Surgeon Barnes' Report 1852

Report on the Sickness and Mortality

Among the Troops in the Middle Division

Report Title of Barnes

Medical Topography and Diseases of Fort Scott

By

Assistant Surgeon Joseph K. Barnes, 1852

Fort Scott was established in the spring of 1842, by the removal of the garrison from Fort Wayne, Cherokee Nation. The position selected for the encampment, and subsequent site of the post, is in latitude 38 [degrees] N. longitude 17 [degrees] 30 [minutes] W. of Washington; four miles west of the Missouri line, and upon the military road from Leavenworth to Gibson. The nearest point on the Missouri river is ninety-five miles N.N.E. The general features of the country are those of a high table prairie, intersected by well-wooded water-courses, at intervals rarely exceeding ten miles, and cut by limestone ravines, which ordinarily dry, are sometimes the beds of immense torrents. The streams of the section between the Kansas river, ninety-three miles north, and Spring river, fifty-five miles south, are tributaries of the Osage, and preserve generally and easterly course, until forming that river, which flows southeast to join the Missouri.

The immediate site of the post is a flat spur of high prairie, running from S. to N., bounded on the N.W. by the Marmaton River, and on the N.E. by a small, clear-water creek, joining the Marmaton within a short distance of the spur. The plateau opens out rapidly to the south in a beautifully undulating prairie; while to the west, north, and east, it terminates abruptly in an almost precipitous descent of fifty feet to the river and creek bottoms. These bottoms, fifteen to twenty feet above the usual water-level, are heavily timbered, and vary in width from one quarter to one mile, opening again on high prairie, which, to the west and east, runs up into limestone ridges, averaging forty feet more elevation than the land to the south or north. The soil is a dark chocolate-colored loam, with much granular limestone detritus, but little clay, no siliceous sand, retaining moisture but a short time, and when dry, very hard and compact. The prevailing geological formation is limestone, which is found bare on the ridges, in the ravines and beds of streams, and at depths from six inches to six feet in the prairie-valleys and river-bottoms. Bituminous coal, shale, and grey sandstone are also found. Occasionally small spots of timber are met with on the prairie; but as a general rule, this growth is confined to the borders of the streams, and consists of the Juglans nigra [Black Walnut], platanus occidentalis [Sycamore], morus rubra [Red Mulberry], Ulmus americana [American Elm], acer saccharinum [Silver Maple], quercus alba [White Oak], rubia [Red Oak], nigra [Black Oak], aquatica [Water Oak], macrocarpa [Bur Oak], tilia Americana [Basswood], and the juglans alba [White or English Walnut], some of which attain great size. The bottoms are also covered with a luxuriant undergrowth, composed principally of the cercis Canadensis [Redbud], amelanchier Canadensis [Shadblow Serviceberry], hamamelis Virgininca [Witch Hazel], laurus benzoin [Wild Pimento] sambucus nigra [Eldberry ?], ribes grossularia [Goose Berry], rosa Carolina [Rose], rubus odoratus Raspberry], rubus villosus [Dew Berry] , and vitis aestivalis Grape]. The juniperus Virginiana [Red Cedar] is found twenty, and the pinus sylvestris [Scotch Fir] sixty miles south of us. The fauna of this region was originally extensive, but the commercial demand for furs and peltries has caused their almost entire extinction by Indians and trappers. The birds are those of the middle States, with the addition of the pinnated (tetrao cupido) [Prairie Chicken], which exists in great quantities. Reptiles and insects, both noxious and innocuous, abound both upon the prairie-ridges and river-bottoms.

Owing to the physical conformation of the country, the climate is one of extremes of heat and cold, of dryness and moisture. After a long and debilitating summer, the winter, most frequently commencing abruptly with cold storms from the northeast, is a succession of alternations, the mercury falling or rising 30 [degrees] to 40 [degrees in a few hours. Springs and wells supply an abundance of good water, which rarely fails, even is the driest season. Extensive gardens, although sometimes failing in articles intended for winter use, have always afforded a sufficiency of esculents during the spring and summer. The quarters are exceeding roomy, well ventilated and comfortable, and, with the necessary outhouses, are furnished with good drainage, preventing all accumulations of water and filth; the general arrangement of the post being such, that any inattention to police would be at once become apparent.

An accurate examination of the country, for several miles in each direction, has failed to discover any local feature which may be considered objectionable, or as remotely the cause of disease. There are no grass-ponds, swamps, or lakes near us; the streams are numerous, but without stagnant pools; the bottom-lands extensive, and sometimes overflowed, but they drain as rapidly and thoroughly as the prairies.

