and thus, by an alternate process of sloughing and phagedenic ulceration, large portions of the affected member or large masses of the body are destroyed. In this condition gangrene usually sets in, and if not speedily arrested soon puts and end to the poor sufferer's existence.
Gangrene first made its appearance in the stockade in the latter part of April or first of May last. The first that came under our observation was the result of frostbite. These cases (three or four in number) occurred among the prisoners who had been imprisoned on Belle Island last winter, where they received the injury. The parts attacked from this cause were usually the toes. The treatment was cold-water dressing, and the whole affected member enveloped in cloths spread with simple cerate, with tonics to support the system. This treatment usually succeeded, with the loss, perhaps, of one or more of the affected toes.
Early in the spring smallpox made its appearance in the prison, and as a prophylastic measure we were ordered to vaccinate "all who could not show a healthy scar." Consequently we went to work, and in week or ten days 2,000 or 3,000 were vaccinated. Out of these nearly every man who happened to be affected with scurvy was attacked with ulceration of the pustule. These small ulcers soon began to slough and extend over a large extent of surface. These sloughs would become detached, the parts beneath suppurate, as in the case of other ulcers in a sloughy condition, until at last the ulcer would become phagedenic and destroy every structure in its track for a considerable extent. In this condition gangrene would set in, and if the disease be not speedily arrested by powerful escharotics, emollient poultices, and the proper vegetable diet, amputation became necessary, or the poor wrethc would sink under the irritation; diarrhea or dysentery would supervene and speedily destroy the patient. The next and most common from of ulcers with us are what we call the scorbutic ulcer.
In severe cases of scurvy we have the upper and lower extremities covered with blue or livid spots, varying from the size of a millet seed to three or four inches in diameter, or the whole leg may be of a dark livid or copper color. These blotches become painful, open and ulcerate. This condition continues for a time, and finally slough, destroying whole toes, feet, and even arms and legs, apparently without there being sufficient energy or vitality in the system to set up inflammatory action. In this lamentable conditiongangrene sets in and exhibits a more striking example of hospital gangrene than any other from of gangrene with which we have had to contend. The most prominent symptoms of this kind of gangrene are a weak and small pulse, great prostration of the already enfeebled vital powers, a dry glazed tongue, great anxiety of countenance, with a foul grayish slough all over the surface of the wound or ulcer, which discharges a large quantity of filthy and very offensive sanies, destroying muscles and everything before it down to the bone. If an operation be not resorted to, we have hemorrhage, caused by the destruction of the blood vessels of the part. We have operated on perhaps twenty or thirty cases in this condition, and we do not recollect of a single case where the gangrene did not reappear in the stump and speedily destroy the patient. In the other forms of gangrene, however, we have had much better success. Out of perhaps a hundred operations twenty or thirty are well and as many others apparently doing well. We think the above a fair estimate of all the capital operations performed in this hospital during the spring and summer.