National Historic Site Kansas
In order to understand the practice of 19th century medicine, one must understand the theory of disease that was predominant in the day.
The medical theory of the day held that poor health was caused by either too much or too little stimulation or inflammation of the nervous system. Symptoms of those diseases caused by overstimulation included high fever, strong pulse, flushed skin, rapid breathing, agitation (exceeding restlessness and mental distress or shaking) and active delirium (hallucinations and illusions accompanied by extreme excitability). Treatment for these diseases included bleeding, purging, sweating, blistering, and minimal amounts of food. Sedatives might also be used to calm these excitable symptoms.
Under stimulation was characterized by a weakened or depressed state. Symptoms included weakness, exhaustion, weak pulse and respirations, general wasting and quiet delirium marked by confusion of ideas and slowness of mental action rather than by excitement. Treatments for these conditions included alcohol, drugs or stimulants, and large amounts of food.
It was also felt that good health depended upon a proper balance of nerve stimulation to muscle, blood vessels, and intestinal tract. It was then recommended that to restore this balance to an afflicted person either stimulants or sedatives could be used.
Doctors performed "bleeding" or "bloodletting" to remedy symptoms of most diseases. This procedure involved cutting the patient and draining "extra or unwanted" blood.
The practice of bloodletting seems barbarian to our modern mind, but was very popular among physicians of the 1840s. As much as 20 ounces of blood would be bled at a time, this sometimes repeated ten times a day, in severe cases of fever, or severe pain. Unfortunately, physicians thought the blood volume a person has was about twice what it actually is, so undoubtedly much harm was actually done as the heroic therapy was vigorously used.
Purging, Vomiting, and Sweating
The idea here was to relieve the body of harmful poisons which may be caused by inflammation. Medicine was given to induce vomiting, sweating, or purging (relieving the body of fecal material i.e. using the restroom).
Cases of respiratory illness were treated with a procedure called "cupping" or "blistering" of the chest. Intended to relieve lung pain, the procedure required the filling of a small glass cup with alcohol which was ignited and applied directly to the skin; the resulting blister was then lanced. The idea was that the inflammation of the interior organ would then be transferred to the skin and relieved through blistering.
Not surprisingly, most deaths at Fort Scott occurred due to illness rather than injury. Disease spread quickly through the ranks due to close living quarters, lack of sanitation, want of knowledge about contagion and infection, and inadequate diet.
We do have a list of hospital cases which occurred between 1842 and 1849. There were 3,415 cases, of these there were 1,717 of malarious fevers, 331 cases of disease of the respiratory organs, 287 cases dealing with the digestive organs, principally diarrhea, collica, and obstipatio, with an occasional case of hepatitis and dysenteria. There were 133 cases of disease of fibrous and muscular tissues and 77 cases of diseases of the brain and nervous system, most caused by habits of intemperance. There were 45 cases of venereal disease, primarily syphilis and gonorrhea. There were also 467 surgical cases, 145 abscess and ulcers, and 322 wounds and injuries. Lastly, there were 17 deaths, only two of which were related to gunshots.
Malaria (aka intermittent fever)
Although diseases such as yellow fever, measles, chickenpox, and cholera came and went on the western frontier, malaria was the dominant health problem faced by the frontier forts. Fort Smith, Fort Gibson, and to a lesser extent Fort Leavenworth were known as pestholes - mainly due to the prevalence of malaria. Fort Scott had two very bad outbreaks, one the first year of the occupation of the site - 1842 - when most of the men were quartered in tents and cabins down by mill creek, and 1845, which had an especially wet second half.
We now know that malaria is carried by mosquitoes. The theory of their day was that it was due to contact or breathing of air containing decomposing vegetative gases- thus the name malaria or "bad air". Although few men died of the disease, the recurring shaking chills and fevers could totally debilitate a dragoon or infantryman, and make him useless on campaign. The disease was treated and cured with Quinine. Quinine was used in all cases of fever including mumps, measles, typhoid, yellow and scarlet fevers, as well as chicken pox, but was only effective as a cure for malaria.
One preventative measure to escape diseases such as malaria was open air. Open air was believed to be conducive to good health. The hospital was designed with a porch all the way around to provide convalescing patients an area to exercise and breathe in good air.
