Madness, Genius, & Sherman’s Ruthless March

By David Dobbs, 02.13.12

In 1864, in a radically risky move crucial to winning the Civil War, William Tecumseh Sherman led his army of some 80,000 men to Atlanta, burned it to the ground, and then marched to the coast of South Carolina, destroying almost all in his path. It was a wild, improbable gambit: He meant to and did destroy the South’s infrastructure, crops, railways, and will. But to do so he had to work for weeks without supply lines for his own army and in near total isolation — no supplies, little communication — from both civilian and military leadership to the north.

Was there a method to Sherman’s March? And what did it have to do with him being crazy? Nassir Ghaemi’s "A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness", which I’m now reading with mixed feelings and total fascination, raises these questions in a single, succinct, startling chapter, and answers Yes and Yes.

I have a few beefs with this book, which I’ll note and then set aside. Ghaemi seems a wonderful psychiatrist, and he writes vividly. But, following Ernest Kretschmer, he pathologizes not just dysfunction but abnormality; he defines mental health as “the absence of mental disease, plus being near the statistical average of personality traits.” Thus if you’re too far from the average, you’re not healthy. Both the mad and the abnormal, he says, can excel “in crisis,” but presumably not in ‘normal’ life. This ignores countless examples of odd eccentrics who thrive absent crisis — from Einstein, Woolf, Beethoven to Curie, Proust, and Manny Ramirez. Ghaemi’s schema of normal versus abnormal people operating in either stable or crisis environments seems to me unnecessarily black and white; the value of any trait depends on environment, and Ghaemi seems to assume a stable environment is the norm, which is hardly the case.

Yet I forgive Ghaemi all this and more in exchange for his sensitive insights into how patients actually experience and talk about their troubles, and for the way he mines some of the literature surrounding the lives of the people he examines in this book. He is especially sensitive to the creeping, often vague nature of melancholy and madness as it actually shows itself. His thumbnail sketch of depression’s distinctive reality, for instance, brings to mind that of William Styron’s incomparable Darkness Visible. His close-focus definition holds far more nuance than do his high-altitude distinctions:

[D]epression adds to sadness the constellation of physical symptoms that produce a general slowing and deadening of bodily functions. A depressive person sleeps less, and the nighttime becomes a dreaded chore that one can never achieve properly. One never gets out of bed; better sleep, if one can, since one can’t do anything else. Interest in life and activities declines. Thinking itself is difficult; concentration is shot; it’s hard enough to focus on three consecutive thoughts, much less read an entire book. Energy is low; constant fatigue, inexplicable and unyielding, wears one down. Food loses its taste. Or to feel better, one might eat more, perhaps to stave off boredom. The body moves slowly, falling to the declining rhythm of one’s thoughts. Or one paces anxiously, unable to relax. One feels that everything is one’s own fault; guilty, remorseful thoughts recur over and over. For some depressives, suicide can seem like the only way out of this morass; about 10% take their own lives.

“Depression is a terrifying experience,” one of his patients tells him, “knowing that  somebody is going to kill you, and that person is you.”  This gets at something that only true depressives know: once you’ve thought of killing yourself, the thought, even when it goes away for long periods, is never the stranger it should be.

How do we reconcile this morass with the idea that madness can generate a sort of genius, much less more modest increases in performance or happiness? I have written before that I think depression itself is not terribly adaptive but is rather just one result, distinctly a downside result, of a broader sensitivity that can be an asset. Such sensitivity can open the door to depression, but it can also generate traits ranging from empathy to the appreciation of pleasures that generate happiness, from the hard-won exuberant agony of Mozart or Led Zeppelin to the unpracticed glittering beauty of one’s children.

To this Ghaemi offers to add some direct upsides of depression and mania — and convinces me against my prejudices.

First, he argues that the long dark struggles with the black dog, as Samuel Johnson called depression, can generate the resilience, determination, and ruthless focus needed to counter external challenges. Thus Winston Churchill, for instance, found the strength to rally a nation against the threat of Nazi Germany. Churchill struggled long and mortally with depression. At times he prayed daily for death. He learned to stand vigilant against the the opportunities that life offers for escape. From Ghaemi:

He had thoughts of killing himself. “I don’t like standing at the edge of the platform when an express train is passing through,” he told his doctor. “I like to stand right back and if possible get a pillar between me and the train. I don’t like to stand by the side of the ship and looked down into the water. A second’s action would end everything.”

After the war, when he’d lost re-election and had to leave 10 Downing Street, he complained about the balcony of his new flat.

“I don’t like sleeping near a precipice like that,” he said. “I’ve no desire to quit the world, but thoughts, desperate thoughts, come into the head.”

Ghaemi argues that enduring such times can spawn a paradoxical resilience: Depression, though it can drive to his knees a person amid seemingly happy circumstance, as it did Churchill at an early career peak around 1930, can generate such a talent for enduring murky darkness that the sufferer can enthusiastically attack even so enormous a problem as Nazi Germany —  grateful to face a challenge both external and relatively coherent. To Churchill, in short, Hitler and his armies were nothing compared to the black dog. To win you had only refuse to succumb. This is partly what Churchill meant when he said, “If you find yourself going through hell — keep going.”

Thus vulnerability can generate resilience. Ghaemi also argues that depression can help increase one’s sense of empathy. I resisted this at first. It has long seemed to me that empathy too is part of the sensitivity to experience that can open the door to depression, rather than depression’s by-product. Ghaemi makes me reconsider. He does so mainly through his description of how Sherman conceived, framed, and explained his decision not just to sack the city of Atlanta, but to tell the South and Atlanta that that was exactly his plan.

This too seems paradoxical. How can a decision to sack a city and destroy an entire region’s infrastructure be a sign of empathy? Sherman’s decision can seem sociopathic –  the work of a mind that understands others’ suffering only so he can exploit it. Yet it’s hard to square such a view of Sherman with the extraordinary letter that Ghaemi excerpts in his book. This letter Sherman wrote, publicly, to the mayor of Atlanta when the mayor had objected to Sherman’s announced intention to destroy the city.

Gentlemen:

… You might as well appeal against the thunder-storm as against these terrible hardships of war. They are inevitable, and the only way the people of Atlanta can hope once more to live in peace and quiet at home, is to stop the war; which can only be done by admitting that it began in error and is perpetuated in pride.

