Those who have been once afflicted with hospital gangrene are extremely liable to its recurrence, and that too on the same sore; though the secondary disease is much less acute. This form has been termed Sloughing Phagædena, and may seize a sore not previously affected with gangrene. The wound, recovering from the first attack, and appearing to heal rapidly, with good discharge and healthy surface, presents, near its edge, a small dark spot or ulceration, of the size of a small bead or shot, of a circular form, with a ragged edge, excavated surface, and fetid discharge. Several such points may appear; they spread rapidly, unite, and the surface is soon destroyed. It is not uncommon to find one part of the sore of a healthy appearance, and even cicatrising, whilst in another part the surface is rapidly disappearing. The patient complains of a burning sensation in the part; suppuration occurs round the edges and beneath the slough, and the dead parts separate; but the same process again takes place, and another slough forms. The malady proceeds often with a rapid and alarming pace; the sloughs are soft, pulpy, and reddish, and separate one after another, exposing muscles, nerves, bloodvessels, and bones. Joints are opened into, and the vessels, having been exposed, perhaps for a day or two, give way, and fatal hemorrhage ensues, their cavities not being obstructed with coagula as in sphacelus. The patient is sick, has no appetite, and labours under other symptoms of deranged stomach; there is restlessness, with a small quick pulse, and all the symptoms of a weakened and sinking system. The ulceration becomes more rapid, the discharge is bloody and peculiarly offensive; all the symptoms increase in violence, and may proceed for fifteen or twenty days, or terminate in four or five, either in convalescence or death. Hospital gangrene is supposed to arise from a variety of causes: from the state of the atmosphere, moist and hot—from inattention to cleanliness, the parts around the sore being seldom wiped, the matter collecting amongst the dressings, and becoming acrid by putrescence—from irritating applications, as rancid ointments—from a too stimulating diet, and from the abuse of wine and spirits—from mechanical irritation, in moving the wounded over rough roads and in bad conveyances, as after great engagements—from specific contagion without immediate contact. After being once generated, it is propagated by direct communication, by the application of morbific matter from sponges, dressings, or instruments. It is not easy to say how the disease originates.