Beautifully Dead - Chapter 15
An Immortal Affections serialized novel
The Fever
Confederate Medical Report
CONFEDERATE STATES OF AMERICA
DEPARTMENT OF VIRGINIA
MEDICAL CORPS FIELD REPORT
Richmond, Virginia
November 25, 1861
Surgeon General Samuel Preston Moore
Confederate States Medical Department
Richmond, Virginia
Sir,
I have the honor to submit this report regarding an outbreak of severe typhomalarial fever affecting Confederate forces across multiple Virginia commands.
Correspondence with field surgeons serving Jackson's forces and physicians treating wounded from the recent Leesburg engagement report similar cases, suggesting a broader outbreak requiring immediate medical attention.
The condition presents as an aggressive variant of typhomalarial fever with unusual characteristics. Patients develop acute fever ranging from 104 to 106 degrees, persisting for three to five days with little response to standard therapeutics. Severe photophobia accompanies the fever, requiring complete darkness during the crisis period. Nervous prostration manifests with heightened sensitivity to auditory and tactile stimuli, causing patients great distress from ordinary hospital sounds.
The mental state alternates between periods of violent delirium and stuporous intervals, with patients displaying unusual strength during agitated episodes. All conscious patients report a persistent metallic taste and refuse standard invalid diet, showing preference for iron-rich preparations. The condition progresses rapidly to constitutional collapse, with mortality rates approaching the totality of documented cases.
Most disturbing are the delirious ravings during the fever crisis.
Patients speak of distant events and unknown locations, display temporary fits of unusual strength, and demonstrate apparent consciousness during periods of apparent insensibility.
Similar phenomena have been reported from field hospitals treating casualties from recent engagements. These manifestations suggest severe nervous system involvement beyond what we typically observe in typhomalarial conditions.
Standard typhoid and malarial therapeutics prove largely ineffective in treating this variant. Quinine affords minimal fever reduction, while calomel and venesection appear to hasten decline rather than provide relief. Complete darkness and quiet provide modest comfort during acute episodes. Iron tonics are better tolerated than beef tea or wine, though patients often refuse all sustenance during the worst phases. Isolation appears beneficial in preventing spread among healthy men, though the exact mechanism of contagion remains unclear.
Of thirty-one documented cases, twenty-eight have resulted in death, with the remainder showing slow and incomplete recovery over several weeks.
The mechanism of transmission is poorly understood, though close contact with affected soldiers increases risk of developing the condition. Medical staff have been largely spared, suggesting constitutional predisposition may influence susceptibility to this particular fever variant.
Our current stock of Dover's powder and laudanum proves insufficient for managing the violent episodes characteristic of this illness. I respectfully request priority allocation of opiates and iron preparations for treatment of future cases, as well as additional supplies of carbolic acid for disinfection purposes.
I recommend establishing isolation protocols for suspected cases, maintaining detailed documentation of symptom progression for future reference, and sharing these findings with regimental surgeons throughout the Virginia theater.
Consultation with physicians experienced in camp fevers would prove valuable in determining appropriate treatment protocols.
Your obedient servant,
James W. Merriweather, M.D.
Chief Medical Officer, Richmond Field Hospital
Personal Correspondence between Dr. James Merriweather and Dr. Samuel Caldwell
Richmond, Virginia
November 28, 1861
My dear Samuel,
I trust this letter finds you in good health despite the demanding conditions of your new appointment.
Secretary Benjamin's recognition of your expertise in requesting your advisory services for the medical department reorganization reflects the high esteem in which the medical community holds you. Your contributions to Confederate medical strategy will surely prove invaluable, though we miss your presence here in Richmond.
I would be most interested to hear details of your work with Benjamin's staff when time permits.
The medical reorganization efforts under his direction could significantly impact how we manage resources and personnel at the regimental level. Any insights you might share regarding new protocols or supply allocations would prove helpful to those of us maintaining field operations during this transition period.
I write today to provide an update on your daughter's progress, as you requested of me before your departure.
Miss Caldwell continues to demonstrate reliable capability in her hospital duties, proving particularly steady during medical crises. Her assistance has become most valuable given our reduced volunteer staff - Mrs. Henderson departed to care for her wounded son, and Miss Williams has been called home due to family circumstances.
Miss Caldwell has shown practical competence with the severe typhomalarial fever cases I documented in my recent report to Surgeon General Moore.
Her composure during patients' difficult episodes and reliability with nursing procedures serve our needs well.
I have noted she occasionally mentions discomfort from the prolonged hours spent attending patients in darkened sickrooms, and reports some fatigue, though nothing beyond what one might expect from demanding hospital work.
