The
following is a dictated translation of the hand-written application to
the U. S. Navy Examination Board during the Civil War by a civilian
physician/surgeon for a position as a medical officer in the Federal
Navy or for promotion to Assistant Surgeon by an Acting Assistant
Surgeon. The actual
applications are in the possession of the author and presented to
enlighten the general public and other researchers as to the education
process before and during the Civil War, the personal history of the
applicants, as well as to show their personal level of medical knowledge
in answering the questions asked by the Navy Board of Examiners.
(Some applicants failed to pass and did not serve or served in the Union
Army.)
This written presentation was first of a part of a two-part exam consisting of a written
exam and an oral exam.
Many of these applications are rich
with highly detailed medical content offering an interesting perspective
on the medical knowledge and practices of the period.
A broad sampling of these exams is presented to
give you a 'picture' of the type of applicant being examined and
admitted to or rejected by the Federal Navy in 1863. Much more detail
on the individuals and their personal and naval history will be
presented in a forth-coming book by Dr. Herman.
(The actual written exam photos are available, but not presented on
these pages due to the size of the files. An
example
of a hand-written exam is on the
List of all Applicants page)
If you have additional information or images for any of these
doctors, please
contact us.
A list with links to
all applicants in this survey of U.S. Navy Applicants for 1863
Example of a handwritten exam given by the Navy Examination Board
Applicant: Christopher J. Cleborne, M.D.
Philadelphia
10th
September 1863.
Gentlemen,
In
obedience to orders received on the 18th May 1861, I reported
for duty on board the U.S. Sloop of war “Jamestown” of which vessel Dr.
Jno Rudenstein was Surgeon. On the 8th of June 1861, we
sailed for Charleston S.Ca, on 20th June, sailed from the
blockade at Charleston to Fernandina Fla. + returned the Hampton Roads
in Sept 1861.
On 27th Sept. we left
Hampton Roads for the blockade off Wilmington N.Ca. In January 1862, I
was detached from the “Jamestown”, + ordered to relieve Passd.
Asst Surgeon A. M. Vedder on the Sloop “Dale” at Helena Sound S.Ca. On
the 20th July 1862, I was surveyed, + sent North to recruit
my health. I reached home in August 1862. On the 17th of
Sept 1862, I received orders to join the U.S. Gun-boat “Aroostook” at
Washington D.C. and left the same month for the blockade off Mobile
Ala. On the 5th August 1863, I was detached from
“Aroostook”, and preceded North pr [sic] Steamer ‘Creole’,
arriving in N. York 21st Aug 1863.
The “Jamestown,” being a
remarkably healthy vessel, afford one but few opportunities for
observing or treating disease; - Some few cases of Rheumatism, Catarrh,
Bronchitis + minor Surgery. - The same remarks apply to the class of
diseases met with on board the “Dale.” + “Aroostook.”
I met with some cases of
gun-shot + other wounds @ the “Hospital” of the 145th regt.
Tenth Vol. (stationed [sic]@ Otter Isld. St. Helena Sound
S.Ca. The Surgeon of that regiment Regt (Dr. Potter) having
been taken sick, was removed to the “Dale”, and duties of the Army
Hospital devolved upon me for some time, this together with my practice
among some 250 Contrabands, (refugees) afford me the only opportunities
I had for observation.
All of which is
respectfully submitted for your consideration.
I am
Gentleman, your obedt. Sert
C. J. Cleborne Asst
Surg. U.S.N.
To the ‘Board of Med.
Examiners’
Naval
Asylum
Questions by the Board:
Questions to be answered in writing,
by, Asst Surgn Christopher J. Cleborne
1. What are the accidents or
injuries which requiring amputation of the thigh?
2. What is the best mode of
controlling the circulation in amputation of the thigh?
3. What is flooding? – how produced?
– and how arrested? ….
4. Give in brief the cartilages,
muscles, and ligaments of the Larynx.
5. Describe the physiology of
digestion.
6. What are the constituents of
Blood?
