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, and 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 the unvarying diet of corn-meal, with but few vegetables,
and imperfect supplies of vinegar and sirup, 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 gasses 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 were more
or less serous effusions into the abdominal cavity. In case of
hospital gangrene of the extremities, and in case of gangrene of
the intestines, heart clots and fibrous coagula were universally
present. The presence of these clots in the cases of hospital
gangrene, while they were absent in the cases in which there were
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 disease 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 of the hospital and stockade appeared to
exert their effects to a considerable distance outside of these
localities. The origin of hospital gangrene among the prisoners
appeared clearly to depend in great measure to 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
case 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 the action of the prison or hospital gangene, for
there was great similarity in the appearance of the ulcers in the
two diseases. So commonly have those two diseases been confined to
their origin and action, that the description of scorbutic ulsers,
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 the tissue
appeared in some cases where there has 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 with gangrenous matter. The
flies swarmed 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 existance of the entire service, 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 direst action of the
poisonous atmosphere upon the ulcerated surface are necessary to
the development of the disease.
7th. In this foul atmosphere amputation did not arrest hospital
gangrene; the disease almost universally 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 escharoties generally in this crowded atmosphere, loaded
with noxious effluvia, exerted only temporary effects; after their
application to the diseased surfaces, the gangrene would frequently
returned 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 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 on
this disease treatment was almost useless, without an abundance of
pure, fresh air, nutricious 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 puss, 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 hygene.
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 captive 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 WITNESS’S TESTIMONY.)
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