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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 a