We don’t want your negroes, or your horses, or your houses, or your lands, or anything you have, but we do want and will have a just obedience to the laws of the United States. That we will have, and, if it involves the destruction of your improvements, we cannot help it.…

I myself have seen in Missouri, Kentucky, Tennessee, Mississippi, hundreds and thousands of women and children fleeing from your armies and desperadoes, hungry and with bleeding feet. In Memphis, Vicksburg, and Mississippi, we find thousands upon thousands of the families of rebel soldiers left on our hands, and who we could not see starve. Now that war comes home to you, you feel very different. You deprecate its horrors, but did not feel them when you sent carloads of soldiers and ammunitions, and moulded shells and shot, to carry war into Kentucky and Tennessee, to desolate the homes of hundreds and thousands of good people who only asked to live in peace at their old homes and under the Government of their inheritance.…

But, my dear Sirs, when peace does come, you may call on me for any thing. Then will I share with you the last cracker, and work with you to shield your homes and families against danger from every quarter.

Now you must go, and take with you the old and feeble, feed and nourish them, and build for them, amid quiet places, proper habitations to shield them against the weather until the mad passions of men cool down, and allow them in peace once more to settle their old homes at Atlanta.

Yours in haste,

W. T. Sherman, Maj.-Gen., commanding

By any measure, an extraordinary letter. “Yours in haste” is quite a touch; a hint of ruthlessness. Yet you cannot read the whole letter and maintain that Sherman did not understand suffering: those bleeding feet, the last cracker, the starving families of rebel soldiers fed, do not appear to the sociopathic mind.

Ghaemi believes that Sherman’s empathy arises partly from his struggles with bipolar disorder, or manic depression. Sherman wrote this letter in the spring of 1864, and throughout his march to and through Georgia and South Carolina, then north to squeeze Lee’s army  between his and Grant’s, forcing Lee’s surrender, he reportedly worked at a pitch of energy and confidence, sleeping little, talking much, his legs in motion even when he sat and talked, “his stockinged feet,” as one account had it, “dart[ing] in and out of their slippers.” This is the sort of sustained but controlled mania, of bounteous energy and unshakeable confidence, uniquely conducive to completing a great work. And as a work of war, his march qualifies.

Three years earlier, though, when his first military campaign had gone badly, Sherman had become so depressed and unhinged that he was relieved of duty. Only appeals to Lincoln — a man once chewed raw by the black dog  — won his return. In such dark stretches, Ghaemi argues,  Sherman forged the strength to conceive and sustain the sort of boldly committed campaign needed to crush the South. He was allowed to by a president and another general, Grant, who understood the depths from which he had risen.

If you felt like being pithy, you could say one sort of insanity started the Civil War, and another sort of madness won it. Pith, of course, lies beneath endlessly complicated layers that both obscures and gives it form. Even the most elemental trait’s value and expression depends on context and environment. And context and environment, at least for the  sentient, memory-laden creatures we are privileged to be, contains always the remembered past and imagined future.

It’s hard amid such complexity to draw clear lines and distinctions. Ghaemi may draw some of these lines boldly. But even as he does so, he paints the complexity whole.

Image: Sherman's troops destroying the Atlanta rail depot -- part of his methodical, seemingly mad destruction of the South's infrastructure

From: wired.com

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Sherman’s Demons

By Michael Fellman, November 9, 2011
Opinionator/The New York Times

By the end of the Civil War, William T. Sherman was one of the most important and celebrated Union commanders, and the most reviled in the Confederacy. During the last year of the conflict, his army conquered Atlanta, reversing a flagging Union war effort and securing Abraham Lincoln’s re-election. After that his men scorched much of Georgia in his famous March to the Sea, then cut a huge swath up through the Carolinas. Not only did his army destroy men and material, but Sherman articulated a ruthless policy of destruction that deeply demoralized Southern morale. He gained perpetual infamy in the South as the grim reaper of the Union war effort, a task he undertook quite consciously, with both anger and joy.

Yet, as few Americans know, during the first year of the war, on Nov. 9, 1861, General Sherman, paralyzed by depression, was relieved of his command in Kentucky at his own request. Five weeks later, the wire services proclaimed to the nation: GENERAL WILLIAM T. SHERMAN INSANE. Just after his participation in the Civil War had begun, Sherman’s service was nearly destroyed.

As all students of the war know, he came back and soared to prominence, but his mental collapse and his recovery, unusually well documented, present a riveting example of the understanding of depressive illness in the Victorian world, and the relationship of bipolar illness to creativity and inspired leadership during difficult times, which Sherman certainly demonstrated later in the war.

As was true of Ulysses S. Grant, Sherman’s prewar life had careened from failure to failure. But where Grant self-medicated his frustrations with drink and retreated into stoic silence, Sherman experienced erratic emotional ups and downs that he shared with his friends and family in a manner that only intensified his self-laceration.

Grant and Sherman were both members of the broad cohort of West Point-trained officers who would populate the upper echelons of the war’s opposing armies. But while others, including Grant, had fought heroic wars in Mexico, Sherman stewed in California, where most of his troops deserted his unit for the lures of the gold fields. Later, out of the Army, although backed by the powerful political forces of his family and wealthy supporters in St. Louis, his bank failed in San Francisco in the Panic of 1857. Subsequently, he bounced forlornly around Kansas and Ohio, achieving little worldly success.

When the war began, Sherman resigned his recently assumed presidency of the Louisiana military academy (which would become Louisiana State University), ran a streetcar line in St. Louis, very badly, and finally took command of a brigade at Bull Run that collapsed in the face of the Confederate advance. Nevertheless, in mid-August, 1861, he was assigned to be second in command of the Army of the Cumberland, in Kentucky, a slaveholding, divided state, and the key to what would become of the Western theater — and perhaps of the Union itself.

Throughout the first six months of the war, Sherman’s psyche was dominated by self-doubt and fear. In fact, when he was assigned to Kentucky, he informed Abraham Lincoln of his “extreme desire to serve in a subordinate capacity, and in no event to be left in a superior command.” This reticence astounded Lincoln, who was far more used to braggart officers demanding important commands; but it was not modesty that led Sherman to his demonstration of uncertainty. Then, on Oct. 5, his superior, Robert Anderson (the commander at Fort Sumter when the war began) resigned because of health issues, almost certainly including major depression. Three days later, Sherman replaced him. Sherman lasted a tormented month before he was removed.

