SANITARY COMMISSION. S. HINTS FOB THE CONTROL AND PREVENTION OK INFECTIOUS DISEASES, IN CAMPS, TRANSPORTS, AND HOSPITALS. Wu. C. Brtant & Co., Printers, 41 Nassau Street, corner op Liberty. 1863. The attention of the Sanitary Commission has been directed to the fact, that most of our Army Surgeons, now in the field, are unavoid- ably deprived of many facilities they have heretofore enjoyed for the consultation of standard medical authorities. It is obviously impossible to place within their reach anything that can be termed a medical library. The only remedy seems to be the preparation and distribution among the medical staff, of a series of brief essays or handbooks, embodying in a condensed form the conclusions of the highest medical authorities in regard to those medical and surgical questions which are likely to present themselves to surgeons in the field, on the largest scale, and which are, therefore, of chief practical importance. The Commission has assigned the duty of preparing papers on several subjects of this nature, to certain of its associate members, in our principal cities, belonging to the medical profession, whose names are the best evidence of their fitness for their duty. The following paper comprising " Hints for the Control and Pre- vention of Infectious Diseases in Camps, Transports, and Hospitals," prepared by a member of the Commission, belongs to this series, and is respectfully recommended by the Commission to the Army. J. FOSTER JENKINS, M. D., Secretary. New York, October, 1863. fjinte for % Control ani frAenttou OF INFECTIOUS DISEASES IN CAMPS, TKANS- PORTS, AND HOSPITALS. The diseases that owe their origin and diffusion to specific Prevention of ... . t .-,,,., infectious discas- lnfectious poisons, though comparatively few m number, es especially im- -1- ' ° x " ' portant in armies are the most troublesome and fatal that can afflict an army. Often have great forces been crippled, and the objects and hopes of many a campaign have been defeated by such dis- eases ; while not unfrequently the same silent enemies of military quarters, camps and transports, have humbled the proudest armies, and brought thousands of brave men to their graves, even after their arms had achieved success in the field. The occurrence of small pox, measles, epidemic dysentery, &rYhal^]^a and typhus, in camps, barracks, or transports, and the prev- to be dreaded. alence of these diseases, together with gangrene and other infections in military hospitals, are calamities that deeply concern all persons who are responsible for the welfare of the soldier, or the efficiency of the national forces: and as it has been demonstrated by repeated observations and varied experience, that such diseases owe their diffusion and en- They owe their demic prevalence to hygienic neglect, and that proper SnegUl^" sanitary measures will not only tend to limit and prevent the prevalence of such infectious and contagious maladies, but urea t^aSe'. will also diminish the severity of other diseases, every mili- ary officer needs to have a practical comprehension of the 6 om^TaSlZ social measures required for sanitary protection under the plication or'such various circumstances of exposure to disease, and to the measures. inconveniences of army life. With this view, we submit the following practical hints upon, the means of arresting and PaPer!gn ° lhl3 preventing the prevalence of infectious diseases in canq>sy barracks, transports, and hospitals. The infectious maladies to which we shall particularly allude, are among the most strongly characterized of the zymotic diseases, and, with the exception of a single group, the specific poisons upon which they respectively depend infectious diseas- are unquestionably capable of being communicated from es,how coramun- , . •, . „ icated, and how the persons sick to persons uninfected. And in the excep- transported. . . * tional group, m which we place certain very fatal maladies, the infecting poison is, in some instances, susceptible of trans- portation by porous substances, or vessels with contaminated air, acting as the media or vehicles of such transmission or transportation. But, without entering upon elaborate de- hom dtaeuiTde". finitioils> i<; is sufficient that we comprehend the fact that Saids conditio^ eyeiT infectious disease depends practically upon certain d1ffu!ion.tivity or sPecinc conditions for its activity, and for the communica- tion or spread of its infectious cause, whether to individuals Those condi- or communities. The most essential of these conditions are tions are within • .-, ..-, . , , . . n. . human control, primarily witlim human control, and to such conditions only does the design of this paper permit us to refer. But we do not lose sight of the fact that there sometimes exist general epidemic influences, the nature and cause of which „ _ . are not fully comprehended or controlled by science, and Epidemic mflu- ,.,.,. ence. that diseases which primarily depend upon such influences, may not at all times be completely submissive to human agency. But there is good reason for believing that the The localizing material agencies by which even the most epidemic types lcamseasfeesPtdoebe of disease are localised and rendered positively infectious, venterd!ledorpre" mav De controlled, anticipated, and prevented, by properly directed sanitary measures. As it is the sole design of this paper to set forth in a prac- tical way the facts upon which effectual measures may rea- obje'et oEpa-1 sonably be based for controlling the infectious maladies ptl' that most afflict armies and recruits, we propose to give to these facts the plainest possible statement, without reference 7 to theoretical and mooted questions. And the purpose of m^a^neiM these pages will be fully attained, if they furnish such J^^ military timely and practical suggestions as the hygienic