical opinion at the time was divided over the true nature of the disease: some thought it to be epidemic scabies, others thought it a unique malady, and still others considered it to be a mix of the many skin conditions that plagued the armies due to poor hygiene. There was no dispute over the seriousness of the itch: at best it was a nuisance, but Cropley notes that it often reduced the effectiveness and morale of afflicted troops to a dangerous degree.

In the main, Dr. Cropley’s paper includes accounts on army itch drawn from the writings of nearly twenty army surgeons and civilian physicians. The excerpts are drawn from period publications such as Medical and Surgical Reporter and the Confederate States Medical and Surgical Journal. Reading the accounts gives witness to several important characteristics of the disease: first, the itch was debilitating – in addition to painful lacerations, the incessant itching was exhausting in itself; second, many of the physicians noted that the disease spread to the local population after an army passed through; third, most soldiers waited too late to approach their medical team about the disease.

“We see this nowadays, too,” Dr. Cropley told me. “Scabies is insidious. The itching is tolerable at first, and patients generally do not seek medical attention. Later, the itch becomes maddening, and it is at that point that patient seeks care.”He suspects that many soldiers with itch did not report for surgeon's call, as they were unlikely to be relieved from duty or treated in many cases.

In the article, Dr. Cropley notes some of the treatments for the itch, including sulphur-based alkaline ointments or washes, to which were added cooling or astringent compounds. Arsenicals and mercury were also used, and while effective were almost certainly toxic. Short on sulphur due to its use in the manufacture of gunpowder, the Confederates established an interesting clinical experiment at Richmond’s Chimborazo Hospital to evaluate alternative treatments. Topical application of strong decoctions of native plants such as poke root, broom straw, and slippery elm were found to be helpful.

Dr. Cropley also told me that the military’s itchy encounters did not end with the Civil War. “Epidemic scabies always follows the population disruptions of wartime,” he said. “The United States Army has had an ongoing scabies eradication program in Kosovo and Bosnia for the last 10 years or so. I have heard from colleagues that Afghanistan and Iraq have significant scabies as well.”Dr. Cropley added that these modern outbreaks are mostly in the local population and not in military personnel, but they still require the attention of Army dermatologists attending to civilians.

Dr. Cropley told me there are many other interesting dermatological mysteries to be found in studying the Civil War. To him, one of the more interesting stories regards General Henry W. Halleck's itchy elbows. “Halleck apparently had the disconcerting habit of rubbing his elbows, especially when under stress,” he told me. “Secretary of the Navy Gideon Welles in particular found this annoying and even commented on it in his diary.”

So why did Halleck rub his elbows? “Itchy elbows can be due to a number of causes, and the scratching behavior can be a habit rather than a response to an actual itch,” Dr. Cropley told me. He added: “Halleck's medical record is pretty short, but the thing that caught my eye was his statement in a fall 1864 letter that he was having his annual trouble with itchy, watery eyes.”

Dr. Cropley believes that Halleck might have been suffering from seasonal allergic keratoconjunctivitis (“hay fever”). “Hay fever is an atopic disease and is frequently accompanied by atopic dermatitis,” he told me. “Atopic diseases often worsen under stress, so I think, but I can't prove, that Halleck had atopic dermatitis as the cause of his itchy elbows.”

Learning more about Halleck’s mysterious condition sounds like a historical itch that Dr. Cropley is destined to scratch, and I’m predicting another award-winning paper about a Civil War-related dermatological story in his future.

[Many thanks are due to Mr. Michael Gay, Ann Arbor, Michigan, for kindly granting permission to use the opening quote, which appears in his great grandfather’s unpublished memoir, “Experience of a Confederate Soldier in Camp and Prison in the Civil War, 1861-1865.”]

