Medical/Surgical History--Part I, Volume I
Introduction.
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An examination of the monthly reports of sick and wounded from these General Hospitals shows that their population was constantly fluctuating. Thousands of patients were often received and sent away in a single month. Events at the front, and the consequent condition of the hospitals near the base of operations, more frequently than the nature of the disease or injury, determined the stay of the patient in any individual hospital. Of course when a number of cases were sent from a hospital in anticipation of fresh arrivals, the less serious cases of both wounds and disease were, so far as possible, selected for transportation, a fact which is not to be overlooked in interpreting the greater mortality which distinguished the hospitals near the base of operations; but it was not always practicable to adhere strictly to this rule. Moreover, no inconsiderable movement of individual patients was determined by the efforts made from time to time by the State authorities to have the sick and wounded transferred for treatment to hospitals within their own State boundaries.
A review of all these facts, and of others of similar character, which need not now be specified, compelled the compiler of this volume reluctantly to abandon the hope of presenting in tabular form the number of cases of each disease treated in General Hospitals. The plan adopted with regard to the matter may be briefly summed up as follows:
The Departmental tables embrace the Cases and Deaths obtained by the consolidation of the monthly sick reports of troops in the Field and in Garrison. They represent the number of men taken sick each month out of the mean strength given, and the nature of their complaints so far as could be ascertained by the medical officers who attended them. They set forth also the number who died with their commands, and in the several Post, Regimental, Brigade, and Division Hospitals attached.
The Hospital tables exhibit the number who died in the General Hospitals of each region, arranged by months and causes of death.
The Consolidated tables for Regions embrace, then, the total number of new Cases occurring from month to month in the strength given, arranged by diseases, and the total number of Deaths, also arranged by months and diseases, and including deaths in General Hospital as well as those occurring in the field and in garrison.
t will then be understood, that in computing the ratio of Cases to strength for any disease, the number of cases may be compared with the strength given in the departmental tables, or with their sum in the regional or army tables. But in computing the ratio of Deaths to strength, the hospital population, as exhibited in the several hospital tables, must be taken into account.
A comparison of the number of cases with the number of deaths for any disease will, however, require the consideration of some additional circumstances. For since it has been impossible to prepare tables showing the number of Cases of each disease received into the General Hospitals, and since every effort has been made to secure the distribution of the Deaths among the real causes of death, the number of deaths exhibited by the Regional and Army tables cannot always be regarded as bearing a direct relationship to the number of cases. The figures are to be regarded rather as independent facts, often intimately connected, and here offered for future reasonable discussion. No attempt has been made to reconcile the apparent discrepancies in the tables arising from this source. It was thought important that both classes of facts should be presented in the most complete manner, and that all attempt to bring them into accord should be postponed to become a subject of discussion in connection with individual diseases of importance in the Second Volume.
An examination of the tables, therefore, will show many instances in which the number of Deaths is disproportionally large as compared with the number of Cases, and even some instances in which more Deaths than Cases are reported. These examples are not to be looked upon as oversights or errors on the part of those to whom the preparation of the tables was entrusted. They are the necessary consequence of the fidelity with which the facts, as reported, were consolidated. A single example will serve as an illustration.
In table LXVII, which is an abstract of the Sickness and Mortality of the Central Region for the year ending June 30, 1864, it will be observed on page 429 that the number of Cases of Inflammation of the Brain reported is 215, with 271 Deaths, which might be supposed to involve an impossibility. But an examination of the previous table shows, page 423, that 128 of these deaths occurred in General Hospital. It would appear, therefore, simply that 215 Cases and 143 Deaths of Inflammation of the Brain were reported among the garrisons and troops in the Central Region during the year, and that besides 128 Deaths of the same disease occurred in the General Hospitals of the Region. Some of the Deaths in hospital were doubtless patients included among the Cases of the garrison and field reports; but the greater part of them were probably men who had entered hospital with other complaints. The detailed facts would be interesting and valuable, but cannot be ascertained. We can,. however, learn from the tables the number of New Cases of the disease which originated in the reported strength in field and in garrison during the time specified. We can also learn the whole number of Deaths attributed to this cause, including those which occurred in the given hospital population. Each of these facts has its own independent value, and each requires separate consideration. The two classes of facts can only be brought into relationship with a view to studying the relative mortality per thousand cases in connection with those affections of which a very large number of cases has been reported, and even in these instances the results attained will often require modification in accordance with considerations peculiar to each disease.
The writer is perfectly aware of the inconvenience of the circumstances just recounted, and has also fully considered many other objections to the plan which he has adopted for dealing with the monthly reports of the General Hospital. He also regrets greatly the impossibility of compiling tables giving general statistical information with regard to the number of cases of each disease which arose de novo in the hospital population, or of secondary diseases and complications. He is firmly convinced, however, that a more ambitious course than he has adopted would have led merely to less reliable results.
It must further be explained in this place that the tables in this volume do not embrace those Killed in Action, those dead of Wounds or Disease while Prisoners of War, or those who died while on Furlough, Leave of Absence. Absence Without Leave, or after Discharge from service on surgeon's certificate of disability. In the case of those Killed in Action, the monthly sick reports could not always be expected to attain accuracy, the Surgeon usually obtaining his information with regard to them indirectly and at second hand. The names of such of the killed as could be learned by him with reasonable certainty were entered in the sick report among the names of the dead, but the printed blanks directed that they should not be included in the statistical portion of the report, and a careful examination of the reports received shows that this rule was advisable.
