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.

5th. A scorbutic condition of the system appeared to favor the origin of
foul ulcers, which frequently 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 Dr. 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, those 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 prison or hospital
gangrene, for there was great similarity in the appearance of the ulcers
in the two diseases. So commonly have those 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 Dr. Lind and Sir Gilbert Blane upon
scorbutic ulcers.

6th. Gangrenous spots followed by rapid destruction of tissue ap