Scurvy and 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. . .  Scurvy consists not only in an alteration in the constitution of the blood, which leads to passive hemorrhages from the bowels, and the effusion into the various tissues of a deeply-colored fibrinous exudation; but, as we have conclusively shown by postmortem examination, this state is attended with consistence of the muscles of the heart, and the mucous membrane of the alimentary canal, and of solid parts generally.  We have, according to the extent of the deficiency of certain articles of food, every degree of scorbutic derangement, from the most fearful depravation of the blood and the perversion of every function subserved by the blood to those slight derangements which are scarcely distinguishable from a state of health.  We are as yet ignorant of the true nature of the changes of the blood and tissues in scurvy, and wide field for investigation is open for the determination the characteristic changes—­physical, chemical, and physiological—­of the blood and tissues, and of the secretions and excretions of scurvy.  Such inquiries would be of great value in their bearing upon the origin of hospital gangrene.  Up to the present war, the results of chemical investigations upon the pathology of the blood in scurvy were not only contradictory, but meager, and wanting in that careful detail of the cases from which the blood was abstracted which would enable us to explain the cause of the apparent discrepancies in different analyses.  Thus it is not yet settled whether the fibrin is increased or diminished in this disease; and the differences which exist in the statements of different writers appear to be referable to the neglect of a critical examination and record of all the symptoms of the cases from which the blood was abstracted.  The true nature of the changes of the blood in scurvy can be established only by numerous analyses during different stages of the disease, and followed up by carefully performed and recorded postmortem examinations.  With such data we could settle such important questions as whether the increase of fibrin in scurvy was invariably dependent upon some local inflammation.

XII.  Gangrenous spots, followed by rapid destruction of tissue, appeared in some cases in which there had been no previous or existing wound or abrasion; and without such well established facts, it might be assumed that the disease was propagated from one patient to another in every case, either by exhalations from the gangrenous surface or by direct contact.