7. Describe the poisonous effects of
strychina, the treatment of such poisoning + the mode of proving the
presence of this substance.
8. Write without abbreviations, a
complete prescription containing colchicum with directions for its use.
9. How would the presence of
hydrocyanic acid be proven in a case of fatal poisoning?
Answers by Cleborne:
1. Accidents requiring
Amputation of the thigh are such as may arise from Railroad, Steamboat +
Mechanical injuries – gun-shot, cannon ball, + other wounds, involving
destruction of the tissues, sufficient to produce extensive sloughing –
very severe comminuted fracture of the bones – injury to the femoral
artery, nerves, + veins – Secondary hemorrhage, severe form of compound
fracture of thigh bone,-
2. The best mode of
controlling the circulation in amputation of the thigh – is to compress
the femoral artery, as it passes over the brim of the pelvis, + under
pouparts [sic, unusual swirl with a dot over the “p” in pen by Cleborne]
ligament by means of the thumbs of an Assistant, one thumb being placed
upon the other, in order to increase the amount of pressure a large key
handle well padded, will do equally well, and is much less tiresome. – a
clamped tourniquet may also be used. To compress artery on thigh, use
Petits tourniquet or some of its modifications._
3. Flooding, may occur before
– during – or After labor, and may be divided into Accidental, +
un-avoidable hemorrhage.
Causes.- are numerous, such as
Shocks, falls, irritability of System, detachment of part, or the whole
of placenta, etc_
Treatment. When it occurs before
labor, the indications are, rest, sedatives, tonics, astringents (as
Infusi Rosæ Comp.) + the tampon_ during labor, we must hasten birth of
child, + produce expulsion of placenta, + contraction of womb as soon as
possible_ After labor – clear the uterus of all coagula, of any
adherent portion of placenta, + produce contraction of the organ by
friction externally, sponge dipped in vinegar, or peeled lemon and
inserted into cavity of the womb, rest, quiet good diet etc.
4. Cartilages of Larynx are 5
in number Thyroid – Cricoid – two arytenoid + Epiglottic cartilages
together with cornicula laryngis_ Ligaments are the Crico-thyroid –
Thyreo-epiglottidean – aryteneo-epiglottidean, vocal ligaments. _ The
muscles are the Thyreo-hyoid – crico-thyroid – crico-arytenoid,
transverse, Thyreo-arytenoid, Epiglottic._
5. The Digestive function
physiologically considered, is a very complicated one. It may be
divided into many parts – 1st The process of Mastication, –
insalivation – deglutition – Chymification – chylification – Absorption,
+ Defecation. = In the mouth, the food is well comminuted by means of
the teeth, + mixed with the Saliva (a compound secretion obtained from
the Parotid, Submaxillary + Sublingual glands + containing water,
Salivin or ptyalin, Salts of Soda, Sulpho-cyanide of Ammonia etc.)
Starchy matters by means of the Saliva, may be turned into Sugar, but in
order to effect this change the Saliva must be in apeculiar [sic]
condition. Deglutition is performed by means of the superior, middle +
inferior constrictor muscles of the pharynx, the food is carried
downward, by the contractions of the longitudinal + circular fibres of
the Oesophagus_ In the Stomach, the food is kept in continual motion, +
triburated well, with the Gastric juice, containing Pepsin, lactic +
hydro-chloric acids _ chyme (a gray pulpy mass) + chyle are formed, +
the food thus prepared enters the small intestines, here it comes in
contact with the bile, + the pancreatic juice; the latter acting upon
the oily matters, forming them into an Emulsin [sic] capable of being
absorbed. The albumen [sic] of the food is turned into Albuminase etc +
thus the food is presented in a proper form to the Villi of the
intestines, lacteals etc for absorption. The coloring matter of the
bile is the only one of its principle that passes off with the feces.
(biliphæn.) The feces derives their odor from the large intestines,
some say from the Appendix Vermiformis.