The day he took over, following a reconnaissance into the Kentucky hinterland, Sherman wrote anxiously to civilian supporters, and to Lincoln as well, that the whole countryside seethed with disunion, that the enemy was conspiring to create a “vast force” that would soon overwhelm Louisville. His own units were green, “too weak, far too weak” to resist the expected onslaught. he anticipated being “overwhelmed” — a defeat that would be “disastrous to the nation. Do not conclude…that I exaggerate the facts. They are as stated, and the future looks as dark as possible. It would be better if a more sanguine mind were here, for I am forced to order according to my expectations.” This was hardly the self-confidence one needs in leaders. And one can only imagine the degree to which Sherman dismayed others serving under him.

Thoroughly alarmed, Lincoln dispatched his secretary of war, Simon Cameron, to make a personal inspection. On Oct. 17, Sherman repeated these apprehensions to Cameron, and insisted that only a force of 200,000 men could hold Kentucky. Cameron replied that he was astonished by this analysis and that he had no idea where such an army might come from. And despite telling Sherman that he was among friends during this interview, Cameron had included Samuel Wilkerson of the New York Tribune in his party, who would later write the story declaring Sherman insane.

The other Union generals in Kentucky whom Cameron and Lincoln consulted assured them that the Confederate side was even more disorganized than they were, and that they did not share Sherman’s negative certainties, which amounted, they were certain, to delusions.

Over the following weeks, Sherman’s fears only intensified, while others observed a tortured man suffering what has long been defined in psychiatric terms as intense mania. For example, two sympathetic New York journalists who shared long nights at the Louisville telegraph office with the general grew deeply alarmed by his behavior. Sherman talked incessantly while never listening, all the while repeatedly making “quick, sharp…odd gestures,” pacing the floor, chain-smoking cigars, “twitching his red whiskers — his coat buttons — playing a tattoo on the table” with his fingers. All in all he was “a bundle of nerves all strung to their highest tension.” Back at his hotel, other guests observed him pacing all night in the corridors, smoking and brooding, “and it was soon whispered about that he was suffering from mental depression.” Such increased energy, talkativeness and hyperactivity (which can sometimes become impulsive and even psychotic), is the definition of mania, the twin — and opposite — of depression in the illness of bipolar disorder.

In letters to his wife, Ellen Ewing Sherman, Sherman himself confirmed and amplified what others observed. Everyone around him seemed poised to betray him, he wrote her. “I am up all night.” He had lost his appetite. Viewing his situation from the perspective of this mental turmoil, he was convinced that he was caught in an impossible military contradiction where “to advance would be madness and to stand still folly.” And he entirely lacked the means to lead others and to control himself: “I find myself riding a whirlwind unable to guide the storm.” In the near future he anticipated total “failure and humiliation,” an onrushing infamy that “nearly makes me crazy — indeed I may be so now.”

Then, on Nov. 8, a captain on Sherman’s staff telegraphed to ask her to come down to relieve him from the pressures of business. In a series of letters to the extended Ewing/Sherman clan over the next week, Ellen described what she found in Louisville: understanding that depression had what we would now call a genetic predisposition, she recalled that one of Sherman’s uncles was a chronic “melancholic.” And she also remembered quite vividly “having seen Cump [his boyhood nickname] in the seize of it in California,” when the bank had failed, a mental event that was repeated at least twice prior to the war. To inheritance and personal history, Ellen Sherman added descriptions of his behavior: he seldom ate or slept, had lost human contact with others, and scarcely talked unless repeating his obsessions that “the whole country is gone irrevocably & ruin & desolation are at hand.”

Sherman was relieved of his command on Nov. 8 and reassigned to a lesser post in St. Louis. When the downward spiral continued, Ellen Sherman came to collect him on Dec. 1, for three weeks’ leave back home in Lancaster, Ohio. There she began to nurse him back to health with a rest cure, the frequently effective 19th-century therapy: favorite foods, reading him his most cherished books, especially Shakespeare, and calming him sufficiently so that he could sleep. The real cure, as in all bipolar illness, is nature: the average mood episode rarely lasts longer than six months before it goes into remission by itself.

Despite the public’s awareness of his insanity, Sherman seemed somewhat strengthened by the time he returned to St. Louis on Dec. 19. His bipolar illness seems to have bottomed out, and he undertook a lengthy period of self-repair. Henry Halleck, Sherman’s commander, who understood and sympathized with Sherman’s inner turmoil, and also valued his intelligence and training, soon placed him in charge of the training camp in St. Louis under his direct supervision. Seven weeks later, trusting Sherman’s recovery sufficiently, Halleck assigned him to Cairo, Ill., to serve as the logistical coordinator for Grant’s army, the beginning of a long and intense friendship between two emotionally wounded warriors. Grant soon brought Sherman down to the front at Pittsburg Landing, Tenn., and put him in charge of a division.

There, on April 6, a vast surprise attack on Grant’s army led to the horrific Battle of Shiloh, in which the casualties totaled 20,000 men. In the thick of things, Sherman led his men with considerable personal bravery and tactical skill. Following this battle, his spirits soared. He experienced an almost instant internal transformation: from the despairing, self-proclaimed loser in Kentucky to the confident and brilliantly creative commander who would do so much, in word as well as deed, to destroy the Confederacy.

Sources: Michael Fellman, “Citizen Sherman”; Brooks D. Simpson and Jean V. Berlin, eds., “Sherman’s Civil War: Selected Correspondence of William T. Sherman, 1860-1865”; Nassir Ghaemi, “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.”

Michael Fellman
Michael Fellman is professor emeritus of history at Simon Fraser University, Vancouver, Canada. He is the author of several volumes on the American Civil War, as well as the forthcoming “Views from the Dark Side of American History.” He would like to acknowledge the careful reading given this essay by Dr. Nassir Ghaemi, professor of psychiatry and director of the Mood Disorders Program at Tufts University.

From: opinionator.blog.nytimes.com

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"Her Daily Concern:" Women's Health Issues in Early 19th-Century Indiana

Author: Timothy Crumrin

Illness-- which might strike, suddenly, openly, like a summer storm, or slowly, furtively, like a night thief-- was an incontrovertible fact of early midwestern life. This, of course, greatly effected pioneer women, who were, after all, prey not only to illnesses which touched everyone, but also to those peculiar to their gender. Indeed, it can be said, that in the matter of health, women often had the worst of both worlds. That pioneer women were much concerned about this is strikingly evident from their letters and diaries. Nearly all made mention of their health or that of loved ones. Often, letters, like those of Mary Hovey, an 1830s immigrant to Indiana, were catalogues of symptoms, illness, and complaints.

