Fifteen Months in Dixie; Or, My Personal Experience in Rebel Prisons

by William W. Day

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 decomposing animal and vegetable filth. The effects of salt meat, and an unvarying diet of corn meal, 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 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 more 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 coagulations 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 was 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, especially in crowded ships and camps, is the 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 is was very difficult to decide at first whether the ulcer was a simple result of scurvy or of the action of the prison or hospital gangrene, for there was great similarity in the appearance of the ulcers in the two diseases, so commonly have these two diseases been combined in their origin and action, that the description of scorbutic ulcers, 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 tissue appeared in some cases where there had 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 of the gangrenous matter. The flies swarming 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 existence of the disease upon the entire surface 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 direct action of the poisonous atmosphere upon the ulcerated surface is necessary to the developement of the disease.

7th. In this foul atmosphere amputation did not arrest hospital gangrene, the disease almost invariably returned. Almost every amputation was followed finally by death, either from the effects of gangrene or from the prevailing diarrhea or dysentry. Nitric acid and escharotics generally in this crowded atmosphere, loaded with noxious effluvia, exerted only temporary effects; after their application to the diseased surfaces, the gangrene would frequently return with redoubled energy; and even after the gangrene had been completely removed by local and constitutional treatment, it would frequently return and destroy the patient. As far as my observation extended, very few of the cases of amputation for gangrene recovered. The progress of these cases was frequently very deceptive. I have observed after death the most extensive disorganization of the structures of the stump, when during life there was but little swelling of the part, and the patient was apparently doing well. I endeavored to impress upon the medical officers the view that in this disease treatment was almost useless, without an abundant supply of pure, fresh air, nutritious food, and tonics and stimulants. Such changes, however, as would allow of the isolation of the cases of hospital gangrene appeared to be out of the power of the medical officers.

8th. The gangrenous mass was without true pus, and consisted chiefly of broken-down, disorganized structures. The reaction of the gangrenous matter in certain stages was alkaline.

9th. The best, and in truth the only means of protecting large armies and navies, as well as prisoners, from the ravages of hospital gangrene, is to furnish liberal supplies of well cured meat, together with fresh beef and vegetables, and to enforce a rigid system of hygiene.

10th. Finally, this gigantic mass of human misery calls loudly for relief, not only for the sake of suffering humanity, but also on account of our own brave soldiers now captives in the hands of the Federal Government. Strict justice to the gallant men of the Confederate Armies, who have been or who may be, so unfortunate as to be compelled to surrender in battle, demands that the Confederate Government should adopt that course which will best secure their health and comfort in captivity; or at least, leave their enemies without a shadow of an excuse for any violation of the rules of civilized warfare in the treatment of prisoners.”