exigencies of hospitals and crowded military quarters continually de- mand. The several diseases to which particular reference will be for the pmpose made, in these pages, may, for the practical ends we have ° in view, be considered in three classes, viz : Small-Pox, ) Exanthematous contagions ; spread by Measles, V communication with the diseased person, Scarlatina, ) —mediately, or immediately. Typhus Fever, Hospital Gangrene, Erysipelas, Typhoid Fever, Asiatic Cholera, Yellow Fever, Class I. Class n. Contingently contagious and infec- tious diseases / perpetuated and spread both by personal and en- demic conditions of hygienic ne- glect. Endemic infections, caused and per- Classin- petuated by external localizing con- ditions / and diffused as well as localized by the neglect of personal and local hygienic measures. The First Class comprises the more important ex- J^l™^™' anthematous infections. It is conceded that all these, as personally communicable poisons, or contagions, are suscept- ible of limitation and control by means of domestic or per- • i -ipi i • in • Domestic quar- sonal isolation of the sick, and ot the things and places m- ant'ne or isoia- i - tion" fected by them; but experience shows that such isolation, to be effective, especially if in the presence of strongly local- izing conditions, or epidemic influences, must be vigilantly The more im. and intelligently managed. Though the essential primary caiiz1ngWhaenl0d causes of the exanthematous fevers are yet unknown, we cmmuIinfluen' may, for all practical purposes, regard it as an ultimate fact that they are spread by communication with the infected thLhee co^SJ°m and sick persons,—mediately or immediately. by the sick. 8 smaii-pox the Smallpox.—The facts relating to this most contagious most dreaded in- ° , , , , /■ fectionuntujBN-malady are too well understood to need any statement 01 ner's discovery. .... T . . , 1 l a j? them in this paper. It is the most strongly marked, type ol specific poisons, and the certainty of its contagious quality, and the liability of its infectious diffusion, made it the scourge of the civilized world until Jenxer discovered the prophylactic power of vaccinia or the cow-pock. vaccination and The value of vaccination in armies has been lucidly set its value in ar- p i • • i mi«- forth, and in a very practical manner enforced, m a special report or monograph upon the subject [Medical Document, E], by a committee of associate members of the Sanitary Report of Profs. Commission. Cordially commending to surgeons and com- smith and sun. mandin -, <. , . -, -, „ , of small-pox. the possibility ot some detects in such duty, as well as the probabilities of the presence of new and unprotected persons, render it expedient to repeat such measures. To officers in charge of recruits for the army, we earnestly importance of ° •' ' J early vaccination recommend that, at the earliest practicable hour after reach- of recruits. ing the first place of rendezvous, all men in their care be effectually protected by vaccination. General sanitary measures, and the isolation or domestic ,The .nece3Si,y •/ ' of special sani- quarantine of patients and their clothing, should apply alike |*ry ^"'f^e to small-pox, measles, scarlatina, and other febrile conta- Sematous lis- gions ; and, notwithstanding the fact that certain epidemic eases* influences may prevail, it is not the less true that intelli- gently directed sanitary measures against tie sources of these nuisances are sure to be rewarded with good results. The value of such measures against typhus and gangrene are popularly conceded, and the following cases will serve to illustrate the importance and utility of specific measures to Extensive prev- i * t . alence of both limit the prevalence ot exanthematous diseases in camps : smaii-pox and • • i i i r>/~ii -n .„ measles in a reg- A short time previous to the battle of Chancellorsville, the imentinthefieid. ---- regiment of Maine volunteers had in hospital and upon its sick list, upwards of eighty cases of small-pox. The same regiment had thirty men sick with measles at one time on its hospital roll at Antietam a few days subsequent to the great battle there, in September, 1862. Orders for transportation, from its first rendezvous, to join the army negieltfnT'sin'i- were received while the measles were beginning to appear ,ary measures- in one company. No timely and effectual measures were 10 Scarlatina deci' mates a new reg- instituted to prevent the introduction or to limit the diffu- sion of either of those in lections, and as a consequence, many lives wrere sacrificed, and the military effectiveness of the regiment has thereby been nearly destroyed. In the month of December, 1802, a first-class new regi- ment arrived in New York, en route to the seat of wTar, from ca1iizringandcondi- hs rendezvous in Massachusetts. A case of scarlatina Btroytheecorpsde appeared during the trip hither. The men were assigned to close and insalubrious quarters in the lofts of a warehouse in this city. The cases of scarlatina continued to multiply from day to day and from week to week, until nearly two hundred cases had occurred, and until one of the most pro- mising regiments ever organized had become so broken the strength" of down by this cause that the dead, together with discharged hopelessly lost invalids, amounted to an aggregate of nearly two full com- panies. This regiment left its pestiferous quarters in the city, after a detention of about two months, with its military effectiveness diminished, as estimated by its veteran colonel, fully thirtu per cent, upon its original strength of one thou- The localizing •' . . . causes of the en- sand men. And it is worthy of mention here that the local demic produced " other diseases, conditions that had rendered scarlatina so fatally endemic, also prostrated the strength of every man, and induced various inflammatory and typhous maladies which broke down the health and vigor of men who seldom had known ductdinVtur sickness previously. 