period terminology

[csabugler]

Does anyone have a source on-hand for the proper and common period terminology and treatment for arthritis?
Patrick

[NoahBriggs]

Re: period terminology

This ought to get you started. It was an article written for the Journal of the Society of Civil War Surgeons.
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RHEUMATIC DISEASES DURING THE U.S. CIVIL WAR:
Arthritis Following Diarrhea or Dysentery
By Bonnie Brice Dorwart

The author presented a paper entitled Rheumatism during the U.S. Civil War: Frequency, Types and Consequences at the eleventh annual meeting of the National Museum of Civil War Medicine in Harpers Ferry, West Virginia, on October 25, 2003. This represents the first systematic study of arthritis as it affected soldiers in that War. Based on data from Sickness and Mortality reports, Mortality in General Hospitals, Discharges on Surgeon’s Certificate of Disability, 44 case reports of rheumatism in 23 hospitals in 11 states, all from the Medical and Surgical History of the War of the Rebellion, and on descriptions of rheumatic diseases by a dozen surgeons who served in the War or on the United States Sanitary Commission, twelve probable causes of arthritis emerged. The present article describes the clinical features of joint disease that follows diarrhea or dysentery, now designated Areactive arthritis.

IMPORTANCE OF RHEUMATISM IN THE WAR. In the Sickness and Mortality Reports of White Troops from the Medical and Surgical History of the War of the Rebellion (hereafter, MSHWR), Rheumatism was the fourth most frequent diagnosis the first year. In the second year it rose to third place, after Diarrhea/Dysenter@ and Fevers, where it remained throughout the conflict.1,2 The United States Colored Troops (U.S.C.T) were similarly affected.3 In 254,738 cases of rheumatism in white soldiers there were 475 deaths;2 in 32,125 cases in U.S.C.T. there occurred 235 deaths.3 4.6% of all white troops who acquired a rheumatic disease were discharged with disability;4 the comparable percentage in U.S.C.T. was 2.7%.5

DEFINITIONS OF RHEUMATISM AND RHEUMATIC DISEASE. Rheumatism is a very old term, which connotes pain, stiffness, and limited motion of joints because of disease arising in joints themselves or in muscles, tendons, ligaments or bones attached to them. As recently as 1987, the American College of Rheumatology (founded in 1938 by physicians in the United States who specialized in the care of patients with arthritis, osteoporosis, and other diseases of the muscles and skeleton) was called the American Rheumatism Association. Arthritis is a very specific term that denotes swelling, pain, warmth, and (variable) redness in a joint, with resulting loss of the ability fully to bend or straighten the joint. Rheumatic disease applies to structures other than merely the joints, e.g., tendons, bursas, muscles. Presently more than 100 distinct types of rheumatic disease are recognized.

During the Civil War there were 1,575,424 officially recorded cases of diarrhea/dysentery in U.S. White Troops2 and 153,939 in U.S. Colored Troops;3 in White Troops 254,738 cases of rheumatism were recorded2, and in Colored Troops
32,125.3

CASES OF DIARRHEA/DYSENTERY PER 1,000 MEAN TROOP STRENGTH

WHITE2 COLORED3

ENDING 6-30-1862 770
ENDING 6-30-1863 850
ENDING 6-30-1864 640 1060
ENDING 6-30-1865 690 885
ENDING 6-30-1866 494 607

CASES OF RHEUMATISM PER 1,000 MEAN TROOP STRENGTH

WHITE2 COLORED3

ENDING 6-30-1862 160
ENDING 6-30-1863 152
ENDING 6-30-1864 84 215
ENDING 6-30-1865 98 181
ENDING 6-30-1866 78 110


COMMENTS ON METHODOLOGY. Physicians (called Surgeons during the Civil War) distinguished between acute and chronic rheumatism not only in case reports describing features of these diseases, but in the required monthly reports of case numbers to the Medical Director and in quarterly reports to the Surgeon General of the Union Army. Because acute and chronic are never defined, and because of overlap in the duration of symptoms between the groups, the distinction appears arbitrary and useless. Patients in this study, therefore, were combined into a single diagnostic group, rheumatic disease, or rheumatism. Considerable guesswork is involved in categorizing the rheumatic diseases represented in case reports because surgeons’ descriptions are few and sketchy, and because a given patient may be suffering from more than one disease or entity at the same time. Furthermore, there are only 44 patients with rheumatic disease described in the Medical and Surgical History of the War of the Rebellion (MSHWR). These limitations notwithstanding, there are probably five cases of post-diarrhea/dysentery reactive arthritis among these 44 cases:

(CASE 3). W.W., age 32. Admitted 8-19-1862 with diarrhea of unknown duration; 22 months later developed fever, headache, and painful joints. By day 3 no fever; day 4 joint swelling subsiding; fever returned day 5 and continued until day 7. Swelling lessened but record does not reveal when completely gone. Acetate of ammonia begun on day 5 until day 9; colchicine given day 1 and given for 4 months. Considered cured after 4 months but given light duty in the ward until 10 months after arthritis began. Also treated with flaxseed poultices to joints, cinchona, iodide of potassium, Dover’s powder (ipecac and opium) 6, sulphate of magnesia. Pain sufficient to require opium. At discharge, not returned to duty, but to Invalid Corps. Duration of symptoms: 4 months (?). Satterlee Hospital, Philadelphia, Pa.7

(CASE 17). W.A.E., age 22. Admitted 8-10-1862 with chronic rheumatism affecting the limbs, after diarrhea during the Peninsular campaign (late June, 1862), since which he was much reduced in strength and flesh. The diarrhoea after a time yielded to astringent and tonic treatment but the rheumatism continued; no redness or swelling of joints, and pains more in bones than joints. Returned to duty 3-4-1863. Duration of rheumatic symptoms: 9 months. Discharged for gunshot wound right foot 4-23-1864. Satterlee Hospital, Philadelphia, Pa.8

(CASE 18). M.P., age 23. Admitted 12-12-1862, with lower back and left hip pain which followed simultaneous [emphasis added] onset of chills, pain affecting all his joints, and severe dysentery in early 9-1862. Dysentery ended late November; by 12-12-1862 still unable to walk without the aid of a stick. Well enough for guard duty 4-17-1863; returned to duty 5-30-1863. Duration of rheumatic symptoms: 8 months. Satterlee Hospital, Philadelphia, Pa.9

(CASE 20). J.O.S., age 22. Admitted 9-23-1863, having chronic rheumatism and diarrhoea, precordial pain, onset unknown. Joints: knees, ankles, and back. Returned to duty 12-2-1863. Duration of rheumatic symptoms: 3 months. Hospital, Quincy, Ill.10

(CASE 40). A.T.H., age not given. Admitted 3-6-1864, with history of conjunctivitis since 11-12-1863. Both eyes inflamed and painful within a few days of each other, feeling as if grains of sand were incommoding the [eye]ball. 5-10-1864 Eyelids granular; vision imperfect; iris inflamed. Patient cannot read longer than fifteen minutes at a time; on a dull day he is unable to recognize an acquaintance at fifty paces; objects at a hundred paces appear double. 6-30-1864 Cornea injected. The lids everted every third day and painted with nitrate of silver in water. 8-7-1864 Diarrhoea for a few days. Gave anodynes and astringents. 8-14 Diarrhoea persisting; articular rheumatism manifested in the lumbar region and in right knee. 8-21 Easier; some debility. 8-31 Rheumatic ophthalmia recurring; flakes of lymph in aqueous humor; iris hazy and sluggish; cornea clouded; vessels much injected, especially those around the upper half of the cornea. 9-16-1864 Discharged from service at which date he was suffering from intense photophobia [light sensitivity because of involvement of the iris and pupil], being unable to keep his eyes open long enough to see anything, even if the condition of the aqueous humor and cornea had permitted him to see. Duration of rheumatic symptoms: 10 months eyes; 7 days joints (following 7 days of diarrhea). Kansas City Hospital, Mo.11

COMMENTS. Case 3 received colchicine and cinchona as therapy for his arthritis. Joseph Carson in 1851 taught his medical students at the University of Pennsylvania about colchicine’s beneficial impression in gout and rheumatism.12 Colchicine (derived from the autumn crocus) is used today to prevent and treat attacks of gout and pseudogout (types of arthritis caused by sudden release of crystals of uric acid and calcium pyrophosphate, respectively, into the joint), and plays a role in the treatment of other rheumatic diseases such as sarcoid, Behcet’s Disease, familial Mediterranean fever, and amyloid. Quinine, obtained from cinchona bark during the Civil War, is also used now (as hydroxychloroquine) in treating rheumatoid arthritis and systemic lupus erythematosus, among other rheumatic diseases.
--------------------------------------

RHEUMATIC DISEASES DURING THE U.S. CIVIL WAR: RHEUMATIC FEVER
By Bonnie Brice Dorwart, M.D.