The medical records of Fort Scott, from May, 1842 to January, 1849, exhibit and aggregate of 3,415 cases, in a command of 3,034 men - a proportion of 1.12 to 1. Of these, 1,717 were malarias fevers, which, deducting 467 surgical cases, gives a proportion of 1.38 to 1, or more than one and one-third per cent over all other diseases. But 8 cases of remittent are recorded, the remaining 1,709 being intermittent, either quotidian, tertian, or quartan. This proportion varies with the different quarters of the year, and with different years; being much greater during the third and fourth than the first and second quarters, and in the years 1843 and 1845 than any others. The next in point of numbers, and by far the most serious in result, are diseases of the respiratory organs, which constitute 331 in 1,241, or more than one-fourth of the cases, after deducting the malarious and surgical. This proportion varies with different years, and is influenced by unimportant epidemics of catarrh and influenza, but maintains a marked increase during the first and fourth quarters of each year, pneumonia being the most frequent and dangerous form. Of the 910 cases not already specified, 287 were diseases of the digestive organs, principally diarrhea, colica, and obstipation, with an occasional case of hepatitis and dysenteria. The second quarter of each year furnishes the greater portion of these cases, owing, doubtless, to the abundance of vegetables obtainable at that season. Recruits newly arrived occasionally complain of the laxative effect of the well and spring water, but this soon passes off; and were it not for errors of diet and intemperance, these affections would be still more infrequent. In this connexion, it is worthy of remark, that although spasmodic cholera has prevailed within fifty miles both north and south of this point, not a single well-marked case has existed here. Diseases of fibrous and muscular tissues have also prevailed to a greater extent during the second quarters; of the whole number (133), 51 occurring during the months of April, May, and June. These months include the usual rainy season, and diseases excited by the blustering winds of March, are fully developed during the cold easterly storms of April. Of 77 cases of disease of the brain and nervous system, a majority are referable to habits of intemperance. One of the fatal cases of meningitis is directly ascribed to this cause. Exposure to the sun upon the open prairie should also have its due importance, although many of the cases of cephalalgia were doubtless owing to simple gastric derangements. With but few exceptions, the 45 cases of disease of the urinary and genital organs were venereal, primary syphilis, and gonorrhoea. Of the remaining 368, were fourteen cases of eruptive fevers (non-contagious), and two of serious and exhalent vessels; leaving 352 not admissible under either of the foregoing classes, and comprising under the caption of "all other diseases" many of a specific character; as abrietas, toxicum, scirrhus, scorbutus, debilitas, amaurosis, &c., &c. The surgical cases are divided into 145 cases of abscess and ulcers, and 322 of wounds and injuries.

During the six years and nine months included in these statistical details, seventeen deaths have occurred - six of which were accidental, and not affording opportunity for medical treatment; one drowned; one froze to death; one found dead from intoxication; two from gun-shot wounds, immediately fatal; and one stabbed and beaten to death. Of the entire number of cases treated, eleven terminated fatally, viz: four of phthisis pulmonalis, one of pleuropneumonia, three of pneumonia, two of meningitis, and one of apoplexia; making the proportion of deaths under treatment one in three hundred and ten and forty-five hundredths (1 to 310.45).

But few facts concerning the vital statistics of the Osages, the tribe of Indians occupying the country to the west of this post, can be collected. The traders remain but a few years among them, agents are frequently changed, and the intelligence of a half-breed will not carry him back beyond a single hunting season. They are essentially a nomadic race, moving from point to point as their wants compel, and preferring a precarious dependence upon the chase to agricultural pursuits. Their usual hunting seasons are the early summer and winter, when they go upon the plains in pursuit of buffalo. Improvident and wasteful, a successful hunt is but an inducement to feasting and gluttony, and upon their return to the villages and trading stations, but few have made sufficient provisions for the winter. The skins procured on the summer hunt are disposed of for flour, corn, coffee, sugar, &c., &c., when they again start out for the season or winter hunt, which is principally for furs, although they also frequently obtain buffalo. By spring, the proceeds of this hunt are disposed of, and they sometimes suffer for want of food before the grass is high enough for another foray. The history of one year is that of many - wasteful, plenty and intemperance to-day; want, sickness, and misery to-morrow. Of all the frontier tribes, the Osages, originally neither brave nor warlike, would seem to have suffered most from association with the whites; for, with hardly an exception, they are notorious intemperate, and will deprive themselves of the actual necessaries of life to procure whiskey. Filthy in their persons, irregular in their habits, continually subjected to extremes of excess and want, it is not surprising that most diseases assume an unwonted malignancy and fatality among them. Sooner or later in the autumn - and the less successful their spring hunt, the sooner and more severely - diarrhoea, intermittent, remittent, and bilious fevers appear. Diarrhoea and dysentery are almost invariable consequence of an unfortunate hunt; for, in this event, they betake themselves to the fields of the half-breeds and their frontier neighbors, devouring unripe corn, melons, and pumpkins, stripping the bushes of green haws and berries, and searching the bottoms for roots, which necessity has taught them are edible. Deficient nutrition produces its effect as surely in the Indian wigwam as in the hold of an emigrant ship or the over-crowed lanes and alleys of a city. Intermittent fevers become pernicious or congestive; remittent and bilious fevers, typhoid, and diarrhoea, merely a symptom of a graver disease. The advance of the season finds them poorly prepared; the cold storms of winter are but feebly resisted; imperfect calorification predisposing to pulmonary engorgements, pleuritis and typhoid pneumonia are added to their list of evils. In 1845, the Osages numbered about 6,000; in 1851, 5,000; at the enrollment of 1852, it is expected, by those best informed on the subject, that this will be reduced to 3,500. Epidemics of eruptive fever have prevailed, but the intervals so remote that it is impossible to gather any correct data of their history, character, and result. During the past winter and spring, an epidemic of typhoid measles has more than decimated the tribe.

