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 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 surfaces is necessary to the development of the disease.