Scurvy in the twenty-fifth army corps

The Boston Medical and Surgical Journal 1866;74(8; March 22):155-157. https://doi.org/10.1056/NEJM186603220740802 https://archive.org/details/per_the-boston-medical-and-surgical-journal_the-boston-medical-and-surgical-jou_1866-03-22_74_8/page/154/mode/2up https://doi.org/10.5281/zenodo.15582247 SCURVY IN THE TWENTY-FIFTH ARMY CORPS. To the Editors of the Boston Medical and Surgical Journal. IT is known to some of your readers that scurvy has prevailed to p.155 an unprecedented extent along the Rio Grande river since the 25th Army Corps (colored) have occupied its banks. It commenced its sad work immediately after the troops landed at Brazos Santiago, in the latter part of June, 1865, and intensified until August following, when it began to abate. About nine thousand —one third of the whole command—were seriously affected, and many died. During the voyage, and four to six weeks after, fresh vegetables were rarely seen. On the arrival of fresh vegetables in August the disease rapidly declined, though many were left crippled by its prostrating influence, a part of whom have died and some remain incurable. The white troops in this department were affected by scurvy, though of a milder type, and few died. A few new cases have occurred since August, and it has reappeared in others supposed to be cured. The Medical Director of the 25th Army Corps, E. P. Morong, U. S. Vols., is preparing a detailed account of the malady, which will be of great interest, because of his ample resources for facts connected with it, I have examined the bodies of about fifty who have died at this hospital, and have selected one case from my notes for your JOURNAL, not so much for its special interest, as because it is typical of a large class, which you are at liberty to publish if you think it of sufficient interest to the profession. CASE No. 27.—Scurvy.—Henry Colwell, private, Co. E, 114th U. S. C. T.—This man was attacked with scurvy about the first of July. Gums swelled, bleeding easily. Soon had sores on his legs, arms and sides. July 24th, entered post hospital at Brownsville. Gums spongy, dark livid color; small patches had sloughed. Sores on limbs not healed, discharging some pus. Legs and feet said to feel, when put to the ground, as if it was carpeted with pins, points up. Small appetite; much lassitude; bowels torpid. Patient did not improve much until September, when he appeared to be convalescing rapidly. Some time in October he “took cold.” Cough came on, and some expectoration. Complained somewhat of chest, but most of “misery around the navel.” Nov. 1st.—Patient came under my care. Gums pale and shrivelled; sores healed. There was tenderness over the entire abdomen, particularly in the umbilical region and along the border of the costal cartilages. Slight dulness over the upper lobes of both lungs. Some 1 cough and frothy sputa; some dyspnœa; tongue slightly coated. Pulse weak—110; skin hot. Bowels loose, but no diarrhœa. Urine normal. R. Expectorants, anodynes; some stimulus and nutritious diet, followed by tonics; mustard externally. Nov. 18th,—Doing well, apparently improving. Continue treatp.156 ment. Nov. 21st— Not so well; “breast hurts me.” Flinches on percussion. Tenderness over liver; pulse weak and small; muco-purulent discharge from nose and lungs. Some dyspnœa and irritative cough, R. Pulv. Doveri p. r. n.; stimulus and. irritants externally. 23d.—Breathes more easily. Great, tenderness over spleen and epigastric region. Mouth moist. Anxious expression. 24th.—Much the same; except almost pulseless during the past twenty-four hours. - 25th.—In articulo mortis twelve hours, Died. Sectio cadaveris three hours after death. Face anasarcous, especially the eyelids. Legs completely speckled with black cicatrices; scars of the sores existing in the early stage of the disease; some scars on the sides and arms. These scars are one fourth to one inch in diameter. Considerable adipose; but diminished muscular tissue. Inside of lips and gums, palms of hands and soles of feet, nearly white. Thoracic cavities moist. Upper lobes of both lungs somewhat congested; a dense white deposit around the small bronchial tubes, constituting one third of the parenchyma (where it was found), giving a mottled appearance, Some frothy mucus throughout the lungs, which were otherwise crepitant. Pericardium contained six ounces of limpid serum. Heart normal, except all the semilunar valves, which were much attenuated; fibrous structure entirely gone. Liver yellowish and interspersed, one in every half inch of cubic space, with specks, about the size and color of tomato seeds. It firmly adhered to the diaphragm, between which and the liver was a layer of white, cheesy deposit, about one fourth of an inch thick. Spleen about the normal size, but exhibiting an uneven surface, caused by tubercles interspersed through its structure, resembling those in the liver, but larger, some of them red, and some white, and thickest along its lower border. Pancreas. On the posterior, lower side the lobules were enlarged, one from half to one inch in diameter, giving a gritty sound on cutting. Structure not much altered in other respects. Kidneys flaccid, pale, tough, of uniform color. Pyramids distinct. Interspaces of pyramids quite empty; white tissue in pelvis increased. Intestines. Descending colon, sigmoid flexure and rectum small and pale. Diameter of calibre about one inch. The last twelve inches of the ileum, congested and red. The mesenteric glands were enlarged, some of them being one inch in diameter. Similar enlargements existed in the mesocolon. No other changes of interest were noticed. Head not examined. IRA PERRY, Assistant Surgeon, 9th U. S. C. T. Post Hospital, Orange Grove, Brownsville, Texas, Feb. 9th, 1866. 2 P. S.—This hospital has capacity for 300 patients, but contains only about 200 at present, mostly chronic cases. The weather is very fine. Roses and oleanders are in blossom. Garden vegetables p.157 are scarce, and will not grow without irrigation, but are seen in every stage of growth. One large garden near by, belonging to a Frenchman, contains about ten acres in a good state of cultivation. Cabbages, turnips, beets, radishes, carrots, green peas, &c., can be had any day, in quantities, raised in the open air. The mercury has been at 32° three mornings; and at 30° one morning, the 4th of January. Nine days in this month it has varied, from 40° to 83°. I. P. 3