FROM: The Civil War News – “Medical Department” – October 2006

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Dermatology and Skin Disease in the American Civil War

Excerpted from highbeam.com

The American Civil War (1861-1865) took place at an interesting moment in the history of medicine and nursing. Only 5 years before, in the mid-1850s, the well-publicized medical disaster affecting British and French troops in the Crimean War had catalyzed a number of fundamental changes in military and civilian medical practice. Most visible were two innovations championed by the British reformer Florence Nightingale: (a) the introduction of professional, female nurses in the military hospitals and (b) an emphasis on sanitation in hospitals and in military camps. Nightingale's efforts culminated in the formation of the Royal Sanitary Commission, a civilian organization with broad authority over military hospitals. The Royal Sanitary Commission would later serve as the model for the United States Sanitary Commission during the American Civil War.

Much later, from the 1870s on, American medicine and nursing progressed rapidly, as advances in microbiology, aseptic surgery, histopathology, epidemiology, medical education, and professional nursing training--all directly influenced by American wartime medical experiences--propelled the United States into the unaccustomed position of medical world leader.

But in between the Crimean War and the medical boom of the latter third of the 19th century came the Civil War, and it is especially interesting to look back to the 1861-1865 period to find the early traces of our shared history of progress in medicine and in nursing in America. It is not an exaggeration to say that history still resonates in our modem practices. (Some examples: the helmet-like gauze compression dressing still used to bandage large scalp incisions is known as a Nightingale dressing, the American Red Cross is the direct descendent of the U.S. Sanitary Commission, and scabies and lice are treated with pyrethroids first used in the Civil War.)

There was a great deal of skin disease in America during the Civil War, the result of poor hygiene and sanitation, lack of knowledge of microbiology, displacement of civilian populations, and movement of the armies themselves, all of which allowed the spread of infectious diseases and infestations in particular. Table 1 lists the most common skin diseases reported in Federal (Union) soldiers during the war. Table 2 provides a smaller-scale look at skin diseases in a pair of Confederate hospitals in Atlanta. As can be seen in both tables, infections and infestations composed the majority of skin diseases.

It should be mentioned that these patients were not diagnosed and treated by dermatologists. Rather, their doctors were the army surgeons who, despite having little specialized knowledge of skin diseases, generally did the best they could for their patients. There were in fact only about one dozen dermatologists in America at the time of the Civil War, all in the north. There were no dermatologists in the states of the Confederacy, nor were there any military dermatologists in either army. Most of the treatment for skin diseases, such as it was, was administered by the nurses who labored in the army hospitals.

Visit www.CivilWarRx.com to learn more about Civil War medicine.

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Camp Itch

By Glenna R. Schroeder-Lein

"Camp Itch" was a painful skin disease, involving itching, lesions, and inflammation, suffered by soldiers both North and South during the Civil War. Doctors debated the cause of the itch. Certainly some cases were really scabies, a very contagious skin disease caused by mites and quickly spread by shared blankets as well as in crowded conditions. Some doctors, however, stated that camp itch was not scabies as no "animaliculae" were present. Whether scabies or not, the itch resulted from the poor hygiene of troops who bathed infrequently, suffered numerous scratches and bites, and were generally very dirty. Then, when afflicted, the men scratched, making the problem worse. The itch became so severe in some cases that 31,947 Union troops and quite a number of Confederates had to be hospitalized for treatment of the infections that followed.

The standard remedies were evidently sulphur and arsenic taken internally, plus external alkaline baths. Some doctors also prescribed a wash of sulphur and lime. Because many ingredients were difficult to get in the South, Confederate doctors sought to develop treatments using indigenous plants, some of which were tested on patients at Chimborazo Hospital in Richmond, Virginia. Several doctors reported their treatments in the Confederate States Medical and Surgical Journal.

Surgeon John H. Claiborne, in charge of the hospitals in Petersburg, Virginia, reported success in mild cases of camp itch by having the patient change clothes frequently and bathe in a decoction (prepared by boiling) of poke root once or twice daily, followed by washing with soap and water. This regimen generally produced a cure in a week to ten days. Patients with more serious cases found the poke baths too irritating. For them, Claiborne recommended washing with a decoction of broom-straw root or slippery elm, three or four times per day, until the soldier was able to take the poke root baths. Claiborne also recommended a diet of vegetables and grains, as well as a light laxative for the patient. If mercury and arsenic were available, he would give the usual doses in addition to his other treatments.

FROM: The Encyclopedia of Civil War Medicine

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