andersonville-第50部分

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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　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　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　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；　especial