6. The Blood of the human
body is of two kinds, Venous, and Arterial- + is composed of water 700
parts, albumen [sic] 65 to 75 parts, fibrin 3 parts (increased in
inflammations sometimes to 10 + 11 parts) Extractive matters, Red +
white corpuscles_of the former about 150 parts in dry state, about 500
floating) [sic] proportion of white to red corpuscles about 1 of the
former to 50 or 60 of the latter. Coloring matter of the blood is
called Hæmatin, or Hæmatosin (ήμα or ήιμα) Globulin +
hæmato-globulin_ size of corpuscles about 1/3000th_of white
about 1/5000th of an inch – circular in shape – bi-concave in
arterial, + bi-convex in Venous blood_ blood corpuscles of all mammals
circular, except those of the Camel, which are oval in shape.- In
addition we find salts of soda + Potassa + Iron (supposed to exist in
form of an oxide.)
7. Strychnia is procured from
the Strychnos Mix Vomica, + other varieties of Strychnos – It is
poisonous in very small doses ½ gr having produced death. the [sic]
usual dose is 1/32 to 1/16th gr its effects being
carefully watched. It is a cerebro-spinal poison, affecting principally
the nerve centres, + through them the muscles of the body. The Symptoms
of poisoning by strychnia show themselves within two hours – sometimes
in 15 to 25 minutes the patient feels peculiarly, his sensations not
being always describable, nervous twitchings of the muscles are soon
felt, especially of the muscles of the neck, chest + extremities, these
twitchings are increased by the slightest movement of the patient,
difficulty in respiration, headache (not common) full pulse slow, sense
of impending danger, anxiety, difficulty in swallowing liquids or
solids, the pulse now becomes fuller slower, dysphagia increases,
muscular movements are now violent + rapid, Opisthotonas [sic],
Episthotonas [sic] etc sometimes so powerful as to throw patient off the
bed, finally the patient dies exhausted with the excessive convulsive
movements produced by the poison.
Treat. The Stomach pumped or
an Emetic should be had rescource [sic] so immediately_After clearing
out Stomach give Tannin in large doses_Chloroform to relieve the spasm –
Opium etc. Various remedies have been suggested as Lard, Charcoal,
Curara, Tr Iodine in 20 gtt doses etc.
Strychnia may be detected by means of
the Colour test – ie mixing a sol of SO3 with the suspected
liquid, + adding a crystal of Bi-Chromate of Potassa when a play of
color takes place_ “Spas” method, consists in treating with Acetic Acid
+ Ether_evaporating, + adding an alkali – water dissolves but a small
part of strychnia.
8. Colchicum – The root of
Colchicum Autumnale or Meadows Saffron. The root + seed are used in
Medicine, useful in Rheumatism – Arthritis etc. Some consider its
specific effect in Rheumatism, injured by combination with Cathartics as
in Scudamore mixture etc_
Rx Tinctura Colchici
- drachmas duas
Potassa Acetatis
- drachmam unam
Tintura Opii
- Semi drachmam
Aqua Menthis Piperitæ
- uncias septem
Misce_ fiat mistura.
Signetur _
Simat cochleare amplum ter in die
Die Luna, decimo quarto, Septembris
1863.
9. Hydro-cyanic
acid if is a powerful poison, very volatile and consequently very
difficult of detection [sic] after death. It may be prepared by the
action of a weak acid on Ferrocyanide of Potassa, or from Bi-cyanide of
Mercury by Hydrochloric acid. The Acid of the Shops, is called the 2 pr
ct acid_containing but two drops of the pure acid in the 100 of
water. Its presence as a poison, may be detected by its peculiar
odor_ or by means of its effects on a Solution of the persulfate of
Iron, with which it combines, forming Prussian blue. This poison would
be difficult of detection [sic] after a lapse of even a few months_
All of which is
respectfully submitted
C.J. Cleborne
Dysentery.
Colitis
Dysentery = Inflamation
[sic, correction mark in pencil] of the mucous membrane of the large
intestines.
General Remarks
Inflamation [sic, correction marks in
pencil] of the Colon is a disease very common in this Country, depending
on a variety of causes, and assuming in a short time, a serious + often
fatal form.
