Camp diarhoea [and scurvy]

The Medical and Surgical Reporter 1866;15(14; Oct 6):296-298. https://archive.org/details/sim_medical-and-surgical-reporter_1866-10-06_15_14/page/296/mode/2up https://library.si.edu/digital-library/book/medicalsurgical1866phil p.296 https://doi.org/10.5281/zenodo.15581895 CAMP DIARRHŒA [AND SCURVY]. BY D. A. MORSE, M. D., Late Assistant Surgeon, U.S. Vols. Of Alliance, Ohio In the MEDICAL AND SURGICAL REPORTER for p.296 July 21, 1866, was a communication1 from W. E. WHITEHEAD, Assistant Surgeon, U.S.A., in which he requests an answer to the following questions: “Is not the camp diarrhœa of soldiers in the field caused by a scorbutic condition of the system?” Having treated a great many hundred cases of diarrhœa, both acute and chronic, during the rebellion, as well as having made many post mortem and also microscopic examinations of diseased tissue, I will present my views, and the faculty can receive them for what they are worth. Before giving a reply, however, I would state my views of the pathology. There is diminished vitality and consequent power of the nervous system supplying the epithelial structures of the digestive organs; more or less congestion of the portal circulation and vitiated secretions consequent upon these conditions. The diminished absorption and assimilation results from loss of tone in the epithelial structures. Diarrhœa under all circumstances, in my opinion, is the result of this same condition. The principle that “like causes produce like effects” holds true throughout all the broad domain of science. The question then arises, what produces this condition in the soldier? The “scorbutic taint” is the result of mal-assimilation. No one can manufacture a good article out of poor material. In a great number of cases of diarrhœa there is no scorbutic taint shown, To illustrate this: A regiment of robust healthy men enters camp direct from their homes. They are crowded together in tents or barracks; sleep upon boards or the ground; eat a different diet from what they have been accustomed; neglect their persons; in many instances overload their stomachs with indigestible truck from a sutler’s2 1 The communication from Whitehead is copied at the end of this text. 2 Sutler. A civilian provisioner to an army post often with a shop on the post. 1 nest of destruction—for they furnish more patients for the hospital than any other cause in a camp of new troops—then are exposed to the effluvia of an old sink, or accumulation of decomposing matter. These with other depressing mental influences produce the condition mentioned. We have a man in whom there is not the least deviation from the standard of health. He visits a privy where a whole camp deposit their excretions. He is almost stunned by the smell. The next morning he feels languid, feverish, weak; has perhaps headache, nausea. He eats his usual allowance of food. Visits again this source of disease, to find that his food has undergone no change in the alimentary canal, except fermentation and decomposition. He reports sick. The result— opium and chronic diarrhœa. If in the field, the surgeon may be unable to furnish him a change of diet. He treats his case week after week. At last the swollen gums, dark spots upon the limbs, and other symptoms of scorbutus appear as an accompaniment of diarrhœa, and a result of “improperly cooked food and want of anti-scorbutics.” I know of no reason why scurvy should be considered a cause of diarrhœa more than diarrhœa of scurvy. Each results from its own particular cause. The conditions surrounding the soldier which produce scurvy, may militate against a cure of his diarrhœa. When the vitiated secretions are once established, we then have present a constant exciting cause of this same condition of the nervous system. You find yourself in the condition of a man who attempts to heal a flesh-wound which contains the thorn that produced it. The improper action of the digestive organs upon food, when this condition is established, will often result p.297 in scorbutus. This will not be questioned. It is seldom that well-developed scurvy will be shown if proper food is given. But I have had it result with men who were feeding upon a vegetable diet. When once digestion is disordered in camp, proper diet alone will not always prevent scurvy. If the food is not assimilated, the patient is in the same condition as the man who feeds upon an improper diet. The fact being established then, that diarrhœa is produced only by the operation of a cause equal to such an effect, we will consider the third question. “Does not this scorbutic condition of the blood 2 cause fatty or amyloid degeneration of the small arteries supplying the sub-mucous tissue of the intestinal canal?” A microscopic examination alone will reveal this; the degeneration not being recognized by the unaided eye. The microscope shows, in many of these long continued cases, amyloid degeneration existing throughout the whole alimentary tract. Whether this degeneration (question IV.)1 is the cause of the persistency, I am unable to say. Whether it ever exists in obstinate cases which recover, would be a point to be first considered. I know of no ante mortem indications that will inform us. This amyloid degeneration extends to the kidneys in many of these cases, producing symptoms of BRIGHT’S disease; but more frequently