CIVIL WAR CASES THAT MIGHT BE RHEUMATIC FEVER. Knowing whether rheumatic diseases were indeed cases of rheumatic fever in the Civil War is exceedingly difficult because of often scanty descriptions of cases and because rarely was sore throat mentioned. Since there is a two to four week interval between the sore throat and the heart or joint complaints, probably neither patient nor surgeon would connect the two events. These shortcomings notwithstanding, of the 44 cases of rheumatism recorded in the Medical and Surgical History of the War of the Rebellion (hereafter called MSHWR),11 fifteen have features consistent with rheumatic fever:

CASE 1. P.H., no age given. Admitted 1-24-1862 with back pain and sore swollen ankles; left knee involved too, but not described, duration unknown. Pulse elevated, hot skin. Pain disturbed sleep. 24 hours later ankles still very painful, although only slightly swollen, but right knee hot, swollen and painful; pulse accelerated; skin hot. At 48 hours both knees hot and swollen, but the right only painful; ankles sound; pulse 80. Three days after admission pain only in the left knee, which is enlarged from effusion [fluid in the joint]; pulse about 60, very irregular; skin hot; pain in the region of the heart. Five days after admission rested well; appears well; pulse regular. Discharged 6th day to quarters. Treated with colchicum. Duration of rheumatic symptoms: 6 days (?). Hospital 28th Mass.

COMMENT. Although thermometers were known at the time of the Civil War,12 body temperature of patients is almost never recorded. As in this case, skin of patients with fever is usually simply described as hot. The migratory pattern of the arthritis in rheumatic fever is illustrated in this patient, as the swelling left his ankles, and moved to his knees. Pain in the region of the heart was probably pericarditis.

CASE 2. J.G., no age given. Admitted 1-24-1862 evidently with feet and ankles swollen and painful, both knees swollen and painful, pulse not fast. By day 2 left knee still painful; ankle and right knee well; swelling generally disappearing except in the left knee; pulse regular. By day 3 left knee painful swollen and hot; other joints unaffected. By day 4 no pain. Day 5 pain and swelling gone. Returned to duty. Treated with light diet, sulphate of magnesia, nitrate of potash. Duration of symptoms: 5 days. Hospital 28th Mass.

CASE 6. J.R., age 20. Admitted 9-23-1863 with chest pain, cough, coughing up occasional blood. Feb. 3, 1864, Aattacked with acute rheumatism, the knee-joints painful and swollen. On the 5th, as knees improved, his feet and ankles became swollen and he was seized with cardiac pain and [difficulty breathing], while friction sounds were heard on auscultation. These symptoms continued with increasing gravity and much restlessness, and on the 11th the friction sounds were obscured by pericardial effusion. He gradually sank, and died on the 26th. Autopsy: lungs compressed, right lung dense, stuck to diaphragm, left lung lining stuck to pericardium; pericardium thickened and distended with 40 ounces of turbid fluid. Duration of symptoms: 23 days. Cumberland Hospital, Md.

COMMENT. Friction sounds are typical of pericarditis, common in rheumatic fever. Numerous references are made to heart and lung sounds heard with a stethoscope. Ordronaux lists the stethoscope, along with a watch to test deafness, pulse, breathing, magnifying glass to examine the eyes and cutaneous diseases, spatula (presumably tongue depressor), measuring tape, urethral catheter and sound, laryngoscope, speculum auris (ear), speculum ani (anus/rectum), and ophthalmoscope, as equipment needed by a surgeon.13

CASE 8. J.B., no age given. Admitted 3-19-1865 with rheumatic fever. No mention of joints at all. On 4-4 diarrhea and gastric irritation. On 4-6 difficulty breathing, tumultuous action of the heart, heart enlargement by dullness to percussion, irregular, small pulse. Died on 4-8. Autopsy: thick pericardium containing 6 ounces of fluid, clots in both ventricles. Duration of symptoms: 3 weeks fever; joints unknown. Harewood Hospital, Washington, D.C.

