Friday, August 21, 2009

Medical Department #28 - Scratching Your Civil War Itch

Here's an older "Medical Department" column from The Civil War News to add to the archives here on the blog!

By James M. Schmidt
The Civil War News – “Medical Department” – October 2006
“There were two things that stuck closer than a brother; that was the itch and body lice or greyback as they were politely called…I had a bad case of the itch… it became very bad; so much that my hands were swollen and my fingers stood apart. Sores and yellow blisters came between them and they ran corruption. I could scarcely touch anything, my hands were so sore.”-Pvt. Milton Asbury Ryan, Co. B, 14th Mississippi, CSA

In his recent article, “The ‘Army Itch’: A Dermatological Mystery of the American Civil War” (Journal of the American Academy of Dermatology, August 2006, Vol. 55, No. 2, pp. 302-8), Thomas G. Cropley, M.D., provides an excellent review of this chronic, painful, and epidemic skin condition that plagued Private Ryan and thousands of other soldiers, North and South. The article includes a chronology of the disease, extensive excerpts from the writings of period physicians who saw and treated the disease, and a description of the treatments used.

[Note that since the time this article first appeared in The Civil War News in October 2006, Dr. Cropley has authored another interesting article: "Dermatology and skin disease in the American Civil War," Dermatol Nurs, 2008 Feb;20(1):29-33.]

Dr. Cropley received his M.D. from the University of Virginia and completed his residency at Harvard University. (At this writing) he is currently Professor of Medicine at the University of Massachusetts Medical School and director of the school’s Dermatology Residency Program. In addition to his own clinical and teaching work, Dr. Cropley is also deputy editor of the Journal of the American Academy of Dermatology. Earlier this year at their annual meeting, the History of Dermatology Society awarded him its Samuel J. Zakon Award (First Prize) for his research and paper on army itch.

Dr. Cropley (who is named “Thomas” after Thomas J. “Stonewall” Jackson) has been interested in the Civil War for a long time and his interest in Civil War medicine is an outgrowth of his interest in medical history in general. “I grew up in West Virginia, very close to the battlefields of the 1861 Kanawha Valley campaign,” he told me. “My grandfather, an unreconstructed ‘Reb,’ used to take me out hunting for artifacts like Minie balls and the like.” Dr. Cropley also speaks a number of foreign languages (including Gaelic!) and plays the bagpipe competitively.

Army itch, referred to as “camp itch” in the Confederate army, was a disorder that baffled military physicians of the day. The “mystery” is that medical opinion at the time was divided over the true nature of the disease: some thought it to be epidemic scabies, others thought it a unique malady, and still others considered it to be a mix of the many skin conditions that plagued the armies due to poor hygiene. There was no dispute over the seriousness of the itch: at best it was a nuisance, but Cropley notes that it often reduced the effectiveness and morale of afflicted troops to a dangerous degree.

In the main, Dr. Cropley’s paper includes accounts on army itch drawn from the writings of nearly twenty army surgeons and civilian physicians. The excerpts are drawn from period publications such as Medical and Surgical Reporter and the Confederate States Medical and Surgical Journal. Reading the accounts gives witness to several important characteristics of the disease: first, the itch was debilitating – in addition to painful lacerations, the incessant itching was exhausting in itself; second, many of the physicians noted that the disease spread to the local population after an army passed through; third, most soldiers waited too late to approach their medical team about the disease.

“We see this nowadays, too,” Dr. Cropley told me. “Scabies is insidious. The itching is tolerable at first, and patients generally do not seek medical attention. Later, the itch becomes maddening, and it is at that point that patient seeks care.” He suspects that many soldiers with itch did not report for surgeon's call, as they were unlikely to be relieved from duty or treated in many cases.

In the article, Dr. Cropley notes some of the treatments for the itch, including sulphur-based alkaline ointments or washes, to which were added cooling or astringent compounds. Arsenicals and mercury were also used, and while effective were almost certainly toxic. Short on sulphur due to its use in the manufacture of gunpowder, the Confederates established an interesting clinical experiment at Richmond’s Chimborazo Hospital to evaluate alternative treatments. Topical application of strong decoctions of native plants such as poke root, broom straw, and slippery elm were found to be helpful.

Dr. Cropley also told me that the military’s itchy encounters did not end with the Civil War. “Epidemic scabies always follows the population disruptions of wartime,” he said. “The United States Army has had an ongoing scabies eradication program in Kosovo and Bosnia for the last 10 years or so. I have heard from colleagues that Afghanistan and Iraq have significant scabies as well.” Dr. Cropley added that these modern outbreaks are mostly in the local population and not in military personnel, but they still require the attention of Army dermatologists attending to civilians.

Dr. Cropley told me there are many other interesting dermatological mysteries to be found in studying the Civil War. To him, one of the more interesting stories regards General Henry W. Halleck's itchy elbows. “Halleck apparently had the disconcerting habit of rubbing his elbows, especially when under stress,” he told me. “Secretary of the Navy Gideon Welles in particular found this annoying and even commented on it in his diary.”

So why did Halleck rub his elbows? “Itchy elbows can be due to a number of causes, and the scratching behavior can be a habit rather than a response to an actual itch,” Dr. Cropley told me. He added: “Halleck's medical record is pretty short, but the thing that caught my eye was his statement in a fall 1864 letter that he was having his annual trouble with itchy, watery eyes.”

Dr. Cropley believes that Halleck might have been suffering from seasonal allergic keratoconjunctivitis (“hay fever”). “Hay fever is an atopic disease and is frequently accompanied by atopic dermatitis,” he told me. “Atopic diseases often worsen under stress, so I think, but I can't prove, that Halleck had atopic dermatitis as the cause of his itchy elbows.”

Learning more about Halleck’s mysterious condition sounds like a historical itch that Dr. Cropley is destined to scratch, and I’m predicting another award-winning paper about a Civil War-related dermatological story in his future.

[Many thanks are due to Mr. Michael Gay, Ann Arbor, Michigan, for kindly granting permission to use the opening quote, which appears in his great grandfather’s unpublished memoir, “Experience of a Confederate Soldier in Camp and Prison in the Civil War, 1861-1865.”]

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