The volunteer ladies continue their service, though we face persistent staffing challenges as families recall daughters for domestic duties or safety concerns. Miss Caldwell's willingness to maintain regular attendance makes her assistance particularly useful to our operations, especially during the more demanding cases that require extended nursing care.
I understand from Mrs. Patterson that Miss Caldwell has expressed interest in temporarily residing with Mrs. Sarah Everett during your absence.
Mrs. Everett faces considerable challenges managing both an infant and her father-in-law's declining health while her husband serves with the Confederate forces. Such an arrangement would provide appropriate supervision for Miss Caldwell while offering practical assistance to Mrs. Everett during these trying times.
The arrangement might also benefit our hospital staffing, as the Everett residence offers closer proximity to our facility than your family home.
This could prove advantageous during periods when urgent cases require additional nursing assistance outside normal volunteer hours.
I trust in your continued approval of Miss Caldwell's involvement in hospital work.
As fever cases continue to arrive sporadically, and experienced nursing staff remains in short supply, Miss Caldwell's familiarity with our procedures and willingness to assist during challenging cases helps maintain our capacity to treat these difficult medical situations.
Please share what details you can of your work with the medical reorganization efforts.
We all hope Secretary Benjamin's reforms will improve our ability to treat Confederate forces effectively.
Any advance notice of changes in supply allocation or personnel protocols would help us prepare accordingly.
Your colleague and friend,
James W. Merriweather, M.D.
Dr. Merriweather's Private Journal
Richmond, Virginia
December 5, 1861
Private Medical Research Notes - J.W. Merriweather
Lost another three this week. Always the same damned pattern - fever, delirium, death. Waste of perfectly good subjects.
I've seen perhaps twenty cases follow a different course over the years. They enter that stuporous state, then the seeking behavior begins.
Fascinating to observe, but these military conditions make proper study impossible.
No controlled environment, no decent nutrition, certainly no time for the careful conditioning required. They inevitably deteriorate - apoplexy or simple starvation.
Such a shame.
But Miss Caldwell... now there's something worth my attention. Months of exposure, and she's developing the most intriguing symptoms. Light sensitivity increases weekly. Dietary preferences shifting exactly as I would predict. Enhanced perception during patient care that goes far beyond nursing intuition.
At first I dismissed it as occupational fatigue. Foolish of me.
The girl is adapting.
Actually adapting, not dying. Low-level exposure over time - precisely what I've theorized but never had the opportunity to observe. The soldiers receive such massive doses they're destroyed before transformation can take hold. But Miss Caldwell... She's been conditioning gradually, naturally. Perfect circumstances without even realizing it.
Her father's departure could not have been more fortuitous. No parental interference, no tedious explanations about why I require increased access to his daughter.
I've positioned myself as her mentor - the girl fairly glows when I praise her work. So eager for approval, for recognition of her capabilities. Useful trait in a research subject.
The possibilities are extraordinary, and it could not have happened at a better time. Finally we have adequate tools for proper investigation.
These new microscopic techniques, chemical analysis methods - I can document everything with precision my predecessors never possessed.
Blood samples under the guise of routine health monitoring. Tissue examination possibilities if she develops any surface manifestations. For the first time I have both a suitable subject and proper methods.
Three developments demand immediate attention: Her light sensitivity follows the exact progression I witnessed in the Scottish cases years ago. The dietary changes - she's beginning to crave iron-rich preparations without understanding why. Most tellingly, her enhanced perception. Yesterday she identified three patients requiring intervention before their symptoms became apparent to anyone else. Remarkable.
I've begun collecting initial observations during our routine consultations. The girl trusts me completely - asks my advice on cases, seeks my guidance on treatments. Child has no idea she's becoming the most thoroughly documented subject in medical history.
The timing will be crucial. If she is indeed undergoing controlled conditioning, I must guide the process with absolute precision. Too rapid and it will trigger an acute crisis like in the battlefield cases. Too slow and the adaptation may stagnate, or give way to death by other means.
But if I calculate correctly...
Think of it. Understanding this fever could revolutionize everything. No more watching subjects die from overwhelming exposure. Instead, a deliberate, guided transformation under proper medical observation.
The girl could be the key to developing proper procedures for conscious transition.
She is exactly what my work has required for so long - an articulate subject undergoing gradual change while remaining conscious and cooperative. If my guidance proves effective, she'll achieve what those poor souls on the battlefield never could: a successful change with her mind intact.
And I'll be there, documenting every stage of it.
…
Begin intensive observation next week. The girl's trust makes her beautifully compliant.
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© 2025 E.M. di V. - writing as Morgan A. Drake & Joe Gillis. All rights reserved.