andersonville-第46章

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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　a　rigid　system　of　hygiene。

10th。　　Finally；　this　gigantic　mass　of　human　misery　calls　loudly　for
relief；　not　only　for　the　sake　of　suffering　humanity；　but　also　on　account
of　our　own　brave　soldiers　now　captives　in　the　hands　of　the　Federal
Government。　　Strict　justice　to　the　gallant　men　of　the　Confederate　Armies；
who　have　been　or　who　may　be；　so　unfortunate　as　to　be　compelled　to
surrender　in　battle；　demands　that　the　Confederate　Government　should　adopt
that　course　which　will　best　secure　their　health　and　comfort　in　captivity；
or　at　least　leave　their　enemies　without　a　shadow　of　an　excuse　for　any
violation　of　the　rules　of　civilized　warfare　in　the　treatment　of
prisoners。

　　　　　　　　　　　　　　　　　　　　＇End　of　the　Witness's　Testimony。＇


The　variationfrom　month　to　monthof　the　proportion　of　deaths　to　the
whole　number　living　is　singular　and　interesting。　　It　supports　the　theory
I　have　advanced　above；　as　the　following　facts；　taken　from　the　official
report；　will　show：
　　　　　In　April　one　in　every　sixteen　died。
　　　　　In　May　one　in　every　twenty…six　died。
　　　　　In　June　one　in　every　twenty…two　died。
　　　　　In　July　one　in　every　eighteen　died。
　　　　　In　August　one　in　every　eleven　died。
　　　　　In　September　one　in　every　three　died。
　　　　　In　October　one　in　every　two　died。
　　　　　In　November　one　in　every　three　died。

Does　the　reader　fully　understand　that　in　September　one…third　of　those　in
the　pen　died；　that　in　October　one…half　of　the　remainder　perished；　and　in
November　one…third　of　those　who　still　survived；　died？　　Let　him　pause　for
a　moment　and　read　this　over　carefully　again；　because　its　startling
magnitude　will　hardly　dawn　upon　him　at　first　reading。　　It　is　true　that
the　fearfully　disproportionate　mortality　of　those　months　was　largely　due
to　the　fact　that　it　was　mostly　the　sick　that　remained　behind；　but　even
this　diminishes　but　little　the　frightfulness　of　the　showing。　　Did　any　one
ever　hear　of　an　epidemic　so　fatal　that　one…third　of　those　attacked　by　it
in　one　month　died；　one…half　of　the　remnant　the　next　month；　and　one…third