3,7 '"samT'en- In the autumn of 1862, four full regiments of nine months' campment. men were orciereci to encamp, while waiting transportation, in the vicinity of the Bay of New York, upon a plain that domffe8CticVenquSar- lia^ aheady been much used as a camping ground. Measles antine. iia(} a]rea(]y appeared in one of the regiments, and soon the infection had extended to the three other commands. In one regiment only was the malady subjected to an effectual and rigidly enforced domestic quarantine. In that camp the measles ceased with the occurrence of the second case. Neglect of such In the three other camps no such measures of personal iso- measures result- , . ,, . ed in great losses, lation of the sick were adopted until upwards of three hun- dred cases of that disease had occurred. iatfnaeby°meCaans' ^n tne camP mentioned, where measles was arrested, uresethaaTea™est- tne ut^J °f effectual domestic isolation for arresting the ed measles. spread of scarlatina had been tested in a case of that disease 11 which occurred from exposure of one of the soldiers who visited the infectious quarters of the Massachusetts regiment which wc have mentioned. In this instance, the case of scarlatina was removed a short distance from the lines of the encampment the hour that the evidences of his disease appeared, and a rigid domestic quarantine of the sick man and his clothing was established. His nurse was the only other victim of the infection. After a detention of a few weeks, when these four regiments were sent forward to the field, the one last mentioned had its full quota of men; in these four reg- while the three others had only about two-thirds the number of soldiers who, a few weeks previously, had gone into their encampment in full health—except the single company in which the measles first appeared. We might add other illustrative instances of the pernicious effects of the exanthematous contagions in camps, but they would all tend merely to strengthen this cumulative testi- mony to the hygienic utility and military necessity of special Pl.eventive 8an- restrictive measures for arresting and preventing the spread ^aLt^IX! of this class of diseases. And what is true of exanthematous n^Xr/KS contagions, is practically, though in a modified sense, true army" of other diseases that depend upon specific and infections poisons. The special sanitary measures, which such poisons require for their control, may all be comprised under the simple rule that— The immediate sources of infectious poisons should be a general ™ie . , „ . P 7 j i 7 7 • • to be observed in properly isolated from uninfected persons, the Localizing region to aiiin- conditions of their endemic prevalence should be removed, and every circumstance that adds to their virulence or tends to give them existence or activity, should be prevented or controlled by sanitary measures. Tbe statements and suggestions that follow in these pages Applications of will present practical illustrations and specific applica- tions of this rule; and the fact will constantly appear that such hvgienic measures against infections poisons and their immediate causes, are also the most effective sanitary works for the general prevention of disease and the improvement of health. Keo-arding all cases of infection and contagion, whether this rule. 12 infection is Rn individual or endemic, as preventible evils, it might be be continually claimed that they never should occur under proper medical anticipated and t . . . , <■, / 1 guarded against, and military administration; but as Jmtrgeon-Itkxkkai, Hammond has justly remarked, in his treatise on Military Infection may ** •/ ' - exist under good Hygiene, "even with everv effort dictated by tbe most management. ./ o 7 - _ . thorough acquaintance with the science of hygiene, and the most conscientious endeavors to discharge faithfully the duties of his office, the medical officer of a hospital will sometimes find diseases originate under his eyes which can only owe their source to infection." Diversity of in- In resuming the consideration of the specific infections, anCdtl0agenc?es°of it is proper to remark in limine, that, in the classification given in this paper, these poisons may be regarded as having widely diverse causes, operating by means of different agen- cies, most of which are amenable to hygienic regulations. Th imm di ^ne exanthematous poisons, though positively contagious ceTibVof con- anc^ transP°riable, are measurably susceptible of preventive tro1- sanitary control; and most other infectious poisons, though more dependent upon contingencies for their operation, and therefore more difficult of such restraint, are not less sub- missive to it when directed by proper intelligence. why measles To small-pox and vaccination is due the separate con- cause grea[er"io°t sideration given in the monograph [Medical Document, E] 8maiiVor™y than f° which we have referred. Measles and scarlatina, though less dreaded, are actually the causes of greater danger and loss to the army than small-pox, for much greater numbers of soldiers are liable to the former maladies, and the sequlse of those fevers are often fatal, or apt to produce lingering impairment of health. Hence those maladies, though popularly regarded as being simply the inevitable scourges of childhood, do actually demand vigilant measures for their prevention and control in the army. Recapitulation Sanitary Regulations for preventing the spread of the ex- of special meas- anthematous contaqions. 