Like Today, PTSD Was Rampant On Both Sides Of America's Civil War

September 24, 2020 Topic: History Region: Americas Blog Brand: The Buzz Tags: Civil WarPTSDMental IllnessWarMilitary

Like Today, PTSD Was Rampant On Both Sides Of America's Civil War

Extreme homesickness, termed “nostalgia” during the Civil War, often killed more soldiers than enemy bullets.

A slight knee wound brought the New Jersey boy to a Washington military hospital, but “his mind had suffered more than his body,” wrote volunteer nurse Louisa May Alcott. “He lay cheering his comrades on, hurrying them back, then counting them as they fell around him, often clutching my arm, to drag me from the vicinity of a bursting shell, or covering up his head to screen himself from a shower of shot; while an incessant stream of defiant shouts, whispered warnings, and broken laments poured from his lips.” Such hallucinations and flashbacks are consistent with what is now called post-traumatic stress disorder.

Symptoms labeled “shell shock” or “combat fatigue” in later wars were poorly understood during the Civil War, and writings of the period imprecisely labeled them “homesickness,” “nostalgia,” “irritable heart,” or sometimes “sunstroke.” Of course, homesick soldiers were not unusual during the war. The very word homesickness had more serious implications than it does today. Kate Cumming, who worked as a nurse in various Confederate hospitals, recounted a concert at which a hospital matron sang “Home, Sweet Home.” It was a mistake, Cumming wrote. “It scarcely does to sing such a song at present, as it touches the heart a little too deeply.” Similarly, Union Surgeon General William A. Hammond wrote that it was often necessary “to prohibit the regimental bands playing airs which could recall or freshen the memories of home.”

Union surgeon John G. Perry said he had attempted to suppress his emotions before he left home, but on the boat headed to the front he had behaved “as I did when a child for the first time away from home. I cried as I did then, all night long.” Perry thought the man in the berth above him was asleep, “when suddenly he rolled over and looked down upon me. I felt for the moment thoroughly ashamed of myself, but he said nothing and settled back into his place, and then I heard him crying also.” Perry said he was haunted by the word home. “An awful sinking at the heart still sweeps over me, and I can easily understand how soldiers die of homesickness.”

A lieutenant with the 3rd Iowa Regiment observed that “many good soldiers were possessed of a homesickness—a desire to be sent home on furlough or discharged, that amounted almost to a mania.” One Union surgeon went even further, claiming that homesickness “killed as many in our army as did the bullets of the enemy.”

A Concern of Both Armies

Concern over homesickness went up the chain of command in both the Union and Confederate armies. In his Confederate surgeon’s manual, Dr. J. Julian Chisolm said that in the Army of Northern Virginia when “homesickness threatened to break out as an epidemic, an order to erect works was always hailed with pleasure.” Even if the fortifications went unused, they were built “simply to keep the men employed, and make them contented and happy.” In 1863, North Carolina Governor Zebulon B. Vance wrote President Jefferson Davis, listing homesickness as one of “the causes which move our troops to quit their colors.”

On the Union side, an official of the United States Sanitary Commission, an organization that supplemented the U.S. Army’s medical and relief efforts, said homesickness was “a great difficulty which our surgeons have to contend with in their patients. Medicines are then useless.” The Government Hospital for the Insane reported that homesickness was “evident by the character of the morbid mental manifestations exhibited by several of our army patients.”

The Symptoms of Nostalgia

Nostalgia was closely related to homesickness. In fact, some writers equated the two. Assistant Surgeon J. Theodore Calhoun wrote in 1864 that nostalgia was merely the more professional term. The Surgeon General’s official history, The Medical and Surgical History of the War of the Rebellion, said that homesickness occasionally “developed to a morbid degree and was reported as nostalgia.”

Official figures for nostalgia cases were not large—5,547 cases, 74 deaths, and 36 discharges through June 1866—making the malady less prevalent than epilepsy, for example. However, Assistant Surgeon Roberts Bartholow said, “These numbers scarcely express the full extent to which nostalgia influenced the sickness and mortality of the army.” Bartholow, who wrote the surgeon general’s manual for soldier enlistment and discharge, said nostalgia was frequently fatal and was “a ground for discharge if sufficiently decided and pronounced.” Calhoun saw nostalgia often as a cause of other disease, or as a “complication to be dreaded as one of the most serious that could befall the patient.”