In the United States, this
disease is not confined to any one portion of the Country, though in
[sic, correction marks in pencil] occurs in a more severe form in the
South, + South-western states, a fact which may be readily accounted
for, by the greater length of the hot season, + malarial influences
peculiar to that climate.
In England, the largest cities
suffer most; though London (the healthy city in Europe) shows a smaller
average return of deaths from that disease (Dysentery) than Bristol,
Birmingham, or Liverpool. Ireland, has suffered much from its
ravages, due no doubt to the state of distress to which many of her
people have been subjected, from famine, + other causes. Returns from
Scotland, show a small percentage of deaths from this disease, the same
may be said of France. (Except in her sea port towns.) In Russian it is
quite common, but seldom assumes a chronic form. But the place where
we find Dysentery in its worst form, is in the East Indies_ In China,
nearly all European residents are liable to it in consequence of their
mode of living, or miasmatic influence. The disease as it exists @ Hong
Kong; is very fatal, completely breaking down the System, producing
ulceration of the coats of the intestine, perforation, peritonitis, +
death!!- In such cases a slight alteration of “Chapmans” advice in
Cholera Infantum would be advisable, minus the lancing of the gums +
instead of “sending the patient into the Country” – send him out of it
as speedily as possible. Persons who have been attacked with East
Indian dysentery, + recovered from it, always show great susceptibility
to intestinal disorders throughout life.
Anatomy = Before
proceeding further with the subject it will be one well to consider the
anatomy of the viscus involved.
The intestinal tract of the
Mammalia, extends from the mouth to the Anus! In man + and in some of
the higher classes of this order it has numerous divisions, +
subdivisions, to which various names have been given. The intestines
proper, extend from the pyloric extremity of the Stomach, to the anus –
in length about twenty five feet – divided into larger +
smaller intestine the former measuring about five feet, the latter
twenty feet (according to some authors 25 ft – ‘Chesselden + Cruvelhier’
[sic, should be Cruveilhier]). The Colon[sic, correction marks in
pencil] is divided into Cæcum (blind.) Ascending, transverse
+ descending portions. Sigmoid (ζ) flexure +
anus! The small intestines into duodenum, (12) jejunum
(jejunus – empty) + ileum
Structure. The
intestines are composed of four coats = Serous muscular mucous +
Cellular. – The Serous layer is derived from the peritoneum – the
Cellular, contains the vessels. – the muscular is composed of two
layers – longitudinal + circular, + the mucous membrane contains glands,
secretes Succus Entericus, performs the office of absorbing etc etc.
[sic] = Of glands – we find Brunner’s in duodenum agminated or Peyers,
in ileum – glandula solitariæ in whole tract, besides Follicles of
Lieberkuhn, Rivinus etc. The Villi of the intestines are its absorbing
medium – The Epithelium (tessellated) of the intestines – of the whole
tract) [sic] is said to be thrown off every twenty four hours.
Causes. Like all other
diseases, the cause of dysentery is frequently of obscure. Climateric
[sic, correction marks in pencil] influences + miasmata are in most
cases the predisposing causes – Of the exciting causes it may be said
there named is legion! Sudden changes of heat + cold, bad food, checked
perspiration, the emotions,- joy – hope – fear – anxiety of mind, taking
cold drinks while the body is over-heated, fresh fruit, Vegetables –
unchecked diarrhoea – tuberculous diathesis, improper clothing certain
kinds of water, containing alluvial, decaying vegetable + other
deposits. The poor are generally most attacked though all are liable,
but ill-ventilated apartments, bad un-wholesome food, habits of
intemperance, un-cleanliness etc must soon produced disease
Pathology. The changes
which are found to have taken place, are not very diversified in their
nature.
Usually however we find in Acute
dysentery, the purplish red appearance so characteristic of inflamation
[sic, correction marks in pencil] in mucous membranes extending
throughout the colon – obliteration in some part of the rugæ of the
intestines, thickening of the mucous coat, deposits of coagulable lymph,
extravasation of blood under mucous coat etc. In severe cases –
abrasion of mucous membrane, ulcerated patches involving even muscular
coat, shreds of mucous membrane + lymph hanging from coat of intestine,
soft and mushy feel of mucous coat etc.