COMMENT. The enlarged heart was probably caused by fluid in the pericardium. The tumultuous action reflected irregularity of the pulse, common in rheumatic fever. The small pulse was due to constriction of the heart by fluid trapped in the pericardium, restricting the amount of blood the heart could eject into the circulation. Nowadays, high doses of cortisone and surgical drainage of the pericardial fluid would prevent this soldier’s death from this complication.

CASE 9. W.P.T., age 24. Admitted 12-2-1863 with diphtheria. He was improving under quinine and chlorate of potash internally, alternating with nitrate of silver, as a local application when he was attacked with acute rheumatism, the knees and elbows being specially affected. He stated that he had been subject to attacks of this kind all his life. No further details given. Seemed to recover until 12-22, when seized with sharp cutting pains in the bladder and side, and died half an hour afterwards. Treated with saline cathartics also. Autopsy: An enormous pericardial effusion [accumulation of fluid] with some adhesions was found. No mention of abdominal exam. Duration of symptoms: 2 weeks (?). Jarvis Hospital, Baltimore Md.

COMMENT. This soldier probably had rheumatic fever during childhood, with characteristic arthritis and heart involvement after each subsequent streptococcal sore throat. It is well known that people who have had rheumatic fever have abnormal reactivity to group A streptococcal infections. Recurrent rheumatic fever develops in 40% to 50% of such persons if they have a streptococcal infection during the first year after the initial episode of rheumatic fever. As years pass without recurrences of rheumatic fever, hyperreactivity wanes, but the probability of recurrence does not entirely disappear. 14 Major Charles Smart, who succeeded Joseph Janvier Woodward as author of the third part of the MSHWR of 1888, wrote that in recurrent rheumatism a majority of the men affected were known to have suffered from the disease before their enlistment. On exposure they became temporarily crippled. Under favorable conditions they so far recovered as to be able to resume duty, but on a subsequent exposure they were again taken on the sick report.15 Some types of arthritis prevented a man from being accepted into the army, e.g. tuberculosis of the spine and joints with chronic swelling and deformity.16 The arthritis of rheumatic fever, however, does not leave deformities in its wake; when the episode has run its course, the joints return to their normal pre-attack appearance. Thus this man would not have been rejected from the service. His diphtheria may have been streptococcal pharyngitis, the necessary antecedent to rheumatic fever. Culturing bacteria to verify the causative organism would not be possible until Robert Koch’s work of the 1870s.

CASE 10. H.R., colored age 28. Admitted 12-29-1865 with articular rheumatism, the elbows, wrists and knees being affected. Subsequently symptoms of heart disease set in; he became dropsical [filled with fluid; swollen], and died in April, 1866. Autopsy: Fluid in abdomen, under skin everywhere, in pericardium (23 ounces); pneumonia both lungs; ulceration of aortic valve. Duration of symptoms: 4 months (?). Slough Hospital, Alexandria, Va.

CASE 11. O.S.S., no age given. Admitted 10-29-1862 with dropsy from cardiac disease supervening on acute rheumatism. He had chest pain, palpitations, headache, vertigo, heart enlargement, enormous distension of the abdomen and at times a distressing cough. He died suddenly on November 9. Autopsy: Fluid under skin everywhere, 12 gallons of fluid in abdomen, fluid in pericardium, mitral and tricuspid valves thickened, lungs congested [not air-filled]. Duration of symptoms: 2 weeks heart symptoms; joints ? Hospital, Alexandria, Va.

CASE 12. E.M.D., age 20. Admitted 10-5-1864 with...disease of the heart. Suffered a short time before from an attack of articular rheumatism. He had fluid in abdomen, shortness of breath, rapid and tumultuous action of the heart unaccompanied by any decided bellows murmur. He preferred the sitting posture. More irregular pulse, more trouble breathing. Died 10-7. Autopsy: Fluid around right lung, congested lungs, greatly dilated heart, only 2 ounces of fluid in pericardium; small, firm, wart-like excrescences were found on the mitral valve and large ones on the aortic valves. Duration of symptoms:1 week (?).Carver Hospital, Washington,D.C

CASE 37. C.B., age 34. Admitted 3-25-1865, chronic rheumatism and heart disease. Onset or further details not given. Great trouble breathing and heart sounds obscured by a regurgitant murmur; died suddenly 5-27-1865. Autopsy: The pericardium was closely and firmly adherent to the heart, which was very large, weighing thirty ounces; the mitral and semilunar [aortic] valves were thickened and covered with warty vegetations. Duration of rheumatic symptoms: more than 2 months (?). Jarvis Hospital, Baltimore, Md.

