symptoms may or may not precede the local invasion of the disease, according to circumstances. If the constitutional of the patient is greatly debilitated by previous disease, as from scorbutus or chronic diarrhea, we usually have primary symptoms, such as great depression of the vital powers, anxious and expressionless countenance, quick and feeble pulse, and a dry, red, or glazed tongue. Fever and other constitional disturbances are invariably met with in this disease, but do not always precede it. When the disease is brought on in healthy patients with fresh wounds by contagion we have the above symptoms following the local disturbance or invasion of the disease. We have had no chance of settling the question of contagion in this hospital. Our patients have been crowded together on the same ground with other patients suffering from the various diseases incident to the prisoners, and in very many instances in the same tent, or even on the same bed. Again, we only have one wash pan to the tent, and it is utterly impossible for the nurses, if they were ever so particular, to keep those who have no gangrene from using the same basin used by the gangrene patients. The same sponge is doubtless often used for every patient in the tent, and owing to the great scarcity of bandages we are compelled to use the same bandages several times, and in washing they not unfrequently get changed, and thus the disease may be transmitted from one patient to the other by actual contact. So we are not in possession of the proper data to justify us in giving an affirmative answer as to the disease being contagious; but from our limited experience with the disease, and from what we know of its nature and general character, we are inclined to the opinion that it is highly contagious.
We have not the least doubt of the constitutionaity of the disease, but cannot speak from experience as to the success of strictly constituional treatment. We are alwsys so anxious to relieve our patients of whatever disease they may chance to have that we always make every effort for their relief in our power. Hence we have never treated this disease without using local applications, nor do we believe that we would be justifiable in making the experiment of treating hospital gangrene by constitutional means only. With the life of a human being in our hands, we would not think of risking constitutional treatment alone. Therefore we cannot answer the question from experimental knowledge.
Hospital gangrene may appear in slight wounds, even in perfectly healthy patients, if they should be exposed to the atmosphere in which the patient or patients are confined who are suffering from this disease, but the dangers of contagion are not so great as in other diseases of this nature. Having never tried the experiment of inoculation with gangrenous matter, we cannot speak positively, but we have no doubt but that we would have a modified form of the disease as a result. We do not believe this disease ever originates spontaneously in wellregulated and properly ventilated hospitals, unless the patients are overcrowded and neglected. Still, such cases are on record, but it will be remembered that at the time of their occurrence other diseases were prevailing epidemically, such as influenza, erysipelas, and phlebitis, which may, under certain circumstances, act as one of the causes of this affection. Influenza prevailed very extensively in the prison about the time this disease originated, and may have had something to d with its production. Let the causes be what they may, when the disease is once established in an extensive hospital it generally spreads rapidly, by contagion or otherwise, and its rapid spread is only checked by isolating all who are affected with the disease from the other sick and