Originally published in Spring 2004 in the Surgeon’s Call
Early in the Civil War, when men were filled with enthusiasm and were eager to support the cause, examining surgeons had to be vigilant about concealed diseases and infirmities. Recruits who entered the armies with concealed conditions became, at best, a burden on the military and, at worst, a source of contagion. As the war progressed and men were less eager to become soldiers, the surgeons were faced with the task of unmasking feigned diseases and conditions. The deceptions were done both by men wanting to escape the draft and by soldiers who were seeking a medical discharge or a transfer to a hospital.
Since most soldiers had little medical knowledge, the most frequently feigned diseases were ones with which they were most familiar. Chronic rheumatism was the most common feigned ailment early in the war, until the War Department prohibited the discharge of men for that disease in 1862. Pretending to have heart disease, deafness, loss of voice, defects in vision, incipient tuberculosis, and hemorrhoids was also common. The exaggeration of an existing disease or wound was also used in an attempt to fool the surgeons.
Medical officers had to be vigilant to detect the malingerers under their care. In the hospitals, constant surveillance was the best way to discover if a soldier was faking his illness, but such surveillance was impractical for the surgeons and often fell to the nurses or the other patients in the ward. If a surgeon suspected malingering, his best recourse was to perform tests on the patient, appropriate to the disease, and question the patient at length about his condition. Again, as few soldiers possessed medical knowledge their answers would often expose their charade since they would claim inappropriate symptoms or emphasize the symptoms that are least important to the particular disease.
One Union surgeon’s method of dealing with suspected malingerers was to first give them extra duties in the wards and overload them with work, so that they would begin to think their lot would be easier with their regiments. If that approach did not work, the surgeon would make the treatment of the “illness” unbearable for the patients. For example, men who pretended to have chronic rheumatism would be treated with fly blisters applied directly onto their spine, alternating with generous doses of castor oil.
Pain was the most common complaint of malingerers mainly because it was difficult to prove or disprove. Constant headache, chronic rheumatism and generalized neuralgia all fit into this category. Claims of deafness, loss of voice, blindness and paralysis were more easily tested by observation or by sudden noises and threatening movements which distracted the men from their pretense. At times, a light dose of anesthesia was administered since it was difficult for the patient to maintain the ruse under its effects. Simulated epilepsy was harder to ascertain since the disease is very variable and was little understood. The surgeons noted that in most cases of feigned epilepsy the patients often over-acted the seizures and could not reproduce the true loss of consciousness exhibited during these episodes.
Other diseases could be imitated by using external means. The chronic cough typical of incipient tuberculosis can be induced by will, and in some cases was enhanced by adding blood to the expectoration, usually from the gums. Swallowing tobacco produced nausea and vomiting, putting a solution of belladonna in the eyes caused dilated pupils and blurry vision, and coated tongues were created with ashes, chalk, clay, soap, or a number of other common items. Soldiers also resorted to self-inflicted wounds to obtain a discharge.
One soldier was creative in his methods, and had at least partial success. His hospital record reads: “Feigned sick with piles (hemorrhoids) for two months when his deception was detected, he having procured the heart of a turkey and introduced it into the rectum to resemble piles.” The surgeons of the Civil War were constantly challenged by men who wished to avoid service or be discharged from it, and their means of detection had to be as innovative as the ones used by the soldiers.
A Manual of Instructions for Enlisting and Discharging Soldiers; Roberts Bartholow, 1863; reprinted 1991, Norman Publishing Co., San Francisco
A Manual of Military Surgery for the Use of Surgeons in the Confederate States Army, with Explanatory Plates of all Useful Operations; J. Julian Chisolm, M.D., Evans and Cogswell, 1864; reprinted 1983, Morningside House, Dayton, Ohio
Hints on the Preservation of Health in Armies and Manual of Instructions for Military Surgeons on the Examination of Recruits and Discharge of Soldiers; John Ordronaux, 1863; reprinted 1990, Norman Publishing Co., San Francisco
“Nostalgia and Malingering in the Military During the Civil War”, Donald Lee Anderson and Godfrey Tryggve Anderson, Perspectives in Biology and Medicine, Volume 28, No.1, pp156-166, 1984
About the Author
Terry Reimer is presently the Director of Research the National Museum of Civil War Medicine in Frederick, Maryland. Previous work includes over twenty years of experience in historical archaeology and research, specializing in 17th, 18th and 19th century American sites. She holds a B.A. in Anthropology from the University of Maryland and did graduate work in anthropology and folklore studies at George Washington University. She is the author of two books, One Vast Hospital: the Civil War Hospital Sites in Frederick, Maryland after Antietam and Divided by Conflict, United by Compassion: The National Museum of Civil War Medicine, and the co-author of two other books, Bad Doctors: Military Justice Proceedings Against 622 Civil War Surgeons and Caleb Dorsey Baer: Frederick, Maryland’s Confederate Surgeon.