However, by modern standards, there was precious little the women of this period could do about their concerns; they were all but powerless in their struggle against disease. Living in the time before the formulation of the germ theory of disease, women and men were unaware of the important connection between the lack of proper sanitation and illness. Early midwesterners lived side by side with their own waste and that of their neighbors. They drank polluted water and ate poorly prepared, tainted food. Their diets were poor and given over heavily to starchy foods. In addition they were grossly outnumbered by the disease bearing insects which swarmed around them, bringing with them malarial fevers and other illnesses. When the above is added to a general lack of cleanliness and various environmental hazards, it is not difficult to understand why pioneers kept such a weather eye out for symptoms.

The treatment of disease could be equally crude. Early midwesterners sometimes resorted to charms, potions, and home remedies to take up the battle against ill health. A bag of live insects hung around the victims neck was thought to cure whooping cough, while "punkin seed tea" was prescribed for convulsions.

The "medical profession" often offered cures that were only slightly more effective. Physicians were often inadequately trained, with little formal education. Some had learned on the job as apprentices to established doctors and rarely climbed inside a medical text. As a consequence their treatments were often only a step or two above folk remedies. The not so-gentle-ministrations of the period have been summed up as "bleed, blister, and purge." Physicians regularly practiced bloodletting, purging with emetics, and other invasive techniques. The sometimes destructive use of such orthodox, or "heroic" medicine, promoted the growth of quackery, with its various potions, and alternative health care providers like Thomsonians, who relied on herbal remedies. All in all, the antebellum period was not a propitious time for good health.

Disease
Disease lived in the picturesque midwestern landscapes. Fevers of various types were possibly the most prevalent kinds of illness. Bilious, or continued fevers, were the most common in newly settled areas. Close behind were malarial- type intermittent fevers like ague (usually pronounced "ager" in the midwest). Incidence of both diseases usually declined with the clearing of land and draining of swampy lands, which lowered the number of disease-bearing insects. Such fevers were normally seasonal, like Ague which usually appeared between June and October and could be quite deadly. In 1821, one-eighth of the population of Indianapolis died of both intermittent and unremitting fevers. Other seasonal illnesses such as whooping cough, pleurisy, and consumption also collected a grave toll from both sexes.

But disease could strike at any time. Most dreaded were the epidemics of cholera and small pox. Such diseases were like menacing, foreign invaders approaching from a distance; the warning only added to the fears. Alarms were sounded; any preparations which could be effected were made. Areas buzzed with foreboding and rumor as the assailant moved ever nearer. Cholera outbreaks flashed through the midwest in the 1830s, killing 22 in Madison, Indiana in November, 1832 and returning for an even more virulent visit to the Aurora/Salem area of the state in 1838, when cholera morbos took away 100 of 800 residents. Typhoid and smallpox epidemics wrought their havoc also (even though a smallpox vaccine was available in Indiana by 1817) and cancer, heart disease, and other illnesses took large tolls. Women, then, had all these things to consider, plus others.

"Female Trouble"
Pioneer women were subjected to diseases and ailments that were not only exclusive to them, but also exacerbated by their "place" in life. As one historian put it:

"Women were cast in a limited role in the 1800s. Child rearing was a primary responsibility, and women spent much of their married lives either pregnant or caring for children. Safe and effective contraceptives were not popularized until late in the century. Her role as mother contributed substantially to her poor health, and her modesty prevented her from receiving proper medical attention."

The quintessential role for women in the early nineteenth century was that of mother; a woman was to bear and raise children. How often and how well. she did that was often the only determining factor in how she was measured and defined. The number of children she bore was largely determined by the age at which she married and her remaining fertile years. Exact numbers on family size are impossible to ascertain due to many circumstances, but some general figures tell a compelling story. First generation pioneer women in 1820s Illinois had children approximately every 26-30 months. Over sixty percent had six to nine children, thirty percent had ten or more, and only ten percent gave birth to less than six children in their lifetime. According to 1840 census figures, women in Hamilton County, Indiana had an average of eight children during their lifetime.

Such high birth rates (which probably do not reflect miscarriages or stillbirths) undoubtedly had an adverse effect on a woman's health. In fact, a women's life expectancy during her childbearing years of twenty to forty-five was lower than that of men the comparable age, and only rose to that of men with a woman's passage beyond childbearing.

Childbirth, or parturition, was an event especially fraught with peril in antebellum America. Any abnormality might end in disaster. A fetus in the breech or other abnormal position could lead to the death of both mother and child. At times, "difficult or protracted labor" resulted in what today seem barbaric or ghoulish methods of treatment as physicians sometimes had to perform embryotomies to save the mother. An embryotomy was the act of separation of any part of the fetus while in utero. This might involve decapitation or extraction of a limb to permit extraction of the fetus. The physical and emotional toll of such procedures were enormous for the mother (and doctor), but few other options were open to the physician. Caesareans were "rarely performed during the first half of the nineteenth century" so one avenue to alleviate suffering and ensure a safe birth was generally closed. In cases when the rare procedure was performed, fatalities often ensued due to infections.

There was an advancement open to pioneer women which helped alleviate some of childbirth's inherent dangers. The 1740 introduction of the curved forceps and its increasing adoption by doctors lessened the need for embryotomies and greatly facilitated birthing. Forceps also brought more men through the expectant mother' doorway. The birthing area, once an almost exclusively female province of midwives, or "grannies," became host to increasing numbers of males.

Womens-health_forceps
Special training was required to use curved forceps properly, and it was normally only available to men. This training increased the number of physicians with advanced education in obstetrics and led to the rise of male midwives, sometimes also known as accoucheurs, whose specialty was use of the forceps. The advancement was a boon to the expectant mother. Curved forceps (despite the risks involved if ill-used) certainly reduced suffering and offered "safer and shorter" parturition (the process of giving birth). According to some experts, it also placed accouchement and parturition "almost exclusively in the hands" of males-- at least in the east. It is also held by some that untrained midwives had all but been replaced by doctors or male accoucheur in northern urban areas. The same was not so true in the midwest, where midwives were still much employed and medical techniques were sometimes slow in catching on.