we have an accumulation of serum in the abdomen. I have found in one case fatty degeneration of the heart, but this man was a scrofulous patient, and his lungs were stuffed with tuberculous deposits. How much this modified the condition of the heart I am unable to say. I never found fatty degeneration only when there was tuberculosis. I do not think that camp diarrhœa results from a scorbutic taint, but regard it as an expression of the pathological condition given. Whatever cause operates to produce diarrhœa must first produce this condition. In scurvy we may have no diarrhœa, though in the field the cases in which it does not exist are exceptional ones. In the prisons at Camp Chase nearly every one having scurvy had diarrhœa; but a large number having diarrhœa showed no signs of scurvy. The pathological conditions are dissimilar. The changes in the blood, the character of every pathological change being so different, we cannot regard one as the result of the other, further than as the combined influence of causes may tend toward the same result. As regards treatment, I would relieve first the portal system, and thus unload the secreting and excreting organs. The epithelial tissues being the ones involved through the nervous system, our remedies must be directed to them. Their intimate connection with absorption and assimilation, secretion and excretion, renders it evident, that unless we maintain their function, we can accomplish nothing. The diminished or vitiated secretions from the liver and kidneys expresses it too plainly to be mistaken. We should first administer Epsom salts and 3 unload the mucous membranes. Then give diuretics, alteratives, tonics, etc., as indicated. I regard opium as highly injurious in camp diarrhœa. It arrests the secretions you desire to establish. If the patient suffers much pain put a mustard plaster on his belly, or, what is better, draw a blister. I would give a pill, in acute cases, of small doses of ipecac., calomel, podophyllin and ext. hyoscyamus. I would excite the secretions of the liver, but avoid the use of mercurials as much as possible. As an astringent I prefer catechu. Give antacids, nux vomica, ale; baths of salt water, iron, ete., in chronic cases. Under the use of tannin, both in large and small doses, I have found no beneficial results. Bismuth I have used in a great many cases, in doses varying from three grains to fifteen grains. In one lot of a hundred cases I used eighteen ounces in a single week. I lost but one case, but think the benefit obtained from treatment was from other remedies combined with the bismuth. Lead, while it is a good sedative and astringent in acute cases, should not be given in chronic diarrhœa. For the treatment of a chronic case, a plan must be adopted that is indicated—then stick to it. If there is ulceration of the bowels, give enemas of argenti nitras, or cupri sulphas. If you wish to use opium ever, use a supository of opium, camphor, and soap. This will relieve tenesmus; the blister tormina. As an evidence that the disease affects the whole digestive system, we have the arrest of all the secretions. As an evidence that the disease is not confined to the large intestines, we have ulceration in other parts—thus, in O’Brien, who died at Madison, Indiana, in hospital, there was an ulcer which produced death by perforating the duodenum a little below the pylorus. He had ulceration of the rectum, which had been cured by injections of nitrate of silver, as the cicatrix showed. In one case examined at Rome, Georgia, with Surgeon G. F. FRENCH, U. S. Vols. there was ulceration of the cæcum, extending through all the tissues, and forming an artificial p.298 anus. The liquid flowing out was acid. The man died, post mortem examination showed an attempt of nature to fasten the bowel to surrounding tissues, but without success. The man was a chronic diarrhœa patient. No amount of drugs poured into either of these cases would have saved them. 4 ########################################## The Medical and Surgical Reporter 1866;15(3; July 21):82. https://archive.org/details/sim_medical-and-surgical-reporter_1866-07-21_15_3/page/82/mode/2up https://library.si.edu/digital-library/book/medicalsurgical1866phil p.82 Camp Diarrhœa. WE Whitehead EDITOR MEDICAL AND SURGICAL REPORTER: After four years’ experience in the army I have come to the conclusion that the causes of camp diarrhœa, or the diarrhœa that prevailed to such an alarming extent in our army, as well as the rebel army, during the late rebellion, are the following; which I shall put in the form of interrogations, hoping that some of my army civil professional brethren will throw some light upon this question by answering, through your valuable journal, one or more of the following questions: I. Is not the camp diarrhœa of soldiers in the field caused by a scorbutic condition of the system? II. Is not this scorbutic taint caused not only from lack of antiscorbutics, but as well from improperly cooked food? III. Does not this scorbutic condition of the blood cause fatty or amyloid degeneration of the small arteries, supplying the sub-mucus tissue of the intestinal canal? IV. Is not this amyloid degeneration the cause of the persistency and difficulty of cure of this disease? W. E. WHITEHEAD, M. D., Assistant Surgeon U. S. A. Cape Disappointment, W. T., April 30th, 1866. 5