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.