Symptoms attributed to nostalgia varied from doctor to doctor. Bartholow listed “weeping, sighing, groaning, and a constant yearning for home; hallucinations and sometimes maniacal delirium.” Dr. Samuel D. Gross, a professor of surgery, said nostalgia was “characterized by a love of solitude, a vacant, stultified expression of the countenance, a morose, peevish disposition, absence of mind, pallor of the cheeks; and progressive emaciation.”

Assistant Surgeon De Witt C. Peters noted that early symptoms included great mental dejection, loss of appetite, and indifference to external influences. These gave way to hysterical weeping, throbbing of the temporal arteries, an anxious expression of the face, and “watchfulness,” among other symptoms. Another surgeon referred to “impaired digestion and prostration of nerve-power manifested by languor, tremulousness, palpitations and obscure cardiac pains.”

Peters said that among young prisoners of war, nostalgia was the worst complication to encounter. Anna Holstein, a volunteer nurse, had experienced the condition with former prisoners. A Union soldier under her care became frantic with terror. When asked if the flags on the walls looked like Rebel flags to him, the soldier replied, “Oh, no, that looks like home.”

Treating Nostalgia

There was no agreement on how to treat nostalgia patients. Calhoun recalled his boarding school days, where ridicule was wholly relied upon. “The patient can often be laughed out of it by his comrades, or reasoned out of it by appeals to his manhood,” wrote Calhoun, “but of all potent agents, an active campaign, with its attendant marches, and more particularly its battles, is the best curative.” As evidence, he discussed a unit that lost men daily in camp while adjacent regiments remained healthy. Actively engaged at the Battle Chancellorsville, however, they fought nobly, developed a strong esprit de corps, “and from that day to this, there has been but little or no sickness, and but two or three deaths.”

Similarly, Surgeon John L. Taylor noted that “kind and sympathizing words—amusements—seemed to invite a more deplorable condition.” That approach predominated in his regiment, whose officers told soldiers that their disease was merely moral turpitude, looked upon with contempt, and that “soldiers of courage, patriotism and sense should be superior to the influences that brought about their condition.” Taylor claimed better success with his method. “This course incited resentment, passions were aroused, a new life was instilled and the patients rapidly recovered,” he said.

In sharp contrast, Gross argued for more sympathy and less criticism. “The treatment is moral rather than medical,” he advised, “agreeable amusements, kindness, gentle but incessant occupation, and the promise of an early return to home and friends constituting the most important means of relief.”

Another surgeon’s view was to give the troops something to do to pass the dull hours. “An officer should be detailed as Superintendent of Public Amusements, who should be manager of theatrical performances, races, competitive shooting and prize competitions of all sorts.”  Ultimately, such treatments may say more about the surgeon than about the patient or disease.

Cases of an “Irritable Heart”

Some surgeons noted heart-related symptoms in nostalgia patients early in the war. In 1862, Surgeon A.J. McKelway reported heart disease caused by “overexertion preceding the battle and excitement and effort during its continuance.” With the benefit of two decades of hindsight, the surgeon general’s history observed: “Overaction of the heart during an engagement was due perhaps as much to nervous excitement and anticipation of danger as to overexertion. Even soldiers accustomed to the alarms of battle were not at all times exempt from the results of mental impressions.” Many cases arrived in hospitals after the continued exertion, anxieties, and excitement. Some patients experienced acute chest pain even while asleep.

Most Civil War surgeons did not make the now obvious connection between heart disease and stress. In late 1862, Acting Assistant Surgeon Jacob M. Da Costa reported an uncommon malady, called “Chickahominy fever,” among soldiers returning from Maj. Gen. George B. McClellan’s just concluded Peninsula Campaign. “Both body and mind remain for a considerable period enfeebled,” noted Da Costa. Symptoms included memory loss and “mental wandering.” Another surgeon listed such symptoms as “indifferentism, wandering and muttering, restlessness, insomnia, and watchfulness.”

Da Costa described typical cases with heart-related symptoms, including “palpitation and a feeling of uneasiness in the cardiac region.” Another patient had palpitations and sharp chest pains. The patient’s other symptoms improved and he regained his strength, “but any excitement or labor agitates him and brings on violent beating of the heart,” Da Costa observed. “The irritable state of the organ remaining long after the general health was in every other respect fully reestablished, all form a clinical combination of very great interest and frequency.”