by John McElroy
I observed also numerous cases of hospital gangrene, and of spreading scorbutic ulcers, which had supervened upon slight injuries. The scorbutic ulcers presented a dark, purple fungoid, elevated surface, with livid swollen edges, and exuded a thin; fetid, sanious fluid, instead of pus. Many ulcers which originated from the scorbutic condition of the system appeared to become truly gangrenous, assuming all the characteristics of hospital gangrene. From the crowded condition, filthy habits, bad diet, and dejected, depressed condition of the prisoners, their systems had become so disordered that the smallest abrasion of the skin, from the rubbing of a shoe, or from the effects of the sun, or from the prick of a splinter, or from scratching, or a musketo bite, in some cases, took on rapid and frightful ulceration and gangrene. The long use of salt meat, ofttimes imperfectly cured, as well as the most total deprivation of vegetables and fruit, appeared to be the chief causes of the scurvy. I carefully examined the bakery and the bread furnished the prisoners, and found that they were supplied almost entirely with corn-bread from which the husk had not been separated. This husk acted as an irritant to the alimentary canal, without adding any nutriment to the bread. As far as my examination extended no fault could be found with the mode in which the bread was baked; the difficulty lay in the failure to separate the husk from the corn-meal. I strongly urged the preparation of large quantities of soup made from the cow and calves' heads with the brains and tongues, to which a liberal supply of sweet potatos and vegetables might have been advantageously added. The material existed in abundance for the preparation of such soup in large quantities with but little additional expense. Such aliment would have been not only highly nutritious, but it would also have acted as an efficient remedial agent for the removal of the scorbutic condition. The sick within the Stockade lay under several long sheds which were originally built for barracks. These sheds covered two floors which were open on all sides. The sick lay upon the bare boards, or upon such ragged blankets as they possessed, without, as far as I observed, any bedding or even straw.
The haggard, distressed countenances of these miserable, complaining, dejected, living skeletons, crying for medical aid and food, and cursing their Government for its refusal to exchange prisoners, and the ghastly corpses, with their glazed eye balls staring up into vacant space, with the flies swarming down their open and grinning mouths, and over their ragged clothes, infested with numerous lice, as they lay amongst the sick and dying, formed a picture of helpless, hopeless misery which it would be impossible to portray bywords or by the brush. A feeling of disappointment and even resentment on account of the United States Government upon the subject of the exchange of prisoners, appeared to be widespread, and the apparent hopeless nature of the negotiations for some general exchange of prisoners appeared to be a cause of universal regret and deep and injurious despondency. I heard some of the prisoners go so far as to exonerate the Confederate Government from any charge of intentionally subjecting them to a protracted confinement, with its necessary and unavoidable sufferings, in a country cut off from all intercourse with foreign nations, and sorely pressed on all sides, whilst on the other hand they charged their prolonged captivity upon their own Government, which was attempting to make the negro equal to the white man. Some hundred or more of the prisoners had been released from confinement in the Stockade on parole, and filled various offices as clerks, druggists, and carpenters, etc., in the various departments. These men were well clothed, and presented a stout and healthy appearance, and as a general rule they presented a much more robust and healthy appearance than the Confederate troops guarding the prisoners.
The entire grounds are surrounded by a frail board fence, and are strictly guarded by Confederate soldiers, and no prisoner except the paroled attendants is allowed to leave the grounds except by a special permit from the Commandant of the Interior of the Prison.
The patients and attendants, near two thousand in number, are crowded into this confined space and are but poorly supplied with old and ragged tents. Large numbers of them were without any bunks in the tents, and lay upon the ground, oft-times without even a blanket. No beds or straw appeared to have been furnished. The tents extend to within a few yards of the small stream, the eastern portion of which, as we have before said, is used as a privy and is loaded with excrements; and I observed a large pile of corn-bread, bones, and filth of all kinds, thirty feet in diameter and several feet in hight, swarming with myriads of flies, in a vacant space near the pots used for cooking. Millions of flies swarmed over everything, and covered the faces of the sleeping patients, and crawled down their open mouths, and deposited their maggots in the gangrenous wounds of the living, and in the mouths of the dead. Musketos in great numbers also infested the tents, and many of the patients were so stung by these pestiferous insects, that they resembled those suffering from a slight attack of the measles.
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 durin
g 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.
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 o
f 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.
