6th. Gangrenous spots followed by rapid destruction of tissue appeared 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 surface is necessary to the developement 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 or dysentry. 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 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.