War of the Rebellion: Serial 121 Page 0622 PRISONERS OF WAR AND STATE, ETC.

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the abdomen. In almost all the cases which I examined after death, even in the most emaciated, there was more or less serous effusion into the abdominal cavity. In ases of hospital gangrene of the extremities and in cases of gangrene of the instestines, heart clots and firm couagula 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, sustains 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 couagulation 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.

Fourth. 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 wherever the conditions of crowding, filth, foul ari, and bad diet are present. The exhalations from the hospital and stockade appeared toe xert these effects to a considerable distance outisde of these localities. The origin of hospital gangrene amongst these prisoners appeared clearly to depend in great measure upon the state of the general system, induced by diet and various external naxious 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 poision in the atmosphre, 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 it in all essential respects, 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 atmosphre of the C. S. military prison hospital, in the depressed, depraved condition of the system of these Federal prisoners.

Fifth. A scorbutic condition of the system appeared to favor the origin of foul ulcers, which freqnelty took on true hospital gangrene. Scurvy and hospital 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.

From the results of the existing war for the establishment of the independence of the Confederate States, as well as from the published observations of Doctor Trotter, Sir Gilbert Blane, and others of the English navy and army, it is evident that the scorbutic condition of the system, especially in crowded ships and camps, is most favorable to the origin and spread of foul ulcers and hospital gangrene. As in the present case of Andersonville, so also in past times when medical hygiene was almost entirely neglected, these two diseases were almost universally associated in crowded ships. In many cases it was very difficult to decide at first whether the ulcer was a simple result of scurvy or of the action of the poison of hospital gangrene, for there was great similarity in the appearance of the ulcers in the two diseases. So commonly have these two diseases been combined in their origin and action that the description of scorbutic ulcers by many authors evidently includes also many of the prominent characteristics of hospital gangrene. This will be rendered evident by an examination of the observations of Doctor lind and Sir Gilbert Blane upon scorbutic ulcers.