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.