COMMENT. The wart-like growths on the heart valves in the last two cases illustrate a complication of rheumatic fever, namely, seeding of previously damaged valves by bacteria that enter the bloodstream, called bacterial endocarditis.

CASE 83. T.R., age 40. Admitted April 11, 1864, complaining of pain in his arms, shoulders and legs; his ankles were slightly swollen. He seemed to improve; but on the evening of the 15th he had a slight chill with pain in the chest and some cough; slight crepitation was heard over the lower part of the right lung. Wet cups were applied and five-grain doses of blue-pill given every four hours. Afterwards a blister was applied and carbonate of ammonia administered. He died on the 23rd. Autopsy: The posterior part of the upper lobe and the greater part of the lower lobe of the left lung were hepatized, partly red, partly gray. The heart was rather flabby and the pericardium contained a large quantity of serum. The liver was enlarged and the nutmeg appearance; the spleen was healthy; the right kidney congested. Duration of symptoms: 12 days. Hospital No. 8, Nashville, Tenn.

CASE 14. J.L.W., age 38. Admitted 9-28-1863, rheumatic fever followed by 4 weeks of rheumatic pains. Able to walk 10-14; returned to duty 10-19-1863. Duration of rheumatic symptoms: 3 weeks. Mustered out 6-7-1865. Officers= Hospital, Louisville, Ky.

COMMENT. This soldier’s arthritis is typical of rheumatic fever. Although the course of the untreated disease is three months, the arthritis subsides in three weeks. He may not have had heart involvement or experienced such mild cardiac disease that he would have been able to return to duty without limitation of activity.

CASE 31. J.F.S., age 21. Admitted 5-7-1863, after rheumatism, approximately 10-1862. Surgeon found high pulse (106), jerking heart impulse; patient had pain on exertion, severe shooting pains in joints, hips and various parts of the body. By 8-17-1863 recovered except swelling of right hand, but 8-20 rheumatism passed to other joints. Discharged 8-21-1863. Duration of rheumatic symptoms: 10 months. Satterlee Hospital, Philadelphia, Pa.

COMMENT. He may have had recurrent episodes of rheumatic fever, but the history is too vague to establish this with certainty.

CASE 32. J.M., age 28. Admitted 12-8-1864, after rheumatism mostly in the knees 11-1864; surgeon found shortness of breath on exertion, pulse 120, increased heart impulse; patient had left chest pain. By 1-1-1865 pulse still rapid; dyspnoea [shortness of breath] aggravated; countenance livid. No better by 3-29-1865; discharged. Duration of rheumatic symptoms: 4 months. Hospital, Quincy, Ill.

COMMENT. Note that the soldiers’ ages ranged between 20 and 40 years. Most initial attacks of rheumatic fever in adults take place at the end of the second and beginning of the third decades of life. Rarely, initial attacks occur as late as the fourth decade and recurrent attacks have been documented as late as the fourth decade.6

CASE 33. E.F., age 34. Admitted 10-24-1864, after rheumatism 2 months. He had some cardiac trouble and there was pericardial inflammation. Discharged 3-23-1865, as the second sound of the heart was indistinct and he suffered from distressing dyspnoea. Duration of rheumatic symptoms: 7 months. Hospital, Quincy, Ill.

CASE 34. W.N.S., age not given. Admitted 10-18-1864, with chronic rheumatism. 12-2-1864 diarrhea for one month, when he began to improve (?). 1-18-1865 return of rheumatism, attributed to exposure, but accompanied by diarrhea and bronchial cough. 1-30-1865 pain over the heart; 2-1-1865 palpitation of the heart, intermittent pulse, [slow, at ] 40 per minute, and shortness of breath when lying down. 2-2-1865 quick pulse, lower chest pain, labored breathing and sudden death at 11:00 P.M. Duration of rheumatic symptoms: 3 2 mos. Whitehall Hospital, Pa.
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These cases were cited from the Medical and Surgical History of the War of the Rebellion.

[springkeeper]

Re: period terminology

These are from "Dr.Chase's Recipes;or Information for Everybody" published in 1867. There are several pages of recipes.

"Remedy for Rheumatism or stiff joints- Strong camphor spirits 1pt; coon, bear or skunk oil 1pt.; spirits of turpintine 1/2pt. Shake the bottle when used and apply 3 times daily by pouring on a little at a time and rubbing in all you can for 20 to 30 minutes."