Doctors and male midwives played an increasing role in Indiana and the midwest during this period, but female midwives were still heavily employed, most frequently in rural or newly settled areas. The reasons were many. Doctors and other specialists were still sparsely represented in many parts of the midwest; many felt more comfortable with the old ways and did not trust "medicine." And many women felt highly uncomfortable with a male's intrusion into such a "private" matter. Thus the midwife was called to many bed sides. A Jay County, Indiana, woman claimed to have delivered over 900 babies from 1840 to 1897. In central Illinois "'grannies'" (midwives) helped more than 'regulars' (doctors) in the most recurrent medical emergency in the country side, the delivery bed." Thomsonian medicine adherents believed parturition should be handled by female midwives who would maintain the mother on herbal potions and keep her "in a state of perspiration" through delivery.

The primary drawback to the use of female midwives was their lack of formal training, which might leave them unable to help a patient enduring a complicated birth. Among their advantages were experience, proximity and availability, and gender. Many women during the period felt much more comfortable with their own sex attending them. For these women, the doctor was called in only when difficulties arose; sometimes he arrived too late.

Birth Control
Birth control was not an openly discussed or viable option for most women of the early nineteenth century. Some women, however, were well aware of the dangers to their health by pregnancy and childbirth and the health difficulties in constantly having to care for a large brood of children. Others simply wished to limit the number of their children for personal reasons. The options open to these groups were limited. Birth control on a systematic basis hardly existed during the period. Contraceptive information was difficult to obtain and most of it, by modern standards, was specious. Additionally, societal norms and pressures encouraged the sacred state of motherhood and dissuaded any attempts at family planning. Still, some women did indeed seek ways of reducing their risks of pregnancy-- usually only with sporadic success.

Womens-health
Some turned to their doctors, but members of the medical fraternity were not always helpful. Many physicians were uncomfortable with dealing with such matters, while others were merely repositories of misinformation. Doctors often could not even help with the most readily available birth control "method." abstinence. A few "so misunderstood" a woman's bodily cycles that they erroneously advised women to abstain from sexual activity during the safe period of the last half of the menstrual cycle and encouraged it "immediately after ovulation," which put the woman at great risk of pregnancy. Abstinence and other "natural" means, such as coitus interruptus and that "long traditional" preindustrial contraceptive method, prolongation of nursing, were the most oft-used methods during the time, but were seldom considered a topic suitable for a proper lady's diary, letter, or conversation.

However, other means were employed. Feminine networking allowed for the dissemination of contraceptive information. On the midwestern frontier, women passed on such unlikely-- and ineffective-- folk remedies as drinking a concoction featuring gunpowder or eating dried chicken gizzards. Although some "mechanical" devices, such as condoms or sponges were known, they were not readily accessible to the pioneer woman and were likely used only by a minuscule number of Americans-- especially prior to the 1830s. Some loosening of the control of contraceptive information occurred in the 1830s. More extensive information became available with the publication of Robert Dale Owens Moral Physiology (1831) and Knowlton's The Fruits of Philosophy (1832), which contained frank discussions of contraception and reached a wide audience despite, or because, of the scandal and legal proceedings attached to their publication.

Abortion
When contraception failed, as it was often wont to do, there was abortion. Abortion in the early nineteenth century simply did not elicit the controversy or comment as today (though it was rarely discussed as openly). Though not openly encouraged, it was not necessarily condemned out of hand if carried out early in the pregnancy. Many believed it permissible if done before "quickening," or movement by the fetus, which usually occurred in the second trimester. The first anti-abortion law was enacted in Connecticut in 1821, but it was basically an anti-poisoning law that stipulated it a crime if the woman was "quick with child." In essence, the law was aimed at doctors or potion-sellers whose medicines might cause an unwanted abortion. Quickening was the decisive issue every time abortion was raised in court prior to 1840. if the abortion took place before quickening it was not adjudged a crime. Indiana made abortions illegal in 1835, and did make the distinction regarding quickening. The Hoosier law was a rarity. Most "laws enacted between 1820 and 1840 retained the quickening doctrine and attempted to protect women from unwanted abortion, rather than prosecute them."

Abortion, however, was not considered a significant "means of family limitation" during the first third of the century. It was mainly viewed as a way of avoiding the scandal attached to an illicit affair or birth out of wedlock. However, by the late 1830s a change in the type of person seeking abortions and, and the reasons behind it, became evident. The rising abortion rate of the period probably reflected a desire on the part of married women to limit family size. It is estimated that the abortion rate jumped from one abortion in every 25-35 live births during 1800-1830 to one in every 5-6 live births by 1850. These figures may be a bit high (evidence is still sketchy), but are indicative of a trend.

Womens-health
As the above indicates, abortion, like birth control information, became more available between 1830 and 1850. That period saw a mail order and retail abortifacient drug trade flourish. A woman could send away for certain pills or discreetly purchase them at a store. Surgical methods were "available, but dangerous." This openness and commercial availability was mainly a feature of northern urban areas. Like much other technological and cultural change, it was later in its arrival in the midwest, and the average midwestern woman likely had a more difficult time in obtaining an abortion than her eastern, urban counterpart if she desired one.

It was not, however, impossible. Such information and abortifacients were within reach of a woman if she grasped hard enough. Herbal abortifacients were the most widely utilized in rural, nineteenth century America. Again, networking and word-of-mouth broadcast specious methods. Women who relied on such information sometimes resorted to rubbing gunpowder on their breasts or drinking a "tea" brewed with rusty nail water. Other suggestions included "bleeding from the foot, hot baths, and cathartics." Midwives were thought reliable informants and were wont to prescribe seneca, snakeroot, or cohosh, the favored method of Native American women. Thomsonians claimed the preferred "remedy" was a mixture of tansy syrup and rum.

More reliable sources of information were the ever popular home medical books. If a woman knew where to look the information was easily gleaned. One book, Samuel Jennings' The Married Ladies Companion, was meant especially to be used by rural women. It offered frank advice for women who "took a common cold," the period colloquialism for missing a period. It urged using cathartics like aloe and calomel, and bleeding to restore menstruation. Abortion information was usually available in two sections of home medical books: how to "release obstructed menses" and "dangers" to avoid during pregnancy.

The latter section was a sort of how-to in reverse that could be effectively put to use by the reader. The most widely consulted work, Buchan's Domestic Medicine, advised emetics and a mixture of prepared steel, powdered myrrh, and aloe to "restore menstrual flow." Under causes of abortion to be avoided, it listed violent exercise, jumping too high, blows to the belly, and lifting great weights. Clearly, any woman wishing badly enough to abort could find a solution to her dilemma, without relying on outside aid. If she wished to rely on herbal remedies, they could be easily obtained. Aloes, one of the most widely urged and effective abortifacient, were regularly advertised in newspapers as being available in local stores.

