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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 imperfect
nature of the rations issued to the Federal prisoners； the difficulties
of their situation were at times greatly increased by the sudden and
desolating Federal raids in Virginia； Georgia； and other States； which
necessitated the sudden transportation from Richmond and other points
threatened of large bodies of prisoners； without the possibility of much
previous preparation； and not only did these men suffer in transition
upon the dilapidated and overburdened line of railroad communication；
but after arriving at Andersonville； the rations were frequently
insufficient to supply the sudden addition of several thousand men。
And as the Confederacy became more and more pressed； and when powerful
hostile armies were plunging through her bosom； the Federal prisoners of
Andersonville suffered incredibly during the hasty removal to Millen；
Savannah； Charleston； and other points； supposed at the time to be secure
from the enemy。 Each one of these causes must be weighed when an attempt
is made to estimate the unusual mortality among these prisoners of war。
VII。 Scurvy； arising from sameness of food and imperfect nutrition；
caused； either directly or indirectly； nine…tenths of the deaths among
the Federal prisoners at Andersonville。
Not only were the deaths referred to unknown causes； to apoplexy； to
anasarca； and to debility； traceable to scurvy and its effects； and not
only was the mortality in small…pox； pneumonia； and typhoid fever； and in
all acute diseases； more than doubled by the scorbutic taint； but even
those all but universal and deadly bowel affections arose from the same
causes； and derived their fatal character from the same conditions which
produced the scurvy。 In truth； these men at Andersonville were in the
condition of a crew at sea； confined in a foul ship upon salt meat and
unvarying food； and without fresh vegetables。 Not only so； but these
unfortunate prisoners were men forcibly confined and crowded upon a ship
tossed about on a stormy ocean； without a rudder； without a compass；
without a guiding…star； and without any apparent boundary or to their
voyage； and they reflected in their steadily increasing miseries the
distressed condition and waning fortunes of devastated and bleeding
country； which was compelled； in justice to her own unfortunate sons； to
hold these men in the most distressing captivity。
I saw nothing in the scurvy which prevailed so universally at
Andersonville； at all different from this disease as described by various
standard writers。 The mortality was no greater than that which has
afflicted a hundred ships upon long voyages； and it did not exceed the
mortality which has； upon me than one occasion； and in a much shorter
period of time； annihilated large armies and desolated beleaguered
cities。 The general results of my investigations upon the chronic
diarrhea and dysentery of the Federal prisoners of Andersonville were
similar to those of the English surgeons during the war against Russia。
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 changesphysical； chemical