The adjacent country to the east, and within the State of Missouri, presents similar physical aspects to that of this immediate vicinity. It is but sparsely settled by agriculturists, who mere cultivate enough land to supply themselves and families with the bare necessaries of life. For the convenience of wood and water, their log cabins are placed upon the banks of streams, or the nearest ground not subject to overflow. Clearings are rarely made; their farms, in most instances, running along the edge of timber into the prairie. Ignorant, without energy, industry, or foresight, the population is principally composed of those whom cheap and rich lands have drawn from the older States, and whose only aim is an easy life - another term for a midway course between idleness and starvation, or labor and abundance. Being but indifferently sheltered, insufficiently clothed, and by no means generously fed, they resist disease badly, and climatic vicissitudes, endemial epidemics, or contagious fevers, which would be comparatively unimportant among the troops, assume an alarming consequence with them. The winter months are considered the most unhealthy, typhoid pneumonia (know as the winter fever) being the prevalent and important disease, and, as they are dependent upon steam doctors and patent medicines, it generally terminates fatally.

The records of the post showing so great a proportion of malarious fevers, and explanation is required of the statement that no applicable local cause for them can be said to exist in this vicinity. This explanation may be found in the history of the occupations, habits, and exposures of the troops, the meteorological conditions of the seasons when most prevalent, and in what I conceive to be the general characteristics of rich prairie country.

From the occupation of the post until late in November, the command was in tents, and every available man was engaged upon fatigue duty, being employed in the erection of temporary log buildings. Assistant Surgeon Simpson, in reporting the medical topography of the post (June, 1843) says "The only cause of sickness I can see will be the employment of the men on fatigue duty in the rich bottom-lands immediately on the river. But diseases arising from this cause must be diminished in proportion as the land is cleared and cultivated."

In the last quarter of 1842, 116 cases of intermittent are reported, with the remark by Assistant Surgeon Walker, that "the exposure of the men on fatigue duty in the bottoms must account for the greater prevalence of intermittent fever than might be expected." During the first quarter of 1843, 70 cases of intermittent, and 47 cases of catarrh, are reported; Dr. Walker accounting therefore "by the unusually severe weather, and the exposure of the command in various ways to it." In the second quarter, 83 cases of intermittent are reported, although the command was reduced by the departure of one company of dragoons for the plains. Dr. W. remarks: "The fatigue duties of the command must be considered the indirect cause of a large proportion of the fevers and diseases of the respiratory system; at the same time, it is difficult to say whether this produces a greater amount of disease than the abuse of ardent spirits, and the exposure undergone in procuring it." On the 25th of July the dragoons returned from the plains, and by the 30th September the number of cases of intermittent had increased to 159; an epidemic of influenza also prevailed, assuming an intermittent type. During the spring 12.79 inches of rain had fallen. Although 127 cases of intermittent are reported during the fourth quarter, a majority of them were relapses on the seventh, fourteenth, and twenty-first days; the air was becoming purified by prairie-fires, and but 5.46 inches of rain had fallen during the three months. On the 31st March, 1844, only 42 cases on intermittent are reported; the men were still constantly engaged on fatigue duties in the bottom-lands; but a temperance reform had been started, and much of the night exposure was thus done away with. During the second quarter, "the men have been very much exposed to rain, which has fallen in unusual quantities," and the number of intermittents was 73 - the weather being remarkably dry and mild during the remainder of the year; and, until June, 1845, the proportion of malarious fevers was greatly reduced. The annual rains did not set in until late in June, and in September Doctor Walker reports: "Intermittent fevers constitute three-fourths of the cases occurring during the quarter; 114 have occurred in September; they have also been unusually prevalent throughout the country around us; but the circumstances of the companies have increased it still more with us, as they have been previous to their arrival here, living upon commissary rations; here they indulged in a variety of vegetables, melons, green apples, &c., to an unlimited extent." By this time, most of the permanent works were completed; and the fatigue duties were less arduous, and the men were very comfortably quartered. The spring of 1846 was very dry, the rains no commencing until July, and a healthy season was predicted; but the reports of the third and fourth quarters show a proportion of seven-eighths of intermittent to all other diseases. From this time a gradual decrease appears until, in the last quarter, 1848, the proportion was only one-twentieth of all other diseases.

