4131 A145 1768 CIRCULAR No. 1. WAR DEPARTMENT, SURGEON GENERAL'S OFFICE, Washington, D. C., June 10, 1868. The following Report on Epidemic Cholera and Yellow Fever, as they occurred in the U. S. Army last year, is published for the information of Medical Officers. J. K. BARNES, Surgeon General. 30220 REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER IN THE ARMY OF THE UNITED STATES, DURING THE YEAR 1867. By Brevet Lieut. Col. J. J. Woodward, Assistant Surgeon, U. S. A. SURGEON GENERAL'S OFFICE, May 5, 1868. GENERAL: In accordance with your instructions, I have prepared an account of the prevalence of cholera and yellow fever in the army during the year 1867, which I herewith respectfully submit: I.-EPIDEMIC CHOLERA. In view of the possible appearance of cholera during the approaching summer, the Surgeon General issued a circular on the 20th of April, 1867, which gave instructions as to precautionary measures, and directed that in case the pestilence should appear among the troops at any post, a special report should be made, giving a statement of the facts, and transmitting the names of all officers and soldiers attacked, together with the nativity, age, rank, regiment, company, length of service, date of attack, and date of recovery or of death, in each case. (See Circular No. 3, Appendix, p. 17.) These reports were made with commendable diligence by the medical officers brought in contact with cholera during the year, and from these, mainly, the following sketch of the epidemic has been prepared. In compiling the statistical tables appended, (Appendix I, pp. 1-15,) the figures contained in the monthly reports of sick and wounded have been carefully compared with the lists of names, and all discrepancies inquired into and corrected. It is therefore believed that the figures are worthy of all confidence. These tables show the monthly mean strength at each station mentioned, and the monthly number of cases and deaths of cholera, cholera morbus, acute diarrhoea, chronic diarrhoea, acute dysentery, and chronic dysentery, are presented separately; the tables also give a monthly total for these diarrhoeal diseases, a total for all other diseases, and an aggregate. Wounds, accidents, injuries, and violent deaths are not included under the head of all other diseases, and are not considered in this report. This rule was also followed in constructing the tables in Circular No. 5, of 1867, which gave an account of epidemic cholera in the army during 1866. The second part of Appendix I, under the head of extracts from official reports, contains such portions of the special cholera reports elicited by Circular No. 3, and of other official documents, as were thought to possess professional interest. To these the reader is referred for details, a mere outline of the progress of the epidemic being presented in this report. (See Appendix, pp. 16-69.) It is well known that cholera prevailed extensively in the army during the year 1866, causing over 1,200 deaths among officers and men.* Circular No. 5, of 1867, giving a detailed account of the epidemic of 1866, was sent to each medical officer, in anticipation of the possible return of the disease in 1867. It will be seen, by consulting that document, that cholera spread over the country during the year 1866, extending as far westward as Forts Leavenworth, Riley, and Gibson; and in the southwest as far as Texas. In its progress the disease followed the lines of travel rather than any general westward course, and, in the case of the army, it especially followed the movements of bodies of recruits, which were the most important movements from infected points during the year. The compiler of Circular No. 5 drew hence an argument in favor of quarantine, and the Surgeon General, in Circular No. 3, instructed medical officers to endeavor, as far as possible, to protect any threatened command by a proper quarantine. The measures thus adopted, in conjunction with the hygienic precautions directed in the same circular, undoubtedly saved· many lives in the army, for the total number of deaths from cholera during 1867 was but 230, and it cannot be claimed that the disease in itself was less virulent during 1867, for the proportion of deaths to the total number of cases was 1 death to 2.19 cases, while during 1866 it was 1 to 2.22. In a general way, it may here be said that the experience of the army during 1867 confirms the views in favor of quarantine formed during 1866, and especially confirms the opinions formed with regard to the danger of distributing recruits or other bodies of troops from an infected point to other garrisons. An additional point, however, is also suggested by the experience of 1867, namely: The possibility of cholera reappearing on the following year at places visited by it during an epidemic, if the most stringent hygienic precautions are not adopted. It is believed that an examination of the appended documents will convince the reader that, so far as the troops were concerned, such hygienic precautions were rigidly enforced during 1867. But, as the summer opened, cholera reappeared in the valley of the Mississippi, and to the westward, at a number of the places where it prevailed during the previous year. At most of these points it occurred first among the citizens, and afterwards appeared among the troops; but it has not always been possible to obtain the date of the first case among the citizens, and hence it is not possible to assert that this was the invariable rule, though it is believed it was so. Had the cases thus originating been the only ones, the mortality from the disease. would have been comparatively small; but the unfortunate movement of infected troops * Circular No. 5 reports, page XIII, 2,724 cases, 1,217 deaths. Additional reports from Texas, not received at the date of publication, contain 89 cases and 52 deaths; making a total of 2,813 cases and 1,269 deaths. |