fibrous element of the blood was increased; while
in simple diarrhea, uncomplicated with ulceration,
it was either diminished or else remained stationary.
Heart clots were very common, if not universally
present, in cases of ulceration of the intestinal
mucous membrane, while in the uncomplicated cases of
diarrhea and scurvy, the blood was fluid and did not
coagulate readily, and the heart clots and fibrous
concretions were almost universally absent. From
the watery condition of the blood, there resulted various
serous effusions into the pericardium, ventricles
of the brain, and into the abdomen. In almost
all the cases which I examined after death, even 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 fibrous coagula
were universally present. The presence of those
clots in the cases of hospital gangrene, while they
were absent in the cases in which there was 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 fibrous
element and coagulation 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 fibrous constituent.
4th. 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 hospital gangrene among these prisoners
appeared clearly to depend in great measure upon the
state of the general system induced by diet, and 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 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 atmosphere of the Confederate States
Military Hospital, in the depressed, depraved condition
of the system of these Federal prisoners.