Did the medical history of Fort Scott terminate here, the above remarks might be considered amply explanatory of the prevalence of malarious fevers. The large amount of timber cut for building purposes, leaving the bottom-lands covered with immense quantities of decaying vegetable matter - the duties of the troops requiring unusual exposure to the sun and rain in the midst of its exhalations - would appear to predispose to such affections; and the prediction that these diseases would diminish in frequency with the completion of the post, would seem to be verified. But this is not the case. After an interval of some years, malarious fevers again appeared, and during the third quarter of 1851, reached the proportion of two hundred and fifty per cent, to all other diseases. They also prevailed to an extent hitherto unknown throughout the surrounding country. So intense was the malarial influence, that no one escaped, no precautions were of avail; the youngest infant, as well as the most robust adult, was affected; and all other forms of disease were influenced and modified by it. Epizootics appeared; in some districts hundreds of young cattle, in other all the horses sickened and died, with every appearance of sudden and violent congestion. The circumstances which had been considered prolific causes of disease in previous years, had ceased to exist; the troops were but little exposed; their fatigue duties were light, and did not require them to be in the woods or bottom-lands more than an hour or two, occasionally; the emigration into the country was small, and but few new farms were opened. We must, therefore, look to other than these causes for an explanation, which I believe can be found to exist in "the general characteristics of rich prairie lands, and the influence of different seasons upon them." It will be found, although the different varieties of gramineous plants are considered the usual growth of prairies, that, in some sections, these are almost entirely crowed out by a stronger and larger growth of other species. The richer the soil, the greater the predominance of the latter growth - amounting, in some instances, to an almost entire exclusion of the grasses, so that, in the language of the country, a distinction is made between grass prairies and weed prairies; the latter being the character of much of this section of country. , This distinction is not confined to one locality; it is noticeable in Texas, where the difference between the mesquite - grass prairies of the west, and the weed prairies nearer the coast, is quite as decided in salubrity as in vegetable productions. It will be found, also, throughout the vast extent of uncultivated lands, lying upon our western and northwestern frontiers, that the rains are periodical, occurring, for the most part, in spring and winter; the intermittent times being comparatively dry.

The time of the spring rains affects the growth of these prairies much more than the quantity, and upon a supply of moisture at a certain period the vegetation of the year will principally depend. In an ordinarily productive and healthy season, the spring rains commence in April, and do not continue beyond the middle of May; the weeds and grasses shoot up rapidly, are fully matured in July, desiccation commences in August, and in September the horizon becomes smoky from numerous fires, which, extending, sweep off the greater portion of the year's growth. Should, however, the spring rains not set in until June or July, the weeds will have withstood the drought better than the grasses, and will then start into rank luxuriance, the prairies remain green until late in the fall, and winter rains commence before desiccation is completed, or the surface burned over. That the growth, as well as the decay of this vast amount of vegetable matter, spread over the entire region so controlled, generates a malarial influence either by the evolution of miasma, or, as is most probable, by the development of organic germs (cryptogamous growths in such seasons being inconceivably abundant), can hardly be questioned. The epidemics of 1843, 1845, and 1851 commenced while the prairies were still clothed with verdure, and reached their acme before decomposition was established, the striking feature of resemblance in these seasons being the lateness of the spring rains.

Summer showers, and the later rains of September and October, can have but little influence upon this production, although undoubtedly increasing the liability to a recurrence of attack. Their effect upon the soil and watercourses is very temporary; and by removing quantities of leaves and other debris, should be rather beneficial than otherwise. The deductions from these observations are in accordance with the experience of the oldest residents of the country, who (without recognizing their mode of action) look to the early commencement of the spring rains as the harbinger of a healthy summer and fall, and vice versa.

A marked relation may be observed between the prevalence of diseases of the respiratory organs, and the preexistence of malarious fevers. Among the country people, a severe winter following the epidemic of intermittent, produces much mortality; for either through the debilitating effect of long exposure to malarial influences, or a predisposition induced directly by them, pneumonia, pleuritis, and pleura-pneumonia usually assume a typhoid form.

Were it possible to institute a statistical comparison between the sickness and mortality of the troops and an equal number of persons in any portion of this country, I am convinced that, making the fullest allowance for the superior comforts of the former, the advantages of discipline, strict police, and prompt medical attendance, the difference in their favor would be so striking as to clearly indicate the greater healthiness of location, and the entire absence of any purely local cause of disease.

 

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