peared
in some cases where there had been no known wound. Without such
well-established 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 Confederate States Military Prison at
Andersonville, it was impossible to isolate the 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
scanty supplies of rags, and the limited supply of washing utensils, the
same wash-bowl serving for scores of patients, were sources of such
constant circulation of the gangrenous matter that the disease might
rapidly spread from a single gangrenous wound. The fact already stated,
that a form of moist gangrene, resembling hospital gangrene, was quite
common in this foul atmosphere, in cases of dysentery, both with and
without the existence of the disease upon the entire 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
poisonous atmosphere upon the ulcerated surfaces is necessary to the
development of the disease.

7th. 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 gangrene would frequently 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 of
amputation 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, when 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