1st. The patients and all infected ures for the sani- & -t they examhema- tmn»s—at least, all the personal clothing worn during the tous contagions, period of eruption—should be immediately separated from all persons that are liable to contract or to communicate the contagion; and such domestic or limited quarantine should be 13 enforced, as will insure entire security against its diffusion Personal isoia- -rj i ■• ti0D 0r dome3tIC -Both the nurses and the infected clothing of such per- quarantine. sons should be treated as in quarantine. Purification of persons and places exposed to the infection should be effected by means of washing, and thorough ventilation, while all , , . &' & ' . Infected per- clothing and porous materials must be disinfected by washing, sons and places, -,.,.,. how to be treated. at boiling heat, if practicable, otherwise by sufficiently pro- tracted ventilation—which, in the case of articles contam- Cl0thing ana inated by small-pox, should be aided by fumigations ofporous materials- chlorine or bromine. And in case neither a high heat nor strong fumigations of the latter chemicals can be applied special disin- to such contaminated materials, let them be destroyed by fecting asent3' fire. Boiling heat, or high steam, is the surest disinfect- ant of small-pox and all other contagions. Even a tem- perature of 140° F. effectually neutralizes the virus of vac- cinia. The transportation of patients having small-pox or measles L Ambulances, r -1 ° x tents, and equi- should ill all cases, when practicable, be provided in vehicles Pa|*> how man- exclusively employed for the purpose; and, in any case where an ambulance or saddle has been used for conveying a small-pox patient or his clothing, it should be placed in quarantine until properly purified. Tents and equipage that have been immediately exposed to the exanthematous infections, should be washed with boiling water. It should be borne in mind that a low temperature tends d0egr°not destroy rather to increase than diminish the activity of the exan- {0|;a "fVcuoM?" thematous poisons and most other febrile contagions. It is only upon the yellow fever miasma, and other infections which depend upon warmth and moisture, that cold acts as a disinfecting agency. Second Class of Infections.—Typhus fever, hospital j^S^u! gangrene, and erysipelas, are here grouped for consideration c\T£s0.fthesecond as infectious maladies, and sources of specific poisons that obey similar laws of generation and of prevention, and which also depend upon a given class of hygienic agencies for the mitigation of their activity. • No ai'inv surgeon can be uninformed respecting the in- The dangerous j.i u au",; >-"* & i o nature of these in- fectious nature, and the peculiar activity and perils of this J^ion. «• weu 14 Means of pro- class of contagions in hospitals and crowded quarters, and should be" det£ as even the subordinate officers in wards, and the command- stood. "" ing officers in military quarters, where any of these diseases are found, ought definitely to understand the requisite mea- sures for providing sanitary protection against them, the following concise statement is here given, without explana- tion, and at the pleasant risk of recapitulating, in a very synoptical manner, the special information and hygienic regulations which every medical officer in charge of a mili- The object of tary hospital may justly claim as his own. Were an thus stating what J . , . . sanitary mens- apology required for reiterating such statements of accepted urea are required. x 0,/ x o x medical knowledge, or for reducing these statements to aphorisms, we need but refer to the circumstance, " that it stands prominent as a fact in military history, that serious "Contngion" a evils frequently arise in armies from the ravages of conta- contingent evil. . n ' •• ., , ... . . ., . . gious lever; and that, as contagion is a contingent evil, it is obvious to common sense, that the chances which give rise to its action ought to be precluded with every possible Active warfare care." [Dr. Hobt. Jackson on Armies,p. 368.] demands a choice tt iij.j.1 i • v x' t l of evils and some However excellent the plans providing for medical service ease°.sur< ' ls" in hospitals and in the field, and however well directed may be the sanitary regulations of great armies, active warfare involves the repeated and almost constant occurrence of con- tingencies that necessitate a choice of evils, and require much exposure to causes of disease. The crowding and ac- infectio^poisons cumulation of men which occur in war, tend to produce and overcrowding™ perpetuate infectious maladies. Hospitals and transports are frequently overcrowded from the very necessities that war creates; wdiile the regulations of encampments are made to crowd upon given areas populations more dense Encampingsoi- than can be found in any city. Our army regulations permit diers at the rate 86,000 to the sq. crowding in the regimental camp at the rate of 86,000 men to the square mile; while in liospitals and transports the natural evacuations and bodily excretions, the suppurating wounds, the gangrenous parts, and the uncleansed persons and cloth- speciai sources ing of vast numbers of soldiers in an unhealthy condition, of infection, in , . , . . . , , . 'TT -, , hospitals and are combined to vitiate the local atmosphere. Under such transports. . /» • • i -i • -i i • i c ^ circumstances of inevitable insalubrity, the worst or ende- mic infections may suddenly spring into fatal activity, and almost any imported virus of disease will readily become 15 localized. It is manifest, therefore, that hygienic measures ^££^™ for the control and the prevention of infectious contamina- •rurlt»tl^e9p^ tion will mainly consist in sanitary works for the preservation object. of atmospheric purity, and for the special restoration of such purity to the places, things, and persons contaminated. To be accom- 1 J l 5 & ? r plished by the To accomplish this object, sanitary science commands the resources of L J ' J chemistry, engin- abundant resources of police regulations, engineering, chem- eering.and saut- x o JO o' tary police. istry and medical science. localizing and Endemic Causes of Infections of the Loca]izin and Second Class—Putrid Contagions.