bones denuded of mucles that amputation was deemed necessary. At the time that I examined this case he was isolated in a tent. After the amputation gangrene reappeared in the stump, but the use of nitric acid and the constitutional treatment with quinine and tincture and muriate of iron arrested the progress of the disease and the stump is now suppurating. The pus, however, is thin, unhealthy, and offensive, and the constitutional symptoms are unfavorable-weak, feeble, rapid pulse, hectic flush on cheek, sallow, unhealthy, leaden hue of complexion, loose bowels, no appetite, depressed spirits.
Various inquiries wee adressed to the medical officers relating to themost important disease, and especially to hospital gangrene prevailing amongst the Federal prisoners. I received but one communication to my written inquiries. The Surgeon-General will find this in the appendix containing documents connected with my objeservations upon the diseases of the Federal prisoners confined in Camp Sumter, Andersonville, attached to this portion of my labors.*
I also instituted a series of post-mortem examinations, designed to illustrate and determine the true causes of the great mortality amongst the Federal prisoners.
The following conclusions from these and the preceding investigations, relating in large measure to the origin and nature of hospital gangrene, are respectfully submitted to the consideration of the Surgeon-General.
First. The great mortality amongst 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.
Second. 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 duet to the diet, the habits of the patients, the depressed, dejected state of the nervous system and moral and itellectual powers, and to the effluvia arising from the 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 sirup, 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.
Third. From the sameness of the food and from the action of 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 fibrinous element was deficient. In cases of ulceration of the mucous membrane of the intestinal canal the fibrinous element of the blood was increased; shilst in simple diarrhea, uncomplicated with ulceration, it was either diminished or else remained stationary. Heart lots were very common if not universally present in the cases of ulceration of the intestinal mucous membrane, shilst in the uncomplicated cases of diarrhea and scurvy the blood was fluid and did not cougulate 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 perficardium, ventricles of the brain, and into
*See p. 625.