Andersonville: A Story of Rebel Military Prisons

by John McElroy

IX. Drugs exercised but little influence over the progress and fatal termination of chronic diarrhea and dysentery in the Military Prison and Hospital at Andersonville, chiefly because the proper form of nourishment (milk, rice, vegetables, anti-scorbutics, and nourishing animal and vegetable soups) was not issued, and could not be procured in sufficient quantities for the sick prisoners.

Opium allayed pain and checked the bowels temporarily, but the frail dam was soon swept away, and the patient appears to be but little better, if not the worse, for this merely palliative treatment. The root of the difficulty could not be reached by drugs; nothing short of the wanting elements of nutrition would have tended in any manner to restore the tone of the digestive system, and of all the wasted and degenerated organs and tissues. My opinion to this effect was expressed most decidedly to the medical officers in charge of these unfortunate men. The correctness of this view was sustained by the healthy and robust condition of the paroled prisoners, who received an extra ration, and who were able to make considerable sums by trading, and who supplied themselves with a liberal and varied diet.

X. 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 gangrene among these prisoners appeared clearly to depend in great measure upon the state of the general system, induced by diet, exposure, neglect of personal cleanliness; and by 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 this form of gangrene, 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 Prison Hospital; and in the depressed, depraved condition of the system of these Federal prisoners, death ensued very rapidly after the gangrenous state of the intestines was established.

XI. A scorbutic condition of the system appeared to favor the origin of foul ulcers, which frequently took on true hospital gangrene.

Scurvy and 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. . . Scurvy consists not only in an alteration in the constitution of the blood, which leads to passive hemorrhages from the bowels, and the effusion into the various tissues of a deeply-colored fibrinous exudation; but, as we have conclusively shown by postmortem examination, this state is attended with consistence of the muscles of the heart, and the mucous membrane of the alimentary canal, and of solid parts generally. We have, according to the extent of the deficiency of certain articles of food, every degree of scorbutic derangement, from the most fearful depravation of the blood and the perversion of every function subserved by the blood to those slight derangements which are scarcely distinguishable from a state of health. We are as yet ignorant of the true nature of the changes of the blood and tissues in scurvy, and wide field for investigation is open for the determination the characteristic changes—physical, chemical, and physiological—of the blood and tissues, and of the secretions and excretions of scurvy. Such inquiries would be of great value in their bearing upon the origin of hospital gangrene. Up to the present war, the results of chemical investigations upon the pathology of the blood in scurvy were not only contradictory, but meager, and wanting in that careful detail of the cases from which the blood was abstracted which would enable us to explain the cause of the apparent discrepancies in different analyses. Thus it is not yet settled whether the fibrin is increased or diminished in this disease; and the differences which exist in the statements of different writers appear to be referable to the neglect of a critical examination and record of all the symptoms of the cases from which the blood was abstracted. The true nature of the changes of the blood in scurvy can be established only by numerous analyses during different stages of the disease, and followed up by carefully performed and recorded postmortem examinations. With such data we could settle such important questions as whether the increase of fibrin in scurvy was invariably dependent upon some local inflammation.

XII. Gangrenous spots, followed by rapid destruction of tissue, appeared in some cases in which there had been no previous or existing wound or abrasion; and without such well established facts, it might be assumed that the disease was propagated from one patient to another in every case, either by exhalations from the gangrenous surface or by direct contact.

In such a filthy and crowded hospital as that of the Confederate, States Military Prison of Camp Sumter, Andersonville, it was impossible to isolate the wounded from the sources of actual contact of the gangrenous matter. The flies swarming over the wounds and over filth of every description; the filthy, imperfectly washed, and scanty rags; the limited number of sponges and wash-bowls (the same wash-bowl and sponge serving for a score or more of patients), were one and all sources of such constant circulation of the gangrenous matter, that the disease might rapidly be propagated from a single gangrenous wound. While the fact already considered, 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 existence of hospital gangrene upon the surface, demonstrates the dependence of the disease upon the state of the constitution, and proves in a clear manner that neither the contact of the poisonous matter of gangrene, nor the direct action of the poisoned atmosphere upon the ulcerated surface, is necessary to the development of the disease; on the other hand, it is equally well-established that the disease may be communicated by the various ways just mentioned. It is impossible to determine the length of time which rags and clothing saturated with gangrenous matter will retain the power of reproducing the disease when applied to healthy wounds. Professor Brugmans, as quoted by Guthrie in his commentaries on the surgery of the war in Portugal, Spain, France, and the Netherlands, says that in 1797, in Holland, 'charpie,' composed of linen threads cut of different lengths, which, on inquiry, it was found had been already used in the great hospitals in France, and had been subsequently washed and bleached, caused every ulcer to which it was applied to be affected by hospital gangrene. Guthrie affirms in the same work, that the fact that this disease was readily communicated by the application of instruments, lint, or bandages which had been in contact with infected parts, was too firmly established by the experience of every one in Portugal and Spain to be a matter of doubt. There are facts to show that flies may be the means of communicating malignant pustules. Dr. Wagner, who has related several cases of malignant pustule produced in man and beasts, both by contact and by eating the flesh of diseased animals, which happened in the village of Striessa in Saxony, in 1834, gives two very remarkable cases which occurred eight days after any beast had been affected with the disease. Both were women, one of twenty-six and the other of fifty years, and in them the pustules were well marked, and the general symptoms similar to the other cases. The latter patient said she had been bitten by a fly upon the back d the neck, at which part the carbuncle appeared; and the former, that she had also been bitten upon the right upper arm by a gnat. Upon inquiry, Wagner found that the skin of one of the infected beasts had been hung on a neighboring wall, and thought it very possible that the insects might have been attracted to them by the smell, and had thence conveyed the poison.

[End of Dr. Stevenson's Statement]