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and scurvy； the blood was fluid and did not coagulate readily； and the
heart…clots and fibrinous concretions were almost universally absent。
From the watery condition of the blood there resulted various serous
effusions into the pericardium； into the ventricles of the brain； and
into the abdominal cavity。
In almost all cases which I examined after death； even in 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 firm coagula were
universally present。 The presence of these clots in the cases of
hospital gangrene； whilst they were absent in the cases in which there
were no inflammatory symptoms； appears to sustain the conclusion that
hospital gangrene is a species of inflammation （imperfect and irregular
though it may be in its progress）； in which the fibrinous element and
coagulability 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 fibrinous constituent。
VI。 The impoverished condition of the blood； which led to serous
effusions within the ventricles of the brain； and around the brain and
spinal cord； and into the pericardial and abdominal cavities； was
gradually induced by the action of several causes； but chiefly by the
character of the food。
The Federal prisoners； as a general rule； had been reared upon wheat
bread and Irish potatos； and the Indian corn so extensively used at the
South； was almost unknown to them as an article of diet previous to their
capture。 Owing to the impossibility of obtaining the necessary sieves in
the Confederacy for the separation of the husk from the corn…meal； the
rations of the Confederate soldiers； as well as of the Federal prisoners；
consisted of unbolted corn…flour； and meal and grist； this circumstance
rendered the corn…bread still more disagreeable and distasteful to the
Federal prisoners。 While Indian meal； even when prepared with the husk；
is one of the most wholesome and nutritious forms of food； as has been
already shown by the health and rapid increase of the Southern
population； and especially of the negros； previous to the present war；
and by the strength； endurance and activity of the Confederate soldiers；
who were throughout the war confined to a great extent to unbolted corn…
meal； it is nevertheless true that those who have not been reared upon
corn…meal； or who have not accustomed themselves to its use gradually；
become excessively tired of this kind of diet when suddenly confined to
it without a due proportion of wheat bread。 Large numbers of the Federal
prisoners appeared to be utterly disgusted with Indian corn； and immense
piles of corn…bread could be seen in the Stockade and Hospital
inclosures。 Those who were so disgusted with this form of food that they
had no appetite to partake of it； except in quantities insufficient to
supply the waste of the tissues； were； of course； in the condition of men
slowly starving； notwithstanding that the only farinaceous form of food
which the Confederate States produced in sufficient abundance for the
maintenance of armies was not withheld from them。 In such cases； an
urgent feeling of hunger was not a prominent symptom； and even when it
existed at first； it soon disappeared； and was succeeded by an actual
loathing of food。 In this state the muscular strength was rapidly
diminished； the tissues wasted； and the thin； skeleton…like forms moved
about with the appearance of utter exhaustion and dejection。 The mental
condition connected with long confinement； with the most miserable
surroundings； and with no hope for the future； also depressed all the
nervous and vital actions； and was especially active in destroying the
appetite。 The effects of mental depression； and of defective nutrition；
were manifested not only in the slow； feeble motions of the wasted；
skeleton…like forms； but also in such lethargy； listlessness； and torpor
of the mental faculties as rendered these unfortunate men oblivious and
indifferent to their afflicted condition。 In many cases； even of the
greatest apparent suffering and distress； instead of showing any anxiety
to communicate the causes of their distress； or to relate their
privations； and their longings for their homes and their friends and
relatives； they lay in a listless； lethargic； uncomplaining state； taking
no notice either of their own distressed condition； or of the gigantic
mass of human misery by which they were surrounded。 Nothing appalled and
depressed me so much as this silent； uncomplaining misery。 It is a fact
of great interest； that notwithstanding this defective nutrition in men
subjected to crowding and filth； contagious fevers were rare； and typhus
fever； which is supposed to be generated in just such a state of things
as existed at Andersonville； was unknown。 These facts； established by my
investigations； stand in striking contrast with such a statement as the
following by a recent English writer：
〃A deficiency of food； especially of the nitrogenous part； quickly leads
to the breaking up of the animal frame。 Plague； pestilence and famine
are associated with each other in the public mind； and the records of
every country show how closely they are related。 The medical history of
Ireland is remarkable for the illustrations of how much mischief may be
occasioned by a general deficiency of food。 Always the habitat of fever；
it every now and then becomes the very hot…bed of its propagation and
development。 Let there be but a small failure in the usual imperfect
supply of food； and the lurking seeds of pestilence are ready to burst
into frightful activity。 The famine of the present century is but too
forcible and illustrative of this。 It fostered epidemics which have not
been witnessed in this generation； and gave rise to scenes of devastation
and misery which are not surpassed by the most appalling epidemics of the
Middle Ages。 The principal form of the scourge was known as the
contagious famine fever （typhus）； and it spread； not merely from end to
end of the country in which it had originated； but； breaking through all
boundaries； it crossed the broad ocean； and made itself painfully
manifest in localities where it was previously unknown。 Thousands fell
under the virulence of its action； for wherever it came it struck down a
seventh of the people； and of those whom it attacked； one out of nine
perished。 Even those who escaped the fatal influence of it； were left
the miserable victims of scurvy and low fever。〃
While we readily admit that famine induces that state of the system which
is the most susceptible to the action of fever poisons； and thus induces
the state of the entire population which is most favorable for the rapid
and destructive spread of all contagious fevers； at the same time we are
forced by the facts established by the present war； as well as by a host
of others； both old and new； to admit that we are still ignorant of the
causes necessary for the origin of typhus fever。 Added to the impe