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cent。； terminated fatally。 This increase of mortality was due in great
measure to the accumulation of the sources of disease； as the increase of
excrements and filth of all kinds； and the concentration of noxious
effluvia； and also to the progressive effects of salt diet； crowding； and
the hot climate。
CONCLUSIONS。
1st。 The great mortality among the Federal prisoners confined in the
military prison at Andersonville was not referable to climatic causes； or
to the nature of the soil and waters。
2d。 The chief causes of death were scurvy and its results and bowel
affections…chronic and acute diarrhea and dysentery。 The bowel
affections appear to have been due to the diet； the habits of the
patients； the depressed； dejected state of the nervous system and moral
and intellectual powers； and to the effluvia arising from the decomposing
animal and vegetable filth。 The effects of salt meat； and an unvarying
diet of cornmeal； with but few vegetables； and imperfect supplies of
vinegar and syrup； were manifested in the great prevalence of scurvy。
This disease； without doubt； was also influenced to an important extent
in its origin and course by the foul animal emanations。
3d。 From the sameness of the food and form； the action of the poisonous
gases in the densely crowded and filthy Stockade and hospital； the blood
was altered in its constitution； even before the manifestation of actual
disease。 In both the well and the sick the red corpuscles were
diminished； and in all diseases uncomplicated with inflammation；
the fibrous element was deficient。 In cases of ulceration of the mucous
membrane of the intestinal canal； the fibrous element of the blood was
increased； while in simple diarrhea； uncomplicated with ulceration；
it was either diminished or else remained stationary。 Heart clots were
very common； if not universally present； in cases of ulceration of the
intestinal mucous membrane； while in the uncomplicated cases of diarrhea
and scurvy； the blood was fluid and did not coagulate readily； and the
heart clots and fibrous concretions were almost universally absent。
From the watery condition of the blood； there resulted various serous
effusions into the pericardium； ventricles of the brain； and into the
abdomen。 In almost all the cases which I examined after death； even the
most emaciated； there was more or less serous effusion into the abdominal
cavity。 In cases of hospital gangrene of the extremities； and in cases
of gangrene of the intestines； heart clots and fibrous coagula were
universally present。 The presence of those clots in the cases of
hospital gangrene； while they were absent in the cases in which there was
no inflammatory symptoms； sustains the conclusion that hospital gangrene
is a species of inflammation； imperfect and irregular though it may be in
its progress； in which the fibrous element and coagulation of the blood
are increased； even in those who are suffering from such a condition of
the blood； and from such diseases as are naturally accompanied with a
decrease in the fibrous constituent。
4th。 The fact that hospital Gangrene appeared in the Stockade first； and
originated spontaneously without any previous contagion； and occurred
sporadically all over the Stockade and prison hospital； was proof
positive that this disease will arise whenever the conditions of
crowding； filth； foul air； and bad diet are present。 The exhalations
from the hospital and Stockade appeared to exert their effects to a
considerable distance outside of these localities。 The origin of
hospital gangrene among these prisoners appeared clearly to depend in
great measure upon the state of the general system induced by diet； and
various external noxious influences。 The rapidity of the appearance and
action of the gangrene depended upon the powers and state of the
constitution； as well as upon the intensity of the poison in the
atmosphere； or upon the direct application of poisonous matter to the
wounded surface。 This was further illustrated by the important fact that
hospital gangrene； or a disease resembling it in all essential respects；
attacked the intestinal canal of patients laboring under ulceration of
the bowels； although there were no local manifestations of gangrene upon
the surface of the body。 This mode of termination in cases of dysentery
was quite common in the foul atmosphere of the Confederate States
Military Hospital； in the depressed； depraved condition of the system of
these Federal prisoners。
5th。 A scorbutic condition of the system appeared to favor the origin of
foul ulcers； which frequently took on true hospital gangrene。 Scurvy and
hospital gangrene frequently existed in the same individual。 In such
cases； vegetable diet； with vegetable acids； would remove the scorbutic
condition without curing the hospital gangrene。 From the results of the
existing war for the establishment of the independence of the Confederate
States； as well as from the published observations of Dr。 Trotter； Sir
Gilbert Blane； and others of the English navy and army； it is evident
that the scorbutic condition of the system； especially in crowded ships
and camps； is most favorable to the origin and spread of foul ulcers and
hospital gangrene。 As in the present case of Andersonville； so also in
past times when medical hygiene was almost entirely neglected； those two
diseases were almost universally associated in crowded ships。 In many
cases it was very difficult to decide at first whether the ulcer was a
simple result of scurvy or of the action of the prison or hospital
gangrene； for there was great similarity in the appearance of the ulcers
in the two diseases。 So commonly have those two diseases been combined
in their origin and action； that the description of scorbutic ulcers； by
many authors； evidently includes also many of the prominent
characteristics of hospital gangrene。 This will be rendered evident by
an examination of the observations of Dr。 Lind and Sir Gilbert Blane upon
scorbutic ulcers。
6th。 Gangrenous spots followed by rapid destruction of tissue appeared
in some cases where there had been no known wound。 Without such well…
established facts； it might be assumed that the disease was propagated
from one patient to another。 In such a filthy and crowded hospital as
that of the Confederate States Military Prison at Andersonville； it was
impossible to isolate the wounded from the sources of actual contact of
the gangrenous matter。 The flies swarming over the wounds and over filth
of every kind； the filthy； imperfectly washed and scanty supplies of
rags； and the limited supply of washing utensils； the same wash…bowl
serving for scores of patients； were sources of such constant circulation
of the gangrenous matter that the disease might rapidly spread from a
single gangrenous wound。 The fact already stated； that a form of moist
gangrene； resembling hospital gangrene； was quite common in this foul
atmosphere； in cases of dysentery； both with and without the existence of
the disease upon the entire surface； not only demonstrates the dependence
of the disease upon the state of the constitution； but proves in the
clearest manner that neither the contact of the poisonous matter of
gangrene； nor the direct action of the poisonous atmosphere upon the
ulcerated surfaces is necessary to the development of the disease。
7th。 In this foul atmosphere amputation did not arrest hospital
gangrene； the disease almost invariably returned。 Almost every
amputation was followed finally by death； either from the effects of
gangrene or from the prevailing diarrhea and dysentery。 Nitric acid and
escharotics generally in this crowded atmosphere； loaded with noxious
effluvia； exerted only temporary effects； after their application to the
diseased surfaces； the gangrene would frequently return with redoubled
energy； and even after the gangrene had been completely removed by local
and constitutional treatment； it would frequently return and destroy the
patient。 As far as my observation extended； very few of the cases of
amputation for gangrene recovered。 The progress of these cases was
frequently very deceptive。 I have observed after death the most
extensive disorganization of the structures of the stump； when during
life there was but little swelling of the part； and the patient was
apparently doing well。 I endeavored to impress upon the medical officers
the view that in this disease treatment was almost useless； without an
abundant supply of pure； fresh air； nutritious food； and tonics and
stimulants。 Such changes； however； as would allow of the isolation of
the cases of hospital gangrene appeared to be out of the power of the
medical officers。
8th。 The gangrenous mass was without true pus； and consisted chiefly of
broken…down； disorganized structures。 The reaction of the gangrenous
matter in certain stages was alkaline。
9th。 The best； and in truth the only means of protecting large armies
and navies； as well as prisoners； from the ravages of hospital gangrene；
is to furnish liberal supplies of well…cured meat； together with fresh
beef and vegetables； and to enforce