Of course, the number of women who availed themselves of the abortion option cannot be properly approximated. It is enough to say that abortion was feasible, available, and used option; it was a likely contributor to the birth rate falling by mid-century.

"Female Matters"
Public discussion of a woman's body and its health was frowned upon during the first half of the nineteenth century. Some have called it a taboo topic. Not only was it seldom mentioned publicly, women and their own doctors were uncomfortable discussing "female matters." Vaginal and pelvic exams were rare and cursory at best. Such prudishness undoubtedly contributed to a more rapid progression of disease and a quicker deterioration of an afflicted woman's condition. gynecological problems often went unmentioned and untreated. Simple operations on breast tumors took place, but treatment was rudimentary and met with little success. For the most part, then, treatment of "female matters'" suffered due to the same lack of knowledge and technique as other diseases.

In essence, the pioneer woman's body was much less her than that of her modern counterpart. Indeed, it was much less her own than her contemporaries living in northern urban areas. The midwestern woman of 1800-1850 was likely exposed to disease, more unhealthy conditions, more of life's hazards, than most of her gender. As with other aspects of her life, her existence was a problematic one. Yet, hampered by ignorance, exposed to a myriad number of diseases, she survived, even flourished.

From: connerprairie.org

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A Soldier Gets Sick

From: historyengine.richmond.edu

Lewis E. Parsons wrote many letters during the Civil War to his family in Talladega, Alabama. Parsons talks about many different things in his letters to home. He mainly asks questions about the home front, and he also talks a great deal about how war is an awful thing. He describes many different situations that he and his fellow men have to go through during the time of war. One of the situations or problems that these soldiers had to face was being sick or getting a disease. Sickness was a very serious problem that many soldiers had to deal with while they were off at war. Parsons does not talk very much about sickness or disease, but he does make one reference to sickness in a letter that he wrote on May 17. He says “I am still having chills and am very weak.” Many soldiers had these same symptoms or feelings that Parsons had. These chills that Parsons takes note of could probably be the symptoms of typhoid fever. The men in the camps started calling the sickness “camp fever”. Many soldiers got sick during the war because of the camps that they had to stay in all the time.

The camps were very unsanitary, and disease was all around the men because of these unsanitary conditions. Historian Thomas Cutrer wrote about some letters from a Confederate soldier to his wife. The soldier’s name was William Moxley, and he served in the Eighteenth Alabama Infantry during the war. Cutrer tells of how Moxley wrote a lot about the sickness of the soldiers and diseases that they had. The soldiers “never acquired the immunities necessary to fight off even the most common of childhood diseases such as measles, mumps, and scarlet fever.” So when the soldiers had to leave their homes to go live in these unsanitary camps they contracted many different diseases. Cutrer also says that a “great interest and value in the Moxley letters is their wealth of commentary concerning the epidemics of disease that shattered both Southern armies and Southern home communities.” These diseases wiped out a huge percentage of both armies during the war. The main disease that was “especially deadly was typhoid.” There were many other diseases and infections that went through these soldiers, but typhoid fever killed the most number of men.

 Another historian by the name of James Pate writes about the letters of the Francis brothers who were soldiers in the Civil War. Pate says that “health issues were a major subject, and outbreaks of measles, mumps, and typhoid fever were routinely reported.” So, Lewis Parsons was not the only soldier sitting in his camp with chills and a feeling of weakness. Every other soldier in that same camp with Parsons probably had some type of sickness or disease. Parsons probably had one of the diseases mentioned above. He did not say in his letter how bad he was feeling, but the sentence he writes does let the reader know that Parsons was sick or on the verge of getting sick. It could have been one of the deadly  diseases that were rampaging through both armies.

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How a American Civil War Invention Is Used Today for Relief From Osteoarthritic Knee Pain

By Pariswiederstein M

As an orthopaedic surgeon specialising in knee problems the majority of my patients suffer from osteoarthritis and although knee replacement surgery is generally successful, most patients who are referred to me are not suitable for surgery. These patients are managed with conservative treatment, the main components of which are painkillers and anti-inflammatories, weight loss and exercise.

Each treatment has its own advantages and disadvantages. Painkillers can be very effective in reducing the symptoms of osteoarthritis and for long term use in chronic conditions, paracetamol is the safest drug. Adding an anti-inflammatory like ibuprofen significantly improves the effectiveness of the medication.

However, there are risks associated with long term use of anti-inflammatories. Stomach ulcers with bleeding, kidney failure and cardiac problems are all associated with anti-inflammatory use. Side effects can be decreased by using the anti-inflammatory as a cream which is applied to the knee but in general, I have found that many of my patients simply do not like the idea of having to take long term medication in any form for their knee pain.

Weight loss is very effective in those patients who are overweight but as anyone who is overweight knows, it is not easy to lose weight and many patients often cannot manage this. Exercise has a dual benefit of encouraging weight loss and releasing 'feel good' endorphins which can act as a natural painkiller. However, exercising the knee is difficult when the knee is painful.

What is needed for successful conservative treatment is a form of pain relief which is not drug based, is easy and convenient to use and effective in managing patients symptoms of Osteoarthritis. In fact, such a treatment has been available for over 150 years!

In 1862 during the American civil war a technique was discovered that is becoming increasingly available today as a method of treating pain. With no available anaesthetics for battlefield use it was discovered that injured soldiers with painful amputation stumps could obtain pain relief by having the painful stump 'drummed' with drumsticks at a particular frequency. This produced pain relief lasting for many hours. By 1865 nearing the end of the conflict, drummer boys, when not leading the troops into battle, were employed to provide pain relief in field hospitals using this technique.

The mechanism by which this effect was produced would not be discovered for another 100 years.

It was only in the early 1960′s that two scientists Merzack and Wall discovered the process and named it the 'gate theory of pain'. They found that stimulating the vibration sensors in the body causes the pain signal to be blocked on its way to the brain, producing a pain relieving effect. This is due to the spinal column being unable to carry both the pain signal and the vibration signal together. The introduction of the vibratory signal 'closed the gate' to the pain signal.

