Part 20

I visited two thousand sick within the stockade, laying under some long sheds which had been built at the northern portion for themselves. At this time only one medical officer was in attendance, whereas at least twenty medical officers should have been employed.

Scurvy, diarrhea, dysentary, and hospital gangrene were the prevailing diseases. I was surprised to find but few cases of malarial fever, and no well-marked cases either of typhus or typhoid fever. The absence of the different forms of malarial fever may be accounted for in the supposition that the artificial atmosphere of the stockade, crowded densely with human beings and loaded with animal exhalations, was unfavorable to the existence and action of the malarial poison. The absence of typhoid and typhus fevers amongst all the causes which are known to generate these diseases, appeared to be due to the fact that the great majority of these prisoners had been in captivity in Virginia, at Belle Isle, and in other parts of the Confederacy for months, and even as long as two years, and during this time they had been subjected to the same bad influences, and those who had not had these fevers before either had them during their confinement in Confederate prisons or else their systems, from long exposure, were proof against their action.

The effects of scurvy were manifest on every hand, and in all its various stages, from the muddy pale complexion, pale gums, feeble, languid muscular motions, lowness of spirits, and fetid breath, to the dusky, dirty, leaden complexion, swollen features, spongy, purple, livid, fungoid, bleeding gums, loose teeth, œdematous limbs, covered with livid vibices, and petechiæ spasmodically flexed, painful and hardened extremities, spontaneous hemorrhages from mucous canals, and large, ill-conditioned, spreading ulcers covered with a dark purplish fungus growth. I observed that in some of the cases of scurvy the parotid glands were greatly swollen, and in some instances to such an extent as to preclude entirely the power to articulate. In several cases of dropsy the abdomen and lower extremities supervening upon scurvy, the patients affirmed that previously to the appearance of the dropsy they had suffered with profuse and obstinate diarrhea, and that when this was checked by a change of diet, from Indian corn-bread baked with the husk, to boiled rice, the dropsy disappeared. The severe pains and livid patches were frequently associated with swellings in various parts, and especially in the lower extremities, accompanied with stiffness and contractions of the knee joints and ankles, and often with a brawny feel of those parts, as if lymph had been effused between the integuments and apeneuroses, preventing the motion of the skin over the swollen parts. Many of the prisoners believed that scurvy was contagious, and I saw men guarding their wells and springs, fearing lest some man suffering with scurvy might use the water and thus poison them. 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 abration 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 musquito bite, in some cases, took on a rapid and frightful ulceration and gangrene. The long use of salt meat, oft-times 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 bran. 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 from the cow and calves’ heads, with the brains and tongues, to which a liberal supply of sweet potatoes 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 nutricious, 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 lice, as they lay amongst the sick and dying, formed a picture of helpless, hopeless misery which it would be impossible to portray by words 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 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 druggists, clerks, 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 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 their 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 high, 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. Musquetos in great numbers also infest 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 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 entrusted 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 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 negroes 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 the hospital for the cooking of two thousand men; and the patients were dependent in a 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 of the part of the patient, of personal cleanliness; their persons and clothing in most instances, and especially those suffering with gangrene and scorbutic ulcers, were filthy in the extreme and covered with vermin. It was too often the case that the patients were received from the stockade in a most deplorable condition. I have seen men brought in from the stockade in a dying condition, begrimmed from head to foot with their own excrements, and so black from smoke and filth that they resembled negroes rather than white men. That this description of the stockade has not been overdrawn, will appear from the reports of the surgeon in charge.

We will first examine 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 sickness 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, demonstrates that these figures, large as they seem 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 dysentary or scurvy, the classification in like manner should 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 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 23.3 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, 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.