—1. Overcrowding and ip^^lJ*™** special hygienic neglect of wards, barracks, quarters, tents, or transports, may justly be regarded as the most active and common localizing condition, and the chief originat- » ' " The chief cause ing cause of tvphus, and of that state of the blood and of typhus is over- ~ • l ' _ crowding. the nervous system that primarily establishes the gan- grenous process, and renders simple erysipelas malignant How gangrene and contagious. Any apartment or place that has generated £ncdom^p*ga! or localized any of these dangerous infections, should, if °us- practicable, be immediately and entirely vacated by all Iofected wardg sick and wounded persons; but if such removals are im- aacatpldacest0 be possible, let there be made the best practicable distri- bution of patients, and election of places and apartments for Distributian of them, and, as a protective measure, let no delay be made in patients' commencing the best methods of purification. These are— 2. Thorough cleansing and ventilation, constantly and . „ , Special disin- rigidly enforced; fection. 3. The immediate and effectual employment of appropri- cJaensfi.'onand ate and most available disinfectants. The following are the DeSt . Chemical dis- f Chlorine and the Alkaline Chlorides, infectants: I „. , . , In wards and . , , \ Nitrous Acid vapor, or quarters. In hosmtal wards, \ „ , „ , ■, x» >iv r iu t Bromine vapor, carefully employed ; barrack*, tram- 1 Perman te of Potassa> ■) Tn solution and ports and ~»"< N;trata of Lead> or J. upon evapo- taminated ?Ma'']Sulphate of Tl.0n (copperas) ; j rating cloths. ters' f Charcoal powders, Gypsum, Quicklime, or I Coal tar compounds. For sinks and ^ external nui- For special cleansing f ^^ compoundg> chloride of Lime> of latrines, sew\ ^^ Qf ^ Charcoal> and en, sinks aM«-jG m> Quicklime, or dry Earth; after proper other external! deansing and water.flushiDg. nuisances. *. 16 Removal ofsur- 4. The immediate removal of all surface-filth, garbage, face filth, etc.: . -.t-,. /• i i -i • • Drying of humid and decomposing materials, and the drvmgol such localities surfaces. ' , and all wet surfaces by means of surface drainage, dry sand or earth, and desiccating with lime or charcoal if at hand. special ventii- 5. Order such improvement in the ventilation of all occu- sundard supply pied apartments as will insure the steady supply of not less than from twenty to forty cubic feet of fresh external air to each person every minute by day and by night. Also let sunlight into all places an abundance of sunlight. systematic 6. If the infected quarters or place must continue to be occupied many days, institute a system of thorough and deep drainage of the entire locality ; also take measures for water-supply, securing the best water-supply. cheerfulness 7. From the first, and continually, call into operation all °pe- proper means for increasing the cheerfulness, hopefulness, and general morale of all patients and attendants, and let Attention to by. all the principles of hygiene be brought into their fullest operation in the persons and apartments, and throughout the entire locality in which endemic infection prevails or is liable to prevail. Hygienic man- Special Iluqienic Manaqement of Patients and Wards : agement of pa- "^ . . y . . . . t-v ... tients and wards. Ventilation, Disinfection, Distribution, Isolation, etc. Only one kind 1. Avoid allowing more than one of the types or kinds ease to be allow- of really infectious disease at one time in the same apart- ed in a single ml . , , , . . ., ward. ment. Ibis rule is particularly important m managing the infectious diseases comprised in the Second class. Patients not to ^- Prohibit the accumulation of large numbers of patients gre^umbers.111 suffering from these maladies in one apartment or upon a small area ; and if ever it should be necessary to have any- thing like the usually allotted number of patients in a ward, let the ventilation of such an apartment be improved and air-space must be kept in the most effectual operation. When practicable, augmenting^afio there should be an allotment of from 1,500 to 2,500 cubic ggr eg aeteDdT *'* feet of air-space to each patient in such a ward. gienic laws. 17 3. The most scrupulous cleanliness should be rigidly importance of „,. -i • i • i • jx scrupulous clean- entorced m everything that pertains to the patients and to nness. their apartments. In no case should a sponge or towel, or any article of clothing that has been used upon one of this class of patients, be used upon any other patient, unless the article so employed has first been effectually cleansed and boiled. All such contaminated articles must be treated as being held for the time in domestic quarantine, and they should not be released from such rigid restrictions until personal cioth- after having been Avashed and subjected to a boiling heat, sponges, etc. to & -, , ,. . „ x- i • be specially dis- unless treated by direct application ot vapor ot bromine, infected, etc. chlorine, or permanganate of potash in solution. The attend- ' L ° *■ ill- Cleanliness of ants upon the sick with these maladies should give scrupu- nurses and atten- lous attention to personal cleanliness. 4. Thorough dryness should be always enforced in the importance of sick-room ; the floors should be dry-cleaned, and the local mea..s of local atmosphere specially desiccated by means of strong through and through air currents, or, in the absence of such ventila- tion, by the use of special dryers, e. g., quicklime, or sul- phuric acid, distributed on shallow plates; or very dry sand laid as a coating on the floors, and frequently removed. On shipboard with infectious diseases, such drying of the Means for Pro- , n • t • J 'a. • ducing a dry at- local atmosphere is of special importance ; and it is proper mosphere in r , , , . . wards or on ship- to remark that the writer has succeeded best m securing board. such desiccation by means of special ventilation, dry-clean- ing the floors, and the free use of dried sand coatings, with the employment of quicklime, etc., as here mentioned. 