With this in mind I explored using vibration therapy for the management of knee pain in my patients. We used a commercially available vibration therapy device which was designed for use on the elbow and adapted it for the knee. We then tested it with a large group of patients in a clinical trial. The results were impressive. Some patients who suffered with osteoarthritis pain obtained complete pain relief without using drugs and many subsequently improved so much that they reduced their pain reliving medication to much safer levels. We also saw a reduction in stiffness of the knee joint and greater mobility which enabled many patients to go back to work, to take up gentle exercise and start weight loss programmes and to generally increase quality of life.

Although not a miracle cure for osteoarthritis, the trial showed that vibration therapy can allow patients to delay the need for a knee replacement and reduce their medication use, giving greater safety and increased health benefits. I now use vibration therapy as a significant part of my conservative management programme for patients.

From: arthritism.blogspot.com

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History of the U.S. Christian Commission

From: nwuscc.org

Soon after the start of the Civil War, YMCA leaders became concerned with the religious and spiritual needs of the soldiers in the nearby camps. Vincent Colyer, a member of the New York City YMCA, had begun spending time visiting nearby encampments where soldiers were stationed temporarily on their way to the battle front. Colyer mingled with the soldiers, offered words of encouragement, and handed out religious tracts. Since few camps had chaplains, the chaplaincy then being in its infancy, Colyer's ministrations were welcomed by both the soldiers and their officers. As a result of these activities, and the apparent need to extend them, the New York Association established an "Army Committee" with Colyer as chairman, with its mission to provide preaching services, individual religious visitation, and publications for soldiers.

In November, 1861, at the instigation of members of the board of the New York City YMCA, a special convention of fifty delegates representing fifteen YMCAs met in New York. A "Christian Commission" of twelve members was appointed to devise a plan for the Associations to act as a clearinghouse for all religious work in the armed forces. The work of the Commission was organized at the national level. Local Associations were encouraged to support the Commission while maintaining their own activities. Many Associations merged into local branches of the Christian Commission or resolved themselves into army committees in order to facilitate the work of the Commission. The national organization established an office in Philadelphia and the Associations of Baltimore, Boston, Buffalo, Chicago, Louisville, New York, St. Louis, and St. Paul became regional clearinghouses for the various activities channeled through the Commission. George H. Stuart, founder and first president of the Philadelphia Association, and then chairman of the YMCA's Central Committee, was designated as Chairman of the Commission, a post he held throughout the war. The method of operation was the appointment of "delegates" who served on a volunteer basis for terms averaging six weeks.

The general aim of the Commission was "to promote the spiritual and temporal welfare of the soldiers in the army and the sailors in the Navy, in cooperation with the Chaplains." Its early activities included publication of a collection of familiar hymns, bible readings and prayers, devotional meetings in the camps, the organization of of a "working Christian force" in every regiment, and aiding and supporting chaplains. Though originally devised to provide spiritual sustenance, the activities of the Commission soon expanded into the physical and social realm, making the Commission a valuable agency of wartime relief. A newspaper report of its first annual meeting described the objects of the organization as, "the promotion of the intellectual, moral and religious welfare of the Army and Navy, buy suggesting needful national legislation and administration, securing well-qualified chaplains, encouraging Sabbath observance, promoting temperance, multiplying libraries, reading-rooms, and gymnasiums, and endeavoring to arouse the sentiment of the nation to a sense of its obligations to this class of citizens. Delegates, serving both at the front and behind the lines, established tents as social centers with stationery and periodicals provided, distributed emergency medical supplies, food, and clothing, and operated canteens and lending libraries. A special work of compassion performed by delegates of the Commission was the assembling of records of those buried from prisons and in certain major battle areas. Prisoner-of-war work, which was to figure more prominently in YMCA war work in later conflicts, also began during the Civil War.

The establishment of the Commission was a pivotal moment in the history of the YMCA movement in North America, which was then just ten years old. The work of the Commission provided the medium for large-scale cooperation between the Association and the general public and was significant in creating prestige for the YMCA movement. The value of the services rendered was recognized by civil and military authorities during the war and afterward.

After the surrender of the Confederacy in 1865, the Commission continued to minister to the troops until they were discharged from military service. At a meeting of the Executive Committee in December, the decision was made to terminate the work of the Commission on January 1, 1866. During its 4 years of operation, the Christian Commission sent nearly 5,000 agents into the field; distributed 95,000 packages, which included nearly 1.5 million portions or full scriptures, 1 million hymnbooks and over 39 million pages of tract. Total monies spent during the Civil War was estimated at over 6.2 million dollars.

Historical material adapted from Chapter 1, "How it All Began," of Serving the U.S. Armed Forced, 1861-1986: The Story of the YMCA's Ministry to Military Personnel for 125 Years, by Richard C. Lancaster; and from the collection.

History of the United States Christian Commission obtained from web site of the Kautz Family YMCA Archives, University of Minnesota Libraries 

Image: Maimed Soldiers and Others before Office of U.S. Christian Commission – Washington, D.C., April 1865

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Prostitution and Venereal Disease in the Civil War

by Amelia Cotter

During the Civil War, medical and ethical advances were helpful in developing a health care system that benefited both prostitutes and soldiers.

Low wages during the inflationary war period inspired many women, especially of the lower class, to take up prostitution, including women who were barely older than what we today consider to be children.

Dr. William Sanger of the Venereal Disease Hospital on Blackwell’s Island, New York, conducted a survey in 1858 of about 2,000 prostitutes. He found that 80% of them were under age 30, and 40% were under age 20. About 62% of them were foreign-born, with 57% being Irish, 20% German, and 8% English. Most of the prostitutes died within an average of four years due to venereal disease or alcoholism—an important insight into the lives of prostitutes at the time.

TREATMENT OF STDs IN THE CIVIL WAR
Sexually transmitted diseases (STDs) were common during the Civil War. A diagnosis of gonorrhea referred to any form of urethral discharge, and could have encompassed a number of other diseases not yet discovered, such as Chlamydia. Gonorrhea was diagnosed in 102,893 soldiers, and over 79,589 soldiers were diagnosed with syphilis. Of these cases, six white soldiers and one black soldier died of gonorrhea, while 123 white soldiers and 28 black soldiers died of syphilis. It should be noted that doctors were not yet aware of the more advanced forms of syphilis that affected the nervous system and heart, and likely caused numerous deaths years after the war.

Amazingly, only 426 of the men diagnosed with STDs were hospitalized, and the remainder were simply relieved from duty. The attitude towards illnesses and injuries was generally rather harsh, as demonstrated by the following quote found in a surgeon’s journal: “[Norris was] as well as any man in the regiment…diarrhea, swelling of the testicles, scabs, and a large running sore.”

