IV - OTHER DISEASES ATTRIBUTED TO EXPOSURE

I. - CONGESTION AND INFLAMMATION OF THE SPINAL MEMBRANES

Among the cases of disease due apparently to exposure to cold and wet were many in which the spinal cord or its membranes became affected.  Surgeon J. E. Sanborn, 27th Iowa, writing from Jackson, Tenn., March 31, 1863, refers to this spinal affection:

A singular affection has manifested itself in this regiment, taking the form of a severe spinal irritation and, possibly, spinal meningitis.  There is pain in the lumbar region, occasionally sharp but usually dull and aching; at times the feeling is described as a sense of weakness, with inability to stand or sit straight and a difficulty in lying down except in certain positions.  There is tenderness on pressure upon the spinal processes or just upon either side of them.  The first few cases of this disorder I suspected to be feigned, but the prevalence of the affection and the character of many of the subjects soon indicated that in many cases at least it was a serious reality.  Some cases were at first thought to be the result of an affection of the kidneys brought on by lying on the wet ground, an idea suggested by the fact that they were accompanied by dark or very red urine.  In other cases it was observed that this affection either followed or accompanied chronic diarrhea.  In the matter of treatment almost every reasonable mode has been employed:  Constitutionally, quinine and similar antiperiodics on the miasmatic presumption; then combinations of iodine and other alternatives, with tonics in cases of possible rheumatic diathesis.  Locally, stimulating liniments, blisters, cupping, both wet and dry, croton oil, and other forms of external irritation and pustulation, all of which have been almost invariably unsuccessful.  A number, having limped about with canes to support their bending spines for some time, have finally been discharged.  The temptation is so strong to feign such a disease that special care has to be taken the watch the cases and treat them vigorously.

Sometimes the attack was so sudden that the case, as in 1, 4, and 8 of the following series, was reported as one of paralysis; or as inflammation of the spinal cord or its membranes, if associated at its inception with febrile movement and tenderness over some part of the spine, as in cases 2 and 5; again the disease was reported as a chronic myelitis when the spinal tenderness, as in case 6, was not associated with a symptomatic pyrexia.  Whether the inflammatory action in these cases was modified by a rheumatic diathesis is uncertain; but in its light grades, when characterized merely by pain and stiffness, or impairment of muscular power in the limbs, it was generally reported as chronic rheumatism.

According to the records most of the cases of paralysis resulted from exposure in cold and wet weather.  In some instances there was a history of injury to the spine, but the proximate or immediate case in several of these, as in 3 and 10, were evidently the subsequent exposure to the vicissitudes and inclemencies of the weather.  The injury, however, may have determined the localization of the inflammatory results of the exposure.  The acceptance of this view would give a substantial support to Dr. Klapp's explanation of the frequency of rheumatic manifestations in the lower part of the spinal canal among soldiers on active service.  Over-exertion and heavy burdens on the loins would predispose by repetition as surely as a more pronounced injury inflicted but once.

The number of white soldiers reported as taken sick with paralysis amounted to 2,837, the deaths to 231 and the discharges to 2,838.  The anomaly expressed by these numbers is chiefly due to the fact that among the discharges mentioned were many cases that had made their appearance on the sick-report as inflammations of the spinal cord.  Others, reported originally as chronic rheumatism, were discharged on account of an aggravation of the spinal affection manifested by paralysis and muscular tremors, and paralytic sequlae of such diseases as the continued fevers also contributed to the total of those discharged.