5 Patients with other diseases should not be permitted to Nature and ex- kj. -l. ""^"^ _ * it tent of personal vkit wards devoted to tvphus or other infectious maladies, isolation required > isu vvcuvxo "u.v , x x i • x» • \, for infectious dis- and in guarding against the spread of any of the infections, of eases. the second as well as of the first class, there should be no unnecessary intercourse between the apartments assigned to the different diseases. 6. Whatever other diseases or surgical cases may, from W0UAn'd3 ™hbeea^ necessity, be suffered to remain in the same ward, or upon "^J^g* the same floor with the second class of infections, all un- 1™^!°*' 18 healed amputations or open wounds must be kept out of their presence and beyond their influence. sanitary meas- The universal experience of military surgeons and officers ures should be ± J ° both reasonable of hospitals has shown how indispensably important it is and effective. A r j i that a reasonable and effectual system of domestic and per- sonal hygiene, based upon the principles and maxims here stated, should be intelligently enforced wherever the infec- tious pests of armies spring up. And it may be remarked, that the same localizing conditions and the same sanitary The special reg- neglects that we have mentioned in reference to the most ulations that con- • i . o i • r» -i «i • /• . • i n troi and prevent virulent of endemic febrile infections, seem to be equally nie infections', as active and fully as important in the production and other endemic endemic diffusion of the causes of camp dysentery and the fatal diarrhceal affections that follow in the trail of armies. campdysente- And whether personally communicable or not, the latter infectious and maladies are often seen to be as much dependent upon en- demic and localizing causes, in hospital wards and other localities, as typhus and hospital gangrene. A\rere we to group that class of maladies for consideration in these pages, we might properly place them in a separate or sub-class, and regard them as being somewhat allied to both the second and third classes of infections. The maladies here re- ferred to, when occurring in crowded military quarters, en^emicsm^fbe1 transports, or hospitals, should be regarded as being con- tlngentiyas infec- tingently infectious. In these diarrhceal maladies it is ad- admitted that the dejections from the bowels tend to per- petuate and spread the same maladies. And this process may properly be denominated infectious, though there is not as definite a period of incubation as that which charac- terizes the febrile types of infection. Third class of Third Class of Ixfkctioxs — At the risk of some just infections. criticisms upon this classification—an arrangement adopted solely for a practical object—we have, for the occasion, Reasons for grouped together the three remarkably distinct and fatal groupie" ul'ai diseases—typhoid fever, cholera, and yellow fever. Whatever may be true and whatever doubtful in the history of these maladies as regards the mooted question of 19 personally infectious qualities, that question is so involved The mooted in indefinite contingencies and consequent doubts, that it is Som.i communi- -• 11 n - cability not dis- practicaily ot very subordinate importance. It is only cussed in this paper. necessary to our purpose to refer to the causes that tend especially to localize and to perpetuate these maladies. The special con- -p. , x l ditions and local- Dependent upon widely different sources, these diseases uing causes . . •' > alone considered. agree m tbeir dependence mainly upon external agencies, and in a manifest tenacity of their specific poisons or infec- tion in the locality in which they respectively become local- iezd. They are emphatically endemial maladies, and cholera External more 1 . , bid agencies pre- clanns also to be the tvpe of an epidemic of widest range; dominate as " L -i 8 ) causes of this but when localized, the infected locality of any one of these c.lass of infec" , ' J J tlODS. is a place of danger. This is most emphatically true of the specific and unknown cause of yellow fever, and is, contin- gently, not less true of the most active causes respectively of cholera and of enteric and tvphus fevers. And it is de- i0caTtaa1*onyaof monstrated by experience that, to give sanitary security Ph0u0cns.ssof fever against these dreaded diseases, the causes of their infectious poisons must be removed, or, otherwise, that all susceptible persons, tarrying or visiting such infected places, must be prohibited therefrom. All effective sanitary regulations, for protecuon*"'/"n controlling and preventing these diseases, have both these ettoPn°can oniyUbe v.- x* •*. • • secured by re- necessary conditions ot security m view. movai of the io- The separate consideration of the leading points, to be fection^or by im" kept in view in the sanitary control of each of these mala- of the peopie.°T dies, will set forth this subject in a practical light. Typhoid or Enteric Fever.