There is great emaciation over
whole body – the adipose tissue is rapidly absorbed, even to absorption
of Appendices Epiploicæ etc.
Symptoms. Dysentery
may occur in two forms – either Acute, or Chronic! the latter usually
the result of the former.
The disease is usually
ushered in by an attack of ordinary diarrhoea, or dysenteric symptoms
may immediately present them selves. The patient has a general feeling
of malaise sometimes has a decided chill, followed by headache, full +
quick pulse, loss of appetite (anorexia) tongue covered with a heavy
creamy fur, edge + tip frequently red, fugitive pains in back, legs,
side etc, mind dull, temper irritable, skin generally warm + moist,
urine moderate in quantity + usually high colored frequent desire to go
to stool, copious evacuations from the bowels, accompanied with tenesmus,
(straining at stool) and tormina (twisting and griping of the bowels) –
the former is very distressing to the patient, giving him a feeling of
fullness in the anal region, + keeping up the desire to continually
evacuate the bowels; in addition to the disagreeable sensation produced,
it causes hæmorrhoids, or sometimes even a prolapse of the gut.
The griping pains are
excruciating, and this symptom together with the tenesmus, would alone
be sufficient to proclaim the disease. The fecal matters evacuated
are at first diarrhoeal, + consist of the ingesta, but they rapidly
change their character, + become thin, bloody + fetid - the dysenteric
odor is one that cannot be described, but after being once recognized is
not readily forgotten – The discharges finally become almost entirely
hæmorhagic [sic, correction marks in pencil], sometimes appearing like
the washings of flesh, + filled with shreds of mucous membrane.
Diagnosis.
Dysentery may be confounded with Cholera Morbus, or the severe form of
Diarrhoea Crapulosa, from both of these it made be distinguished by the
greater severity of the symptoms, bloody discharges, tormina + tenesmus,
odor of egesta. Peritonitis is marked by excessive + sudden severity of
pain, the decubitus of patient, + perforation by the sudden prostration.
From the paroxysmal non-inflamatory [sic] pain of Colic it is readily
distinguished in fact dysentery per se is too well marked a disease, for
the merest tyre in Medicine to mistake. Intercurrent inflamations [sic,
correction marks in pencil] are apt to ensue. Pneumonia, Bronchitis,
Gastritis, Enteritis etc, we must be on the qui vive for at all times.
Prognosis. When
taken in its first stage it is very favorable, but when allowed to run
un-checked even for a short time, it becomes a formidable opponent.
Usually however it may be considered in this Country favorable!
Treatment. In this,
as in all other diseases Remove the cause! this is the primary
consideration, having done so, clear the prima via of all offending
matters, by means of a mild cathartic combined with some Anodyne, such
as, (Mist. Ol. Ricini), or a seidlity powder combined with 15 or 20 gtts
Tinctura Opii, then commence with astringents as Rx Plumbi Acetatis gr
xij Pulvis Opii gr vj Misce. Fac pilulas duodecine – Signetur – Unum
omni tertius hora sumendus – In case the disease does not give way by
the 5th day, try small doses of blue mass, Ipecac + opii.
In cases depending on
miasmatic influence, Calomel + Quinine will have to be used. Sometimes
the vegetable astringents will alone answer very well, + maybe the Dovers powder at bed-time. Hope’s Camphor Mixture – composed of
℥viij Camphor
(Water [sic], gtts XI Nitrous Acid (the nitrosi – nitric acid of the
shops) + / Ʒi of Tr Opii. gtt. – Dose f℥ss
t.d. This is an excellent remedy in some cases. In dysentery
depending on Malarial influence, remove the patient to some better
climate if possible. The rest of the treatment, will consist in
farinaceous diet, good ventilation, fresh air, clean linens etc.
Disinfectants must be freely used, and all evacuations of patient at
once removed.
Respectfully submitted
C.J. Cleborne
