Extreme homesickness, termed “nostalgia” during the Civil War, often killed more soldiers than enemy bullets.
Source: Warfare History Network
https://warfarehistorynetwork.com/2018/12/28/dying-to-get-home-ptsd-in-the-civil-war/
By Kevin L. Cook
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.”
In early 1863, Dr. Alfred Stillé, who worked at a large
military hospital in Philadelphia, reported heart palpitations to be a common
disease among the soldiers, in a form he had very rarely observed in civil
practice. Stille associated it with “a state of extreme exhaustion, especially
when occurring after violent and prolonged muscular efforts.” A few months
later, Dr. Henry Hartshorne noted among his patients, similar palpitations,
which he evocatively called “trotting heart” or “cardiac muscular exhaustion.”
Hartshorne recognized nervousness as a source of palpitations but found the
soldiers’ palpitations to differ in character from “ordinary sympathetic or
nervous palpitation” in his civilian patients.
Da Costa used the phrase “irritable heart” in the title of
an 1871 journal article in which he summed up his experience with more than 300
soldiers and continued to define it as a functional cardiac disorder. Besides
palpitations, sometimes violent, Da Costa noted that his patients suffered from
“smothering or suffocating sensations at night, a mere feeling of uneasiness
near the heart, shortness of breath, giddiness, and disturbed sleep, including
dreams of unpleasant character.”
Da Costa attributed a plurality, some 38.5 percent, of the
cases to hard field service, particularly excessive marching. Within this
category he included constant and heavy duty on the picket line, active
movements in the face of an enemy, forced marches, and arduous and exciting
fighting and marching. It was entirely opposite from other physicians’ positive
interpretation of battle-related activities during the war.
In contrast to an overall lack of treatment for mental
disease, there were some treatments in place for heart disease. Da Costa first
prescribed rest but also employed plant-based remedies, including digitalis,
aconite, veratrum viride, gelsemium, hyoscyamus (henbane), belladonna and
atropine, conium (hemlock), and Cannabis indica.
The Trouble With Treatment
Massive numbers of casualties made effective or even humane
treatment difficult. Julia Wheelock worked in Washington-area hospitals from 1862
through 1865. She estimated that there were 10,000 wounded in Fredericksburg,
Virginia, at one time. All the public buildings, including the courthouse,
churches, hotels, warehouses, factories, paper mill, theater, school buildings,
stores, stables, and private residences were converted into shelters for the
wounded, until Fredericksburg was one vast hospital.
Wheelock recounted wounded soldiers begging for pillows.
“I’m wounded in the head, and my knapsack is so hard,” said one. Another wanted
one for his stump. “I don’t think it would be so painful if I only had a
pillow, or cushion, or something to keep it from the hard floor,” the soldier
said. One “wretched hospital,” a former grocery store, had only a single small
candle for light. When someone moved the candle to another part of the crowded
room, Wheelock, afraid she would stumble over the injured, crept on her hands
and knees to deliver cups of broth to the wounded, starving soldiers. Many were
so fresh from the battlefield that their wounds were still undressed. Given
such conditions, it was small wonder that the often overwhelmed military
medical establishment could not care adequately for victims with poorly
understood psychological needs.
In 1855, Congress had established in Washington the Government
Hospital for the Insane, later St. Elizabeth’s Hospital. Its stated goals were
to provide “the most humane care and enlightened curative treatment of the
insane of the army and navy of the United States, and of the District of
Columbia.” Diversions of the mind were found to displace morbid feelings. Such
diversions included church services, educational lectures, music, books, and
musical instruments, including several pianos. Caregivers attempted “to render
the institution not only a good hospital, but a kind and sympathizing home.”
Recovering After War
After the Civil War, Congress liberalized the law governing
admissions to the hospital. Those accepted included former patients who
relapsed within three years of their discharge from the hospital, those
discharged from the military for insanity, and “indigent insane persons, who
have become insane within three years after discharge from such service from
causes which arose and were produced by said service.” Giving veterans three
years after discharge to seek treatment was a relatively forward-looking admission
that mental and emotional wounds, like physical wounds, could take years to
heal.
Some wounds never healed. A 2006 study of military and
Pension Board medical records of 17,700 Civil War veterans found an association
between the men’s wartime experiences and the occurrence of cardiac,
gastrointestinal, and nervous diseases throughout the remainder of their lives.
One measure found a 51 percent increase in those three disease categories.
Those removed from the battlefield were marked by their
experiences as well. A civilian relief worker wrote that after the Battles of
the Wilderness and Spotsylvania, “The surgeons were at work, probing,
extracting balls, amputating in the open air, while upon every hand were cries
of agony from the poor fellows, which would have melted any but a heart of
stone.” Years later, nurse Lois Dunbar recalled, “I have had men die clutching
my dress till it was almost impossible to loose their hold.” Even experienced
doctors and nurses could not easily forget such sights and sounds.
One soldier summed up the literal deadliness of nostalgia:
“Would you believe—and yet it is true—that many a poor fellow in the Army of
the Cumberland has literally died to go home; died of the terrible, unsatisfied
longing, home-sickness?” Against the ravages of nostalgia, he wrote,
paraphrasing Shakespeare’s Macbeth, “the surgeon combats in vain, for, ‘who can
minister to a mind diseased?’” Sadly, the answer to Macbeth’s rhetorical
question remained largely true 2½ centuries later, during the Civil War.
“Therein the patient must minister to himself.” For many soldiers, as for the
guilt-stricken Macbeth, there was no cure at all.