—Various morbid agencies Typhoid fever; are usually combined in producing this fever, but we will coV^TjVh'a't specify that which is most important and widely-acting, and uTemoTt^s""™ which is most directly connected with the question of a a°g. Wldely act" specific infectious cause. This has been denominated by Dr. Murchison the pythogenic infection, or the specific miasm The localizing of sewers and neglected latrines—the pest of camps and poison of latrines ,. , . ^ , 0 -Ti T T3 tt • i • and sewers; the badly drained towns, bays Dr. J. 11 Upiiam, in ins report fever poison of upon this fever, published by the U. S. Sanitary Commis- sion (Medical Document If, p. 9): " Its essential causes are by no means well ascertained. * * * Among the immediate causes must be named the ordinary excitants of disease in camps.'' 20 Typhoid fever The fact is now well ascertained that this fever is, under ge0n!iy°infeCc0«ouns; certain contingencies, infectious and communicable through agencies7 what the agency of the bodily excretions of the sick, but the greater truth is, that effete animal and organic matter in a state of putrescence, as in badly policed camps, barracks and How rendered latrines; and, especially, the mephitic effluvia from sinks, endemic. etc ^ are tjie most powerful localizing causes of its endemic prevalence. Special sanitary measures: 1st. Remove from the special preven- pestilent locality the sick, and as many other susceptible tive measures. r . , -, -ii i • i i • persons as practicable, and place them in salubrious quarters. 2d. Wherever patients with typhoid fever are placed, let , , effectual measures be instituted to remedy overcrowding, Removal of per- J °' rocaSiitLhealurifi-1 filth, humidity, neglected bodily excretions, latrines, sinks, cation of the in-gewers anc[ a}} other causes that tend to augment and fected places. " o localize the infection of this malady as an endemic. 3d. In general, pursue the same course of hygienic care and sanitary police as in typhus, but with greater care, if „ ., , possible, to abate external nuisances, and comparatively less Perils of expos- x ' > x j m-e to the local or concern for any degree of absolute isolation of the sick atmospheric in- «/ o efthTn^rom^he Persons- The alvine dejections, and the chamber vessels, sick persons. previous to exposure should be treated with some prompt disinfectant: This must be attended to in all diarrhceal diseases. Cholera.—With as limited and even less certain knowl- choiera, what edge of the essential causes of cholera, the laws which governing°itlaio- govern its endemic prevalence are perhaps as well known endemic 10preava- as those that relate to typhoid fever. And without the least evidence of co-relation of these maladies, or their es- sential causes, still it may be remarked that the same con- ditions of hygienic neglect tend to localize either malady and to perpetuate its infectious power, when a foothold is once obtained. The same sanitary measures apply to both, Avoidance f —with this remark, that there is more urgent necessity infected localities. for immediately removing all uninfected persons from places where cholera is really endemic. It is also, perhaps more uations fromThe urgently important, in the case of cholera, that the evacua- iyCtreated.spec'a' tions from the stomach and bowels should be instantly re- 21 moved and carefully kept from exposure in any way to other persons than the patients themselves. The same disinfectants are required as in the manage- special;; disia- „ x o fectants. ment ot the 2d class of infections, especially should there be a free application of quicklime or the alkaline chlorides in the immediate control of all excretions from the patients, as well as for the preservation of atmospheric dryness and purity. The ventilation of hospital wards and all infected places should be as perfect as possible. Yellow Fever.—Infected places and infected materials, Teiiow fever ; not the persons suffering from this fever, are the recognized tious'p°oisonm ec" sources of danger. The question of a specific infection or Infecte xl • 1 J M j. £ • L cies for dis'nfec- or specific poison ot this malady, are, first, a freezing tem- ting or destroying 77 x x> m r, a t* i -i • the Poison that perature; or secondly, a temperature, ot zl2uJb.—boiling produces thisfe- heat; thirdly, destruction of the infected things by fire. Any of these methods may be employed to destroy the Extremes ot infecting poison which clings to vessels and things—the se- -fro?t YnVhYat cond method, by means of a boiling heat, being the most avo?dlbie7ored^ available and probably the most certain in its operation. [See m ect'°n' Special Report on Heat as a Disinfectant. Proceedings of the National Quarantine and Sanitary Convention, 2 22 I860.] But the 1st method—cold—is nature's sure means of destroying the endemic cause of this tropic pestilence, and it is alone competent to the work of instantly terminating its prevalence in any given district of country. Localizing 3. The localizing and endemic causes of other zymotic causes of other . endemics aggra- maladies seem to augment the virulence of yellow fever, vate the endem- t # 'F3 . .. , ' ics of this fever. an(j m regions specially liable to this fever, hygienic neglect may justly be regarded as an important tributary cause of cie^n'tra'nspons its endemic prevalence. So true is this on shipboard, that iowhfev°erfofyel" not unfrequently this pestilent .malady breaks out with great virulence as soon as the unclean vessel reaches the region or zone in which it is possible for yellow fever to prevail. uresPeforaliimitang 4. The immediate removal of the entire population,—ex- thiSepersatuence.of cepting only those persons that have once had the fever,— from the infected locality, is the first and most necessary sanitary measure to be adopted in any place, when yellow fever has become endemic ; and this protective measure is theRTcInt/T equally important in a single apartment or building, a par- fected. ticular compartment, side, or deck of a ship, or in an entire street or neighborhood that has become infected. Qaarantine reg- 5. Regulations to prevent unnecessary intercourse with ulations; what . n . -, , . , • i • i ^ . , their nature, and infected places may, m particular instances, be essential to 7' protection against the distribution of materials that would communicate and spread this fever, which naturally tends to limit itself to definitely bounded localities. As Dr. Metcalfe very justly says, in the report mentioned on the preceding page, " To abandon quarantine restraints on yellow fever, is to place a price on human life, and barter it for trade." General consid- Sanitary Measures against Infectious Diseases in fngteanfta^eySPreCgt- Transports and Crowded Quarters.