"Rheumatic Lininment- Olive oil, spirtits of camphor, and chloroform, of each 2 ozs; sassafras oil 1 tea-spoon. First add the oil of sassafrass to the olive oil, then the spirits of camphor and shake well before putting in the chloroform, shaking when used, keeping it corked, as the chloroform evaporates very fast if left open. Apply 3 or 4 times a day, rubbing it well, and always toward the body. I had a brother-in-law cured of a very bad case of inflamatory, or swelling rheumatism, by the use of this liniment- accomplished in about 4 days, without other treatment. He paid five dollars for the recipe after the cure."


Carrie Craddock

[Spinster]

Re: period terminology

Oh Lordy, I think I know where this discussion is leading, and to what use its to be put..... :confused_

Patrick, please use bear or coon oil if you can get it, and not skunk. I have a lot longer drive home than the rest of y'all.

And, I've got some sassafrass root but will have to figure out how to make that oil.

[NoahBriggs]

Re: period terminology

Potash was used as a refrigerant in the allopathic world. That fact is buried in the mentally-defoliating article I snipped earlier this morning.

[springkeeper]

Re: period terminology

Leafing through the same book I came upon another remedy.

"Toad Ointment - for sprains, strains, lame back, rheumatsism, caked breasts, caked udders, &c.,&c.

Good sized live toads, 4 in number; put into boiling water and cook very soft.;then take them out and boil the water down to 1/2 pt., and add fresh churnched, unsalted butter 1lb. and simmer together; at the last add ticture of arnica 2 ozs.

This was obtained from an old Physician, who thought more of it than any other prescription in his possession. Some persons might think it hard on toads, but you could not kill them quicker in any other way."

Poor toads... :(

Carrie Craddock

[csabugler]

Re: period terminology

Thanks for the responses. I am still trying to wade thru and digest Noah's post! Fear not my dear Ms Lawson, I have every intention of continuing to use my modern medications! I have always tried to relate my modern existance to my impression. The information ya'll have provided will allow me to speak to the public with some knowlwedge about the limitations in my impression. Thanks again.
Oh, and by the way Mrs Craddock, I will enjoy relating the remedy you sent. But with all due respects, forgive me if I do not try it!!
Patrick

[springkeeper]

Re: period terminology

Mr. Peterson,

I do not blame you for not wanting to try the Toad Remedy. Putting creatures in boiling water is not a pleasant thought. And I do not think your horse would let you near him once he caught a wif of the first remdey...camphor, turpintine, and the animal oil...yuck!

Wouldn't it be nice to only pay $5 after you were cured. Do you think insurance companies would go for that? :sarcastic

Carrie Craddock

[NoahBriggs]

Re: period terminology

sulphate of magnesia, nitrate of potash.

That was copied from my original post.

I wanted to provide a variety of different examples of how Rheum was treated. It's not all-inclusive, but the the represented cases are a good starting point for typical allopathic remedies as would be applied by a physician in the 1850s and 60s. The Army's pharmacopea was derived from the civilian version. Thus your character can describe how it worked for him. (Or not, as the case may be.)

[1stMaine]

Re: period terminology

Comrade,

Another basic, yet effective remedy was the application of moist heat. Still used today. Soaking a small towel in as hot a water as you can stand and then applying to the joint, and covered with a heavy towel or blanket to hold the heat in.

Afterwards, take 2 ounces of whiskey and apply internally. This is especially effective just before retiring, and again upon rising, especially in colder weather.

For those in a more permanent state of habitat, the use of a hot water bottle is very appropriate. These were well known and used frequently. Often times, a period hot water bottle is passed off as a "medical canteen", and it indeed MAY be used for that purpose when circumstances dictate, however, it was designed to hold hot water, and was wrapped in a warm towel before being placed next to the affected area. These were oval, kidney shaped canteens with a prounounced curve to the body so as to allow it to lay evenly against it. Often they had a couple of rings or staples for a strap to carry it by when filling it. Some were of the same thickness as the typical water canteen, but a majority were about 1" in thickness.

The warmth and whiskey regimen is quite effective, as i can personally attest.

Respects,

[csabugler]

Re: period terminology

I don't think my insurance company would have a problem with $5 treatments, that's about all they pay anyway. Now, the whiskey treatment I think I can do!
Patrick