accomplish this desirable result with any degree of accuracy from the almost total absence of records and from the imperfect organization of the hospital. Hospital gangrene was not recognized amongst the list of diseases recorded upon the Confederate sick reports until near the middle of 1864, and hence this disease does not appear in the sick reports of the Federal prisoners at Andersonville prior to July, 1864. During the month of August fifty-fourth cases and thirteen deaths of phagedaena gangraenosa and reported, whilst during the entire six months 230 cases of ulcers are recorded.
I requested the medical officers on duty in the C. S. military prison hospital to prepare a carefully classified report upon the number and character of the cases of gangrene arising from ulcerations and following gunshot wounds and amputations, together with a statement of the causes of the disease, the condition of the patient, the nature of the treatment, and the results of operations. The records of the individual wards and divisions were so incomplete that the report was imperfect in every respect, and from many of the wards it was impossible to obtain any statistics whatever. I examined in person the wards and patients, and by this means also determined the inaccuracy of the record. Upon this incomplete report 266 cases of hospital gangrene were recorded with 67 amputations in consequence of the disease and 25 deaths; 120 casea re supervening upon gunshot wounds, and the remainder were reported as gangrenous ulcers arising from the scornbutic and deranged condition of the general system. Twelve cases of gangrenous ulcers are recorded as following vaccination.
These figures are far below the truth. Many cases of gangrenous ulcerations which arose in the hospital were originally entered upon the shopital register under the head of scurvy, diarrhea, dysentery, or some other disease. The plan of entering the diseases upon the hospital register, which supervened upon the original affection, undera distinct head of "Readmitted during the month," was not inaugurated until the month of July, 1864; and, in fact, it was not properly carried into execution until the month of August. The number of deaths duet to hospital gangrene, given above, is below the true statement, for in the reports of a number of the wards the final result was not given. After careful inquiry I was convinced that the number of amputations for hospitall gangrene had exceeded 100.
Hospital gangrene returned almost invariably after amputation in this infected atmosphere, and in some cases the disease reappeared in the stump within thirty-six hours after the operation. The day before I arrived at Andersonville the cars had run off the track and been crushed against the side of the cut through a hill about three miles from the prison. The cars were loaded with Federal prisoners who were en route for Millen. The accident happened within less than two hours after the prisoners had left the stockade. A number of the prisoners were killed and wounded. I observed the wounded who were brought to the C. S. military prison and noted the first appearance of the gangrene.
In a case of amputation in the middle of the thingh for a compound comminuted fracture of the foot and leg received at this time, the lips of the wound did not unite, and although the patient was a stout Irishman in apparent good health, in the course of twenty-four hours a deep blue line appeared along the edges of the wound, and the skin around the lips of the wound presented an excoriated, blistered appearance. The sutures came away, the edges of the wound gaped pen, the flaps of the stump assumed a grayish, greenish, and bluish appearane, and in