Sixth. Gangrenous spots, followed by rapid destruction of tissue, appeared in some cases when there had been no known wound. Without such well-estabished facts it might be assumed that the disease was propagated from one patient to another. In such a filthy and crowded hospital as that of the C. S. military prison at Andersonville it was impossible to insolate that wounded from the sources of actual contact of the gangrenous matter. The flies swarming over the wounds and over filth of every kind, the filthy, imperfectly washed, and scant supplies of rags, and the limited supplies of washing utensils-the same washbowl serving for scores of patients-were sources of such constant circulation of the gangrenous matter that the disease might rapidly spread from a single gangrenouns wound. The fact already stated that a form of moist gangrene resembling hospital gangrene was quite common in this foul atmosphre in cases of dysentery, both with and without the existence of the disease upon the exterior surface, not only demonstrates the dependence of the disease upon the state of the constitution, but proves in the clearest manner that neither the contact of the poisonous matter of gangrene nor the direct action of the poisoned atmosphere upon the ulcerated surface is necessary to the develpment of the disease.
Seventh. In this foul atmosphere amputation did not arrest hospital gangrene; the disease almost invariably returned. Almost every amputation was followed finally by death, either from the effects of gangrene or from the prevailing diarrhea and dysentery. Nitric acid and escharotics generally in this crowded atmosphere, loaded with noxious effluvia, exerted only temporary effects. After their application to the diseased surfaces the gagrene would freqently return with redoubled energy; and even after the gangrene had been completely removed by local and constitutional treatment, it would frequently return and destroy the patient. As far as my observation extended, very few of the cases ofa mputation for gangrene recovered. The progress of these cases was frequently very deceptive. I have observed after death the most extensive disorganization of the structures of the stump, where during life there was frequently very deceptive. I have observed after death the most extensive disorganization of the structures of the stump, where during life there was but little swelling of the part and the patient was apparently doing well. I endeavored to impress upon the medical officers the view that in this disease treatment was almost useless without an abundant supply of pure fresh air, nutritious food, and tonics and stimulants. Such changes, however, as would allow of the isolation of the cases of hospital gangrene appeared to be out of the power of the medical officers.
Eighth. The gangrenous mass was without true pus, and consisted chiefly of broken-down disorganized structures. The reaction of the gangrenous matter in certain stages was alkaline.
Ninth. The best, and in truth the only, means of protecting large armies and navies, as well as prisoners, from the ravages of hospital gangrene is to furnish liberal supplies of well-cured meat, together with fresh beef and vegetables, and to enforce a rigid system of hygiene.
Tenth. Finally, this gigantic mass of human misery calls loudly for relief, not only for the sake of the sufferers and humanity, but also on account of our own brave soldiers now captives in the hands of the Federal Government. Strict justice to the gallant men of the Confederate armies who have been or who may be so unfortunate as to be compelled to surrender in battle demands that the Confederate Government should adopt that course which will best secure their health and comfort in captivity, or at least leave their enemies without the shadow