—In the foregoing pages fe?uou dbea«» we have endeavored to convey a correct idea of the para- mount importance of intelligent and unceasing attention to personal and local hygiene, whatever may be the special measures required for preventing the activity or spread of infectious poisons. 23 Purity of the local atmosphere, and proper cleanliness of vigiianw and person, and of quarters, can be preserved in hospitals and necessary to Pre- transports only by the most vigilant effort and exact dis- lontam'ma'tion in cipline. In hospitals, the vitiating influences are peculiar transports. and numerous. Said Baron Laerey, before the French Academy, last year, " The natural excretions of the patients, their foetid breath and perspiration, the expectoration of gases and liquids, alvine dejections, evacuations, and urinary fistulas, all these joined to accidental secretions, the suppu- Baron Larrey's ration of wounds and ulcers, and the putridity of hospital [hTsubject. up°n gangrene, are so many mephitic beds from which may arise the most formidable epidemics in field and general hospitals, on the trail of armies in campaigns, exhausted by all the fatigue and privations of war; and above all, in the disas- trous conditions of encombrement" (crowding). We need not enumerate the sources of a vitiated atmos- M.Baudens're- phere and consequent endemic infections in camps and bar- mart racks ; they are known to every soldier. M. Baudens' re- mark that the infection of fever in the Crimea, " had one foot in the camp and one in the field hospital," is fully ex- plained when he states that " the quarters for troops shine with the greasy filth of daily neglect," and that "on re- Results of neg- view day, the fine battalions left, as they passed, the marked andcTmpsT'*8 and wrell-known stench of the barracks." In transports, whether with troops for the field, or with The worst con_ sick and wounded men, the perils of overcrowding, bad ven- f^Xity, 'how tilation, uncleanliness, bad diet, and want of exercise, com- S^transportt bine to induce the worst degrees of infection, and to dimin- ish the vital powers of all who suffer such privations. Fortunately the greater part of the water transportation during the present war has been by the river and bay Advantage fer steamers, whose ample decks and open ventilation have """'J""", b°yf been the best of safeguards against the diseases that most steamers- infest transport ships. Yet even at this stage of progress of the national arms southward, numerous instances have occurred which illustrate the peculiar perils of transports even under favorable circumstances. The following passage is from the report of Surgeon J. II. Brlnton, upon the hos- 24 pital gangrene in the western hospitals. In his special surgeon Brin- report to the Surgeon-General, Dr. Brinton says : " The ton's report upon L ~ ' hospital gan- development of this disease on the route seems to have grene. A been owing to the fact that the transportation of the wounded was effected by means of crowded and ill-ven- tilated boats, and that the trip by the Cumberland and Ohio rivers frequently occupied several days. During this time these patients, who had already undergone much suf- fering, were exposed to all the influences most apt to engender this disease. In contrast with this fact, it was found that, as soon as the Louisville and Nashville Rail- road was opened, so that the wounded could be conveyed from city to city in one day, all importation of gangrenous sores into Louisville ceased. The development of hospital gangrene during the boat transportation is a noticeable fact, and is strikingly analogous with the same phenomena observed among our paroled wounded prisoners from Rich- mond, received into the Annapolis General Hospital some months since." o/earefnui^an* ^n ^e transport ships for troops upon the sea coast and If. „7 «ma.nra£!' the Gulf, the evils of crowding, lack of ventilation, and the ment of trans- ' O' ' ports. presence of infectious diseases, have already produced serious results in a number of instances; and, as the war progresses, there will be constantly increasing necessity for much greater care in the sanitary management of such transports. Especially is an intelligent medical supervision of the transports now needed, to guard against the introduc- in^urhcitiese-?eiu tion an(l spread of the infection of typhus fever, which has army mustb^vig6. again obtained foothold in our cities. The perils to which iiantiy guarded. ^ne patients in military hospitals both at the North and the South will be exposed when typhus gains access to them or to the transports, would be greater than all the casualties of diJryrhffi°a! x preventive meas- presented in these pages. But if timely and effectual sani- tary measures are adopted, and every controllable source of pestilential infection or general disease is anticipated by pre- The results to r . • -it. • t i i i be anticipated ventive means, our vast armies will certainly be spared the sweeping pests of typhus, camp dysentery, and hospital gangrene, and be protected from the scourges of scorbutus, typhoid fever, and cholera,—diseases which in all European armies have proved far more distructive than all the pro- jectiles and sabers of the enemy. APPENDIX Special Disinfectants and their Applications.—That there can be no substitute for fresