andersonville-第57章

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of　others；　both　old　and　new；　to　admit　that　we　are　still　ignorant　of　the
causes　necessary　for　the　origin　of　typhus　fever。　　Added　to　the　imperfect
nature　of　the　rations　issued　to　the　Federal　prisoners；　the　difficulties
of　their　situation　were　at　times　greatly　increased　by　the　sudden　and
desolating　Federal　raids　in　Virginia；　Georgia；　and　other　States；　which
necessitated　the　sudden　transportation　from　Richmond　and　other　points
threatened　of　large　bodies　of　prisoners；　without　the　possibility　of　much
previous　preparation；　and　not　only　did　these　men　suffer　in　transition
upon　the　dilapidated　and　overburdened　line　of　railroad　communication；
but　after　arriving　at　Andersonville；　the　rations　were　frequently
insufficient　to　supply　the　sudden　addition　of　several　thousand　men。
And　as　the　Confederacy　became　more　and　more　pressed；　and　when　powerful
hostile　armies　were　plunging　through　her　bosom；　the　Federal　prisoners　of
Andersonville　suffered　incredibly　during　the　hasty　removal　to　Millen；
Savannah；　Charleston；　and　other　points；　supposed　at　the　time　to　be　secure
from　the　enemy。　　Each　one　of　these　causes　must　be　weighed　when　an　attempt
is　made　to　estimate　the　unusual　mortality　among　these　prisoners　of　war。

VII。　　Scurvy；　arising　from　sameness　of　food　and　imperfect　nutrition；
caused；　either　directly　or　indirectly；　nine…tenths　of　the　deaths　among
the　Federal　prisoners　at　Andersonville。

Not　only　were　the　deaths　referred　to　unknown　causes；　to　apoplexy；　to
anasarca；　and　to　debility；　traceable　to　scurvy　and　its　effects；　and　not
only　was　the　mortality　in　small…pox；　pneumonia；　and　typhoid　fever；　and　in
all　acute　diseases；　more　than　doubled　by　the　scorbutic　taint；　but　even
those　all　but　universal　and　deadly　bowel　affections　arose　from　the　same
causes；　and　derived　their　fatal　character　from　the　same　conditions　which
produced　the　scurvy。　　In　truth；　these　men　at　Andersonville　were　in　the
condition　of　a　crew　at　sea；　confined　in　a　foul　ship　upon　salt　meat　and
unvarying　food；　and　without　fresh　vegetables。　　Not　only　so；　but　these
unfortunate　prisoners　were　men　forcibly　confined　and　crowded　upon　a　ship
tossed　about　on　a　stormy　ocean；　without　a　rudder；　without　a　compass；
without　a　guiding…star；　and　without　any　apparent　boundary　or　to　their
voyage；　and　they　reflected　in　their　steadily　increasing　miseries　the
distressed　condition　and　waning　fortunes　of　devastated　and　bleeding
country；　which　was　compelled；　in　justice　to　her　own　unfortunate　sons；　to
hold　these　men　in　the　most　distressing　captivity。

I　saw　nothing　in　the　scurvy　which　prevailed　so　universally　at
Andersonville；　at　all　different　from　this　disease　as　described　by　various
standard　writers。　　The　mortality　was　no　greater　than　that　which　has
afflicted　a　hundred　ships　upon　long　voyages；　and　it　did　not　exceed　the
mortality　which　has；　upon　me　than　one　occasion；　and　in　a　much　shorter
period　of　time；　annihilated　large　armies　and　desolated　beleaguered
cities。　　The　general　results　of　my　investigations　upon　the　chronic
diarrhea　and　dysentery　of　the　Federal　prisoners　of　Andersonville　were
similar　to　those　of　the　English　surgeons　during　the　war　against　Russia。

IX。　　Drugs　exercised　but　little　influence　over　the　progress　and　fatal
termination　of　chronic　diarrhea　and　dysentery　in　the　Military　Prison　and
Hospital　at　Andersonville；　chiefly　because　the　proper　form　of　nourishment
（milk；　rice；　vegetables；　anti…scorbutics；　and　nourishing　animal　and
vegetable　soups）　was　not　issued；　and　could　not　be　procured　in　sufficient
quantities　for　the　sick　prisoners。

Opium　allayed　pain　and　checked　the　bowels　temporarily；　but　the　frail　dam
was　soon　swept　away；　and　the　patient　appears　to　be　but　little　better；
if　not　the　worse；　for　this　merely　palliative　treatment。　　The　root　of　the
difficulty　could　not　be　reached　by　drugs；　nothing　short　of　the　wanting
elements　of　nutrition　would　have　tended　in　any　manner　to　restore　the　tone
of　the　digestive　system；　and　of　all　the　wasted　and　degenerated　organs　and
tissues。　　My　opinion　to　this　effect　was　expressed　most　decidedly　to　the
medical　officers　in　charge　of　these　unfortunate　men。　　The　correctness　of
this　view　was　sustained　by　the　healthy　and　robust　condition　of　the
paroled　prisoners；　who　received　an　extra　ration；　and　who　were　able　to
make　considerable　sums　by　trading；　and　who　supplied　themselves　with　a
liberal　and　varied　diet。

X。　　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　gangrene　among　these　prisoners　appeared　clearly　to　depend
in　great　measure　upon　the　state　of　the　general　system；　induced　by　diet；
exposure；　neglect　of　personal　cleanliness；　and　by　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　this　form　of　gangrene；　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　Prison　Hospital；　and　in　the
depressed；　depraved　condition　of　the　system　of　these　Federal　prisoners；
death　ensued　very　rapidly　after　the　gangrenous　state　of　the　intestines
was　established。

XI。　　A　scorbutic　condition　of　the　system　appeared　to　favor　the　origin　of
foul　ulcers；　which　frequently　took　on　true　hospital　gangrene。

Scurvy　and　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。　　。　　。　　Scurvy　consists
not　only　in　an　alteration　in　the　constitution　of　the　blood；　which　leads
to　passive　hemorrhages　from　the　bowels；　and　the　effusion　into　the　various
tissues　of　a　deeply…colored　fibrinous　exudation；　but；　as　we　have
conclusively　shown　by　postmortem　examination；　this　state　is　attended　with
consistence　of　the　muscles　of　the　heart；　and　the　mucous　membrane　of　the
alimentary　canal；　and　of　solid　parts　generally。　　We　have；　according　to
the　extent　of　the　deficiency　of　certain　articles　of　food；　every　degree　of
scorbutic　derangement；　from　the　most　fearful　depravation　of　the　blood
and　the　perversion　of　every　function　subserved　by　the　blood　to　those
slight　derangements　which　are　scarcely　distinguishable　from　a　state　of
health。　　We　are　as　yet　ignorant　of　the　true　nature　of　the　changes　of　the
blood　and　tissues　in　scurvy；　and　wide　field　for　investigation　is　open　for
the　determination　the　characteristic　changesphysical；　chemical；　and
physiologicalof　the　blood　and　tissues；　and　of　the　secretions　and
excretions　of　scurvy。　　Such　inquiries　would　be　of　great　value　in　their
bearing　upon　the　origin　of　hospital　gangrene。　　Up　to　the　present　war；
the　results　of　chemical　investigations　upon　the　pathology　of　the　blood　in
scurvy　were　not　only　contradictory；　but　meager；　and　wanting　in　that
careful　detail　of　the　cases　from　which　the　blood　was　abstracted　which
would　enable　us　to　explain　the　cause　of　the　apparent　discrepancies　in
different　analyses。　　Thus　it　is　not　yet　settled　whether　the　fibrin　is
increased　or　diminished　in　this　disease；　and　the　differences　which　exist
in　the　statements　of　different　writers　appear　to　be　referable　to　the
neglect　of　a　critical　examination　and　record　of　all　the　symptoms　of　the
cases　from　which　the　blood　was　abstracted。　　The　true　nature　of　the
changes　of　the　blood　in　scurvy　can　be　established　only　by　numerous
analyses　during　different　stages　of　the　disease；　and　followed　up　by
carefully　performed　and　recorded　postmortem　examinations。　　With　such　data
we　could　settle　such　important　questions　as　whether　the　increase　of
fibrin　in　scurvy　was　invariably　dependent　upon　some　local　inflammation。

XII。　　Gangrenous　spots；　followed　by　rapid　destruction　of　tissue；　appeared
in　some　cases　in　which　there　had　been　no　previous　or　existing　wound　or
abrasion；　and　without　such　well　established　facts；　it　might　be　assumed
that　the　disease　was　propagated　from　one　patient　to　another　in　every
case；　either　by　exhalations　from　the　gangrenous　surface　or　by　direct
contact。

In　such　a　filthy　and　crowded　hospital　as　that　of　the　Confederate；　States
Military　Prison　of　Camp　Sumter；　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
description；　the　filthy；　imperfectly　washed；　and　scanty　rags；　the　limited
number　of　sponges　and　wash…bowls　（the　same　wash…bowl　and　sponge　serving
for　a　score　or　more　of　patients）；　were　one　and　all　sources　of　such
constant　circulation　of　the　gangrenous　matter；　that　the　disease　might
rapidly　be　propagated　from　a　single　gangrenous　wound。　　While　the　fact
already　considered；　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　hospital　gangrene　upon　the
surface；　demonstrates　the　dependence　of　the　disease　upon　the　state　of　the
constitution；　and　proves　in　a　clear　manner　that　neither　the　contact　of
the　poisonous　matter　of　gangrene；　nor　the　direct　action　of　the　poisoned
atmosphere　upon　the　ulcerated　surface；　is　necessary　to　the　development　of
the　disease；　on　the　other　hand；　it　is　equally　well…established　that　the
disease　may　be　communicated　by　the　various　ways　just　mentioned。　　It　is
impossible　to　determine　the　length　of　time　which　rags　and　clothing
saturated　with　gangrenous　matter　will　retain　the　power　of　reproducing　the
disease　when　applied　to　healthy　wounds。　　Professor　Brugmans；　as　quoted　by
Guthrie　in　his　commentaries　on　the　surgery　of　the　war　in　Portugal；　Spain；
France；　and　the　Netherlands；　says　that　in　1797；　in　Holland；　'charpie；'
composed　of　linen　threads　cut　of　different　lengths；　which；　on　inquiry；　it
was　found　had　been　already　used　in　the　great　hospitals　in　France；　and　had
been　subsequently　washed　and　bleached；　caused　every　ulcer　to　which　it　was
applied　to　be　affected　by　hospital　gangrene。　　Guthrie　affirms　in　the　same
work；　that　the　fact　that　this　disease　was　readily　communicated　by　the
application　of　instruments；　lint；　or　bandages　which　had　been　in　contact
with　infected　parts；　was　too　firmly　established　by　the　experience　of
every　one　in　Portugal　and　Spain　to　be　a　matter　of　doubt。　　There　are　facts
to　show　that　flies　may　be　the　means　of　communicating　malignant　pustules。
Dr。　Wagner；　who　has　related　several　cases　of　malignant　pustule　produced
in　man　and　beasts；　both　by　contact　and　by　eating　the　flesh　of　diseased
animals；　which　happened　in　the　village　o