TABLE I. Monthly Mortality Rates of the Armies of the United States during the Year ending June 20, 1862, erpressed in ratio per thousand of mean strength. Atlantic...... Central.... Pacific...... 2.00 2.06 1.79 2.04 2.68 3.24 2.93 2.43 2.58 3.16 3.27 3.53 32.40 1.02 2.73 3.49 4.66 6.36 6.61 8.68 9.27 10.66 6.67 7.40 6.15 82.19 1.45 1.48 1.18 1.54 1.43 0.91 0.21 0.41 1.03 0.26 0.00 0.44 10.76 [Diagram I., on page 711, exhibits the monthly mortality as given in Table I. The three regions are distinguished by the direction given to the lines of shading, as explained at the foot of Diagrams I. and II. The height of the several columns in each month is drawn to a scale, and corresponds to the mortality rate of each region.] GENERAL PREVALENCE OF DISEASE. The difference between the three regions above contrasted is not so conspicuous in the general sickness rates as in the mortality; yet the whole number taken sick in the central region was greater than on the. Atlantic coast, and in this, again, greater than on the Pacific. In the first, the number taken on sick report during the year was 3368.14 per thousand of mean strength, in the second, 2748.83, and in the third, 2586.00. It will thus be seen that in each of these regions a large proportion of the troops must have been taken sick several times during the year. Table II. exhibits the monthly ratio of "taken sick" for each of the three regions. It does not indicate the "constant sickness rate," but the total number taken on sick report during the month. The monthly fluctuations exhibited by this table are, of course, much less instructive than those of individual diseases; they scrve, however, to indicate a gradual improvement in the sanitary condition of the army during the war. It would be exceedingly interesting were it possible to present a table representing the "contant sickness rates" for the same period; but the imperfect data in the Surgeon-General's Office for the first year of the war do not afford the means for computing such a table in a reliable manner. TABLE II. Monthly Sickness Rates of the Armies of the United States during the Year ending June 30, 1862, ezpressed in ratio per thousand of mean strength. Atlantic 391.35 372.18 298.26 267.14 255.90 220.99 199.92 187.33 167.25 214.52 208.45 239.75 2748.83 Central. 258.65| 356.91| 325.40 326.11 209.24 305.71 323.55 219.85 252.61 284.32 259.70 232.83 3268.14 Pacific... 198.91 200.37 245.27 210.19 279.39 198.84 201.13 258.27 236.67 186.08 157.47193.51 2586.00 [Diagram II., on page 711, illustrates this table. It is drawn on a scale different from that of the monthly rates, but is otherwise similar. The three regions are marked by the same shading as in Diagram I.] CAMP FEVER. Under the head of camp fever, all the cases reported to the Surgeon-General's Office as typhus, typhoid, common continued, and remittent fevers, are here included. Of these several categories it may well be doubted how far the cases reported as typhus were really of that character. From the details furnished by sanitary reports, it ap pears probable that, with perhaps rare exceptions, what was regarded as typhus was, in fact, of a very different nature; severe typhoid fever, with cerebral complications, and congestive intermittents, in scorbutic constitutions being shown, in some cases at least, to have been regarded as typhus. This error was not, however, very widely diffused, the whole number of cases reported as typlins amounting to but a few hundred. As for the cases reported as common continued fever, the vast majority appear to have been different only in degree of severity from those reported as typhoid or remittent. Moreover, while a certain amount of uncomplicated enteric and remittent fever certainly did occur, especially at The three regions referred to in the text are distinguished by the direction of the lines of shading, thus, Atlantic coast. Central region. Pacific coast, REGION. the commencement of the war, the vast majority of the camp fevers of the army were of a mixed character, exhibiting undoubted enteric phenomena, variously combined with the periodicity and other peculiarities of malarial disease, and still further modified by the tendency to incipient scurvy which is the ordinary concomitant of camp diet. To indicate this mixed nature, the term" typho-malarial fever," which I had the honor to suggest to the Department in June, 1862, appears appropriate, and at the present time is coming into very general use. A correct understanding of the nature of these fevers is of the utmost importance, as they play a conspicuous part in the mortality of our armies. During the year under consideration, 44.5 per cent. of all the deaths from disease were due to camp fevers. gion the annual ratio of cases was 319.94 per thousand, and the ratio of deaths 101.8 per thousand cases, or one in 9.8. On the Pacific coast the annual ratio of cases was only 60.95 per thousand, and the ratio of deaths to cases 45.2, or one in 22.1. The severity of camp fevers in these several regions is thus shown to differ as considerably as their frequency. An inspection of the table, or of the accompanying diagram, at once exhibits the autumnal character of the disease. On the Atlantic coast the monthly number of attacks steadily increased until Novem ber, 1861, then as steadily diminished until March, 1862; atter which they once more increased in frequency. In the central region the maximum was attained in September, 1861, followed by a gradual diminution till March, and a subsequent increase, as on the Atlantic coast. On the Pacific coast, although there is less regularity in the fluctuates, it will be observed that October was the maximum month. The most superficial observer cannot fail to be struck with the similarity between these three waves and those of the intermittent fevers, of whose malarial nature there is no doubt, and which are illustrated in the next table and diagram. TABLE III. An examination of Table III. shows that the frequency and mortality of camp fever differ considerably in the three great regions. On the Atlantic border the annual ratio of cases was 238.99 per thousand of mean strength, and the ratio of deaths to cases was 71.9 per thousand, or one death to every 13.9 cases. In the central re Monthly Rates of Camp Fever in the Armies of the United States during the Year ending June 30, 1862, expressed in ratio per thousand of mean strength. 