The police and hygiene of the hospital were defective in the extreme;
the attendants, who appeared in almost every instance to have been
selected from the prisoners, seemed to have in many cases but little
interest in the welfare of their fellow-captives. The accusation was
made that the nurses in many cases robbed the sick of their clothing,
money, and rations, and carried on a clandestine trade with the paroled
prisoners and Confederate guards without the hospital enclosure, in the
clothing, effects of the sick, dying, and dead Federals. They certainly
appeared to neglect the comfort and cleanliness of the sick intrusted to
their care in a most shameful manner, even after making due allowances
for the difficulties of the situation. Many of the sick were literally
encrusted with dirt and filth and covered with vermin. When a gangrenous
wound needed washing, the limb was thrust out a little from the blanket,
or board, or rags upon which the patient was lying, and water poured over
it, and all the putrescent matter allowed to soak into the ground floor
of the tent. The supply of rags for dressing wounds was said to be very
scant, and I saw the most filthy rags which had been applied several
times, and imperfectly washed, used in dressing wounds. Where hospital
gangrene was prevailing, it was impossible for any wound to escape
contagion under these circumstances. The results of the treatment of
wounds in the hospital were of the most unsatisfactory character, from
this neglect of cleanliness, in the dressings and wounds themselves, as
well as from various other causes which will be more fully considered.
I saw several gangrenous wounds filled with maggots. I have frequently
seen neglected wounds amongst the Confederate soldiers similarly
affected; and as far as my experience extends, these worms destroy only
the dead tissues and do not injure specially the well parts. I have even
heard surgeons affirm that a gangrenous wound which had been thoroughly
cleansed by maggots, healed more rapidly than if it had been left to
itself. This want of cleanliness on the part of the nurses appeared to
be the result of carelessness and inattention, rather than of malignant
design, and the whole trouble can be traced to the want of the proper
police and sanitary regulations, and to the absence of intelligent
organization and division of labor. The abuses were in a large measure
due to the almost total absence of system, government, and rigid, but
wholesome sanitary regulations. In extenuation of these abuses it was
alleged by the medical officers that the Confederate troops were barely
sufficient to guard the prisoners, and that it was impossible to obtain
any number of experienced nurses from the Confederate forces. In fact
the guard appeared to be too small, even for the regulation of the
internal hygiene and police of the hospital.

The manner of disposing of the dead was also calculated to depress the
already desponding spirits of these men, many of whom have been confined
for months, and even for nearly two years in Richmond and other places,
and whose strength had been wasted by bad air, bad food, and neglect of
personal cleanliness. The dead-house is merely a frame covered with old
tent cloth and a few bushes, situated in the southwestern corner of the
hospital grounds. When a patient dies, he is simply laid in the narrow
street in front of his tent, until he is removed by Federal negros
detailed to carry off the dead; if a patient dies during the night, he
lies there until the morning, and during the day even the dead were
frequently allowed to remain for hours in these walks. In the dead-house
the corpses lie upon the bare ground, and were in most cases covered with
filth and vermin.


The cooking arrangements are of the most defective character. Five large
iron pots similar to those used for boiling sugar cane, appeared to be
the only cooking utensils furnished by the hospital for the cooking of
nearly two thousand men; and the patients were dependent in great measure
upon their own miserable utensils. They were allowed to cook in the tent
doors and in the lanes, and this was another source of filth, and another
favorable condition for the generation and multiplication of flies and
other vermin.

The air of the tents was foul and disagreeable in the extreme, and in
fact the entire grounds emitted a most nauseous and disgusting smell.
I entered nearly all the tents and carefully examined the cases of
interest, and especially the cases of gangrene, upon numerous occasions,
during the prosecution of my pathological inquiries at Andersonville, and
therefore enjoyed every opportunity to judge correctly of the hygiene and
police of the hospital.

There appeared to be almost absolute indifference and neglect on the part
of the patients of personal cleanliness; their persons and clothing
inmost instances, and especially of those suffering with gangrene and
scorbutic ulcers, were filthy in the extreme and covered with vermin.
It was too often the case that patients were received from the Stockade
in a most deplorable condition. I have seen men brought in from the
Stockade in a dying condition, begrimed from head to foot with their own
excrements, and so black from smoke and filth that they, resembled negros
rather than white men. That this description of the Stockade and
hospital has not been overdrawn, will appear from the reports of the
surgeons in charge, appended to this report.


We will examine first the consolidated report of the sick and wounded
Federal prisoners. During six months, from the 1st of March to the 31st
of August, forty-two thousand six hundred and eighty-six cases of
diseases and wounds were reported. No classified record of the sick in
the Stockade was kept after the establishment of the hospital without the
Prison. This fact, in conjunction with those already presented relating
to the insufficiency of medical officers and the extreme illness and even
death of many prisoners in the tents in the Stockade, without any medical
attention or record beyond the bare number of the dead, demonstrate that
these figures, large as they, appear to be, are far below the truth.

As the number of prisoners varied greatly at different periods, the
relations between those reported sick and well, as far as those
statistics extend, can best be determined by a comparison of the
statistics of each month.

During this period of six months no less than five hundred and sixty-five
deaths are recorded under the head of 'morbi vanie.' In other words,
those men died without having received sufficient medical attention for
the determination of even the name of the disease causing death.

During the month of August fifty-three cases and fifty-three deaths are
recorded as due to marasmus. Surely this large number of deaths must
have been due to some other morbid state than slow wasting. If they were
due to improper and insufficient food, they should have been classed
accordingly, and if to diarrhea or dysentery or scurvy, the
classification should in like manner have been explicit.

We observe a progressive increase of the rate of mortality, from 3.11 per
cent. in March to 9.09 per cent. of mean strength, sick and well, in
August. The ratio of mortality continued to increase during September,
for notwithstanding the removal of one-half of the entire number of
prisoners during the early portion of the month, one thousand seven
hundred and sixty-seven (1,767) deaths are registered from September 1 to
21, and the largest number of deaths upon any one day occurred during
this month, on the 16th, viz. one hundred and nineteen.

The entire number of Federal prisoners confined at Andersonville was
about forty thousand six hundred and eleven; and during the period of
near seven months, from February 24 to September 21, nine thousand four
hundred and seventy-nine (9,479) deaths were recorded; that is, during
this period near one-fourth, or more, exactly one in 4.2, or 13.3 per
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.


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.

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