Many soldiers, out of shame or embarrassment, tried to conceal their infections or treat them on their own. Remedies for these diseases included poke roots and berries, sassafras, and wild sarsaparilla. None of these were effective. Mercury, however, actually did provide some relief from pain, but no permanent positive effects—hence the saying, “A night with Venus, a lifetime with Mercury.”

THE VICTORIAN ERA SYSTEM OF PROSTITUTE LICENSING
By mid-war, a licensing system was developed by doctors in Nashville, Tennessee that involved the regular inspection and possible treatment or hospitalization of prostitutes. The inspection fee for a prostitute—which involved checking if she was free of disease and otherwise healthy—was 50 cents.

By January, 1864, over 300 prostitutes were registered in the city, with 60 found to have venereal diseases. Similar systems were instituted in Memphis, Richmond, Washington, D.C., and several other cities. Interestingly, many of these licensing programs were established in the South, where sexuality and gender roles were traditionally more heavily guarded than in other areas of the States.

If a prostitute was found to have a disease, she would be placed under quarantine. Surgeon W.H. Chambers wrote in December of 1864 that early in the year, 10 to 20 of his officers would have had an STD at any given time, but by December, he hadn’t seen a single case. Unfortunately, in the same year, military personnel in some other cities were banned from visiting brothels, perhaps due to the prevalence of venereal disease.

ATTEMPTS TO BAN PROSTITUTION
Not everyone was a fan of prostitution, of course. In an effort to clean up the streets, everything from soliciting prostitution openly down to simply talking to men in public were banned in Memphis and other cities. Many women’s rights and temperance activists attempted to pinpoint links between prostitution and alcoholism in order to outlaw both. Some soldiers could be arrested or even discharged for soliciting prostitutes, though this was rarely enforced.

From: suite.io/amelia-cotter

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Civil War Medicine: Pills, Ointments and Bitters for Soldiers

Written by Rachel Walman

This Father’s Day, June 16th, 2013, eminent historian Harold Holzer will be here [New York Historical Society] to answer families’ burning Civil War questions. Following his talk, families are invited to play a choose-your-own-adventure style game where they get to walk in the shoes of a Civil War soldier. Are you sitting there wishing you could really be a Union hero? Perhaps the next few paragraphs will change your mind.

3.2 million men fought on both sides of the war. A recent study has suggested that between 650,000 and 850,000 men and women (mostly men) died because of the war. More Americans died during this war than during any other war in our history.

The greatest wartime killers were not devastating minie balls (new bullets that did a lot of damage), or piercing bayonets, but rather microscopic bacteria. Disease caused roughly 60% of all Union soldier deaths. Ten out of eleven black Union soldiers who died succumbed to disease, not a bullet.  No one in America at that time could have imagined that invisible microbes caused fatal epidemics.  Doctors and regular folks alike had a hazy theory that illness was transmitted through “miasmas,” or foul air, and that health could be achieved through the balance of four bodily substances called “humors”. Ignorance of the roots of disease combined with poor conditions in Civil War camps and hospitals to cause many deaths – deaths that could be prevented today.

The most common fatal diseases amongst Union (and Confederate) soldiers were diarrhea, dysentery, typhoid, pneumonia and tuberculosis. These diseases, which mostly affect the lungs and intestines, are transmitted through contaminated food and water and contact with an infected person. Bad food, bad water and close quarters were the hallmarks of a Civil War soldier’s life. A staple of the soldier’s diet was a flour-and-water cracker called hardtack that provided them with barely any nutrients or energy, lowering their immune systems. When soldiers did have protein in the form of salted or canned meat, it was often spoiled. And of course, there was the battlefield. Encampment water sources with latrines dug nearby were often contaminated with the soldiers’ waste. Several soldiers shared one tent, allowing disease to spread fast. Of course, there was also the battlefield: a bullet wound could become infected with gangrene or blood poisoning in the field hospital.

So what could a soldier do to keep himself healthy when disease and death lurked around every corner? Camp doctors would often prescribe drugs called purgatives which, guess what, make you poop. That’s not a good idea for a soldier who already has dysentery, diarrhea or typhus! Doctors at the time believed purgatives helped the body expel illness. To avoid untrustworthy doctors, soldiers often treated themselves. Have you ever gone to a drug store for cold medicine or stomach relief? Well, soldiers did too, only their medicines were quite different from yours. We now call these “patent”, “proprietary”, or “quack” medicines. There is no real evidence that any of them worked (in fact, some actually damaged those who took them), and their formulas were kept a secret, which is illegal today.

Three medicines often marketed to soldiers were Brandreth’s Pills, Hostetter’s Bitters, and Holloway’s Ointment. Soldiers who happened to take these drugs and survive often gave testimonials to the companies that made them. The companies used the soldiers’ words to advertise their miracle cures to other soldiers. In an ad for Brandreth’s Pills, “Sixty Voices from Army of Potomac” stated that the pills “protect from the arrows of disease, usually as fatal to Soldiers as the bullets of the foe.” Hostetter’s Bitters, its producers swore, were “a positive protective against the fatal maladies of the Southern swamps, and the poisonous tendency of the impure rivers and bayous.” Holloway claimed his pills could “so purify the blood and strengthen the stomach…” that Union soldiers could handle whatever their environment threw at them.

Though the formulas for these drugs were a mystery to Civil War soldiers, they are not a mystery to us now. Hostetter’s Bitters claimed its disease-fighting ingredients were exotic herbs; however, the ingredient that probably affected soldiers who drank it the most was the whiskey. One bottle of Hostetter’s Bitters was about 47% alcohol. Some soldiers taking this “medicine” undoubtedly believed they were convalescing when in reality they were just intoxicated. Depending on the illness, the alcohol in Hostetters may have made things worse. Brandreth’s pills and Holloway’s Ointment were medically ineffective, but also fairly safe. Brandreth’s Pills had a vegetable base. Holloway’s products were similar. According to the book “Popular Medicines: An Illustrated History,” and Jim Schmidt of the blog Civil War Medicine (and Writing) “the pills contained aloes and rhubarb, with small amounts of saffron and pepper; the ointment was principally olive oil, lard, and waxes.” (Schmidt, 2009)

Quack medicines like these became even more popular among Civil War veterans after the war. These soldiers health was permanently compromised, and some became addicted to their wartime maladies.

From: historydetectives.nyhistory.org

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