1861. 1862. REGION. Atlantic......... Central •uoqoma0 |ki° 8.30 18.78 25.60 27.64 27.88 19.74 13.85 13.81 10.99 17.42 24.88 27.07 238.99 15.94 34.07 38.06 36.57 35.38 26.00 21.98 18.15 16.46 23.71 29.39 27.61 319.94 1.45 6.28 1.97 9.73 5.31 7.43 3.78 5.00 5.15 3.28 5.52 1.78 60.95 [Diagram III. illustrates this table. It is on a different scale from I. and II.; but the three regions are marked by the same shading.] annual ratio was 375.34, the deaths 5.9 per thousand cases, or one to 170.0. On the Pacific coast the annual ratio was 151.68 per thousand of mean strength, and no deaths. INTERMITTENT FEVER. Intermittent fever, although a very frequent affection, has not been the cause of any great mortality. On the Atlantic border the annual The distinctly autumnal character of the disease ratio of cases was 195.94 per thousand of mean is well shown in the following table, and accomstrength, the rate of deaths to cases 6.0 per thou-panying Diagram IV. sand, or one to 165.9. In the central region the TABLE IV. Monthly Rates of Intermittent Fevers in the Armies of the United States during the Year ending June 30, 1862, expressed in ratio per thousand of mean strength. Atlantic. 10.97 27.96 39.32 34.46 22.08 14.08) 7.87 Pacific... 8.13 7.00 12.01 15.25 16.58 195.94 37.27 62.80 53.02 65.27 41.49 29.73 20.94 16.98 18.63 27.41 27.86 26.02 375.34 5.08 6.65 8.68 18.69 19.80 19.21 9.46 13.27 10.70 5.47 9.53 12.46 151.68 [Diagram IV, illustrates this table.] March. April. The three regions referred to in the text are distinguished by the direction of the lines of shading thus, Atlantic coast. Central region Pacific coast. REGION. DIARRHEA AND DYSENTERY. Diarrhoea and dysentery caused about onefourth of all the sickness reported. On the Atlantic border more than hali the army suffered, and in the central region the number of cases almost equalled the mean strength. Although not nearly so fatal as camp fever, affections of this class were an important cause of the mortality of our army. In the chronic cases, though most generally called diarrhoea, and not dysentery, the colon was the seat of the chief lesion. The most characteristic post-mortem appearance was a thickened, softened condition of the mucous membrane, with pigment deposit and enlargement of the solitary follicles, frequently terminating in ulceration, the ulcers being sometimes puncti form, sometimes extensive and irregular. In this condition the small intestine frequently par ticipated more or less, but often presented nothing abnormal. It appears from Table V. that the annual ratio of diarrhoea and dysentery on the Atlantic coast was 616.01 cases per thousand of mean strength, in the central region 994.77 per thousand, and on the Pacific coast 319.64. The relative mortality was, in the Atlantic region, 2.1 deaths per thousand cases, or one in 483; in the central, 9.6 per thousand, or one in 103.8; on the Pacific, 0.9 per thousand, or one in 1159. TABLE V. Monthly Rates of Diarrhea and Dysentery in the Armies of the United States during the Year ending June 30, 1862, express d in rutio per thousand of mean strength. Atlantic...... 168.23 116.23 70.80 62.66 46.06 28.54 23.20 22.30 15.22 67.0 70.92 87.06 616.01 Central... 88.93 127.7 93.34 92.50 69.63 61.27 68.00 54.15 68.66 105.32 97.07 83.02 994.77 Pacific 29.41 40.67 33.12 32.00 35.92 20.12 18.0720.02 23.87 18.97 29.09 30.25 319.64 [Diagram V. illustrates this table.] CATARRHAL AFFECTIONS. Catarrhal affections of every class were excoodingly common, attacking nearly one-half the forces in the field. The relative frequency in the three regions of the country appears to have been about the same:-on the Atlantic border 456.47 per thousand of mean strength, in the central region 427.20 per thousand, and on the Pacific slope 407.61. In all, the frequency of these affections increased greatly during the winter and diminished during the warmer months, the maximum month being January for the Atlantic and central, and February for the Pacific region. A large proportion of the severer catarrhal cases occurred as sequelæ to camp measles. The vast majority of the simple catarrhal cases terminated in recovery, the deaths being one to every 1127.8 A cases on the Atlantic coast, one to every 100.0 cases in the central region, and no deaths occur ring from this cause in the Pacific region. certain number of these catarrhal cases, however, terminated in pneumonia, and thus a part, at least, of the mortality of catarrhal affections is reported under that head. The annual rates of Ineumonia for the three regions were as follows: -On the Atlantic coast, 25.7 cases per thousand of mean strength, the deaths being 11.1 per thousand cases, or one death to every 7.6 cases; in the central region the cases were 61.2 per thousand of mean strength, the deaths 239.2 per thousand, or one to every 4.1; on the Pacific lope the cases were 20.9 per thousand of mean strength, the deaths 13.1 per thousand cases, or one to 76. TABLE VI. Monthly Rate of Catarrhal Affections in the Armies of the United States during the Year ending June 30, 1862, expressed in ratio per thousand of mean strength. Atlantic..... Central Pacific. 23.94 23.56 23.91 32.56 49.36 59.02 61.61 53.84 39.88 29.00 14.94 11.33 456.47 12.81 16.25 25.51 31.23 45.73 63.88 78.73 49.43 49.74 28.07 14.21 11.71 427.20 9.08 11.42 24.05 25.35 40.61 29.73 43.0) 77.46 46.31| 12.77 15.55 17.35 407.61 [Diagram VI. illustrates this table.] April. May. |