As good air was conducive to health, it was believed that many diseases such as malaria were caused by bad air. Bad air was thought to accumulate at lower areas, so high ground was sought to build the fort, and living quarters were located on the second floors of the buildings, as opposed to the basement or ground level.
This was another common disease that was especially prevalent among soldiers during the Civil War, although not many cases were reported at Fort Scott. Whereas malaria is generally characterized by intermittent fever, typhoid is marked by a continuous and sometimes rising fever. Other symptoms include fatigue, depression, a rash on the chest and abdomen, diarrhea and occasionally bloody stools. It was caused by bacteria found in fecally contaminated food and water, although at the time, doctors did not know about bacteria and thought that it was caused by noxious substances found in the air produced in crowded or close conditions.
Since fatigue and depression accompanied this disease, stimulants such as alcohol would have been used to treat the fatigue. Fever indicated inflammation and other poisons in the body so drugs to induce vomiting would have been administered and blistering agents applied. Cold compresses and sponge baths were used to reduce temperatures.
Diarrhea and Dysentery
One of the most common illnesses and one which took many lives, diarrhea and its more severe companion, dysentery were also caused by fecally contaminated water and food. Causes can generally be contributed to poor sanitation. At Fort Scott, this disease existed but was not as severe as it would have been in military camps. Diarrhea symptoms included watery loose stools and low grade fever, whereas dysentery was accompanied by bloody stools and high grade fevers. Treatments often included purging, sweating, and inducing vomiting, to rid the body of unwanted material. This proved to be a huge mistake because it had the effect of further dehydrating someone who was already dehydrated.
Another similar disease reported at Fort Scott was cholera, which was accompanied by severe diarrhea, vomiting and muscle cramps.
Most cases dealing with the brain and nervous system resulted directly from alcoholism, a widespread problem among army troops of the 1840s. Commonly used for medicinal purposes, whiskey was also part of a soldier's ration in the early years of Fort Scott, in quantities as large as three quarts per day. The extensive use of opium as a painkiller, often prescribed to be mixed with whiskey, resulted in numerous cases of addiction and withdrawal. Delirium tremens, a symptom of alcohol and drug withdrawal, were treated as a common ailment rather than an avoidable condition.
Drunkenness was a very real problem among the troops. In 1838, the spirit-ration was abolished and coffee and sugar were substituted. This was modified in 1841, however, to allow a daily extra issue of one gill of whisky per man to those engaged in constant labor of not less than ten days. Money could be substituted for the whisky ration instead, at the option of the soldier. At Fort Scott a real effort was made in 1845 to eliminate drinking. Temperance became the watchword to the disgust of some of the officers.
Delirium tremens was not an uncommon occurrence. Probably even the army did not grasp the extent of the drinking, although the surgeon at Fort Riley reported that "from the statements of convalescents and from other sources, I am satisfied that three quarts of whisky was the customary daily allowance of quite a number of the men; one quart, as the expressed it, being required 'to set them up before breakfast..' " For these habitual drinkers large quantities of opium were required when delirium tremens occurred.
Where supplies were limited to army rations and fresh vegetables were a rarity, scurvy was a much-dreaded disease. One of the disease's symptoms is the loss of teeth. The soldier needed his teeth to tear the paper cartridge that was used to load his weapon. Thus the prevention of scurvy was a top priority.
Doctors did not know at this time that the lack of vitamin C caused scurvy. Thus, the ingenuity of the post doctors in trying to combat and cure this devastating disease was sorely tried. When spring came to a post, wild onions, wild celery and watercress were dug from the earth and brought to the kitchens to cook for the men, usually with beneficial results.
Information for this section came from the Historic Furnishing Plan for The Hospital at Fort Scott by Sally Johnson Ketcham, Civil War Medicine-An Illustrated History by Mark J .Schaadt, M.D (used by permission., and from Medicine at Early Fort Scott, an anonymous article found in the files at Fort Scott National Historic Site. Dorland's Illustrated Medical Dictionary, published by W.B. Saunders Co,. was used as a reference guide for this and subsequent hospital pages