The number of deaths from Gunshot and other Wounds given in the tables, therefore, excludes the Killed in Battle, bat the number of Wounded was intended to embrace all the Wounded among the mean strength given, and when this intention was not carried out, as was sometimes probably the case, especially after certain general engagements, it was in consequence of circumstances which interfered with the efforts of the Medical Officer to obtain full details with regard to the Wounded of the commands to which they belonged.
Instances in which this took place are known, and it, seems reasonable to suppose that many others must have occurred, so that the figures in the tables representing the number of Wounded, and especially the number of Gunshot Wounds, must be regarded as probably less than the real number occurring in the mean strength represented. For the full discussion of this part of the subject, however, the reader must be referred to the Surgical Volumes of this work.
In addition to the foregoing explanations, which it has been thought advisable to offer as aids to the appreciation of the tables contained in this volume, it seems proper to make next some general remarks with regard to the Total Losses of our armies during the war by Death, and by Discharge on surgeon's certificate of disability. These remarks will be founded upon estimates derived from other sources of information than the reports of sick and wounded employed in the construction of the tables, and will therefore be of service as indicating the degree of completeness which these may fairly be considered to possess.
The first source of information which would appear to require consideration is the Adjutant General's Office, in which are preserved the military records of the army. Here are to be found the Returns of posts, armies, and departments, the monthly Muster and Pay Rolls of individual companies, and the Final Statements of deceased soldiers. The last-named of these reports have served as the basis for a most pains-taking investigation with regard to the subject of our present inquiry. It was the duty of company and other officers to furnish such a record of each death occurring within their jurisdiction, and hence the fact and date of death was thus reported in a large part of the whole number of the dead. These returns give, in each case, the name, rank, company, and regiment of the deceased, and state also, whenever the officer making the return was acquainted with the circumstances, whether he was Killed in Battle, or Died of Wounds or of Disease.
Of course many men were killed or died for whom no such final statements were made at the time. After engagements men were often missing, concerning whom it was not known whether they were killed or taken prisoners; deaths not unfrequently occurred among men absent from their commands of which no responsible officer had knowledge; reports were captured by the enemy, lost or mislaid, and the duty of making them out was not invariably performed. At the close of the war, therefore, these files were far from complete.
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In reply to an inquiry from the Surgeon General, the Adjutant General has furnished the following statement dated October 25, 1870:
"The total number of deaths, so far as known at the office, from the commencement to the close of the Rebellion, is as follows:
Regular Army, Commissioned Officers 267
Regular Army, Enlisted Men 4,592
Volunteer Army, Commissioned Officers 8,553
Volunteer Army, Enlisted Men 256,427
Colored Troops, Commissioned Officers 285
Colored Troops, Enlisted Men 33,380
Total number of deaths 303,504"
The commissioned officers of the Colored troops being almost without exception white, the above figures may be classified as follows:
Total mortality among White Officers and Men 270,124
Total mortality among Colored Men 33,380
Total number of deaths 303,504
These numbers are to be understood as embracing the deaths from all causes, including the slain in battle and those who died while prisoners of war, or while absent on furlough or otherwise, so far as it has been possible to collect information with regard to them at the Adjutant General's Office up to the 25th of October, 1870.
The period represented by the words "from the commencement to the close of the Rebellion" in the above statement, was found, on inquiry at the Adjutant General's Office, to have been used in the case of the Regular Army with a somewhat different significance from that with which it was employed in the case of the Volunteer Forces.
For the Regular Army the figures represent the number of officers and men who are known to have died between the 15th of April, 1861, and the 1st of June, 1865.
For the Volunteer Forces, both White and Colored, however, the figures embrace all the deaths known to have occurred in the volunteer organizations called out during the progress of the war up to the date of their muster out of the service. This date may be approximately fixed for the White troops at about the close of the last fiscal year represented in this volume, though a few scattered Companies remained in service subsequently, the last of which, a Battalion of New Mexico Volunteer Cavalry, was not mustered out until November 18, 1867.
In the case, of the Colored Volunteers, the process went on more slowly, the last regiment having been mustered out December 20, 1867.
In both cases it is to be understood that the number of dead given is derived from an actual count of the names of the individuals recorded as dead, and not from the consolidation of numerical returns of any kind. This circumstance renders it quite clear that the real number of deaths cannot be supposed to be less than the statement above given by the Adjutant General, and a consideration of the facts with regard to the additions made to the death files since the war, will give weight to the opinion that it cannot be materially greater.
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Thus, for example, in Part VI of the Final Report of the Provost Marshal General to the Secretary of War, dated March 17, 1866, there will be found under the head of "Casualties in the Military Forces," an official statement of the mortality of the Army as deduced from the muster rolls and returns of the Adjutant General's Office. This statement, which is given in tabular form on page 78 of the report, embraces a considerable number of items, the consolidation of which gives the following results:
Number of deaths among White Officers and Men 250,651
Number of deaths among Colored Men 29,038
Total 279,689
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February 27, 1869, a report on the same subject was made by the Adjutant General to the Secretary of War, for the information of a Committee of the House of Representatives. This report, a copy of which was furnished to the Surgeon General, contained a "Consolidated Statement of the number of Federal Soldiers who died in the Service of the United States during the Rebellion." A consolidation of the items, of this table furnishes the following results:
Number of deaths among White Officers and Men 261,036
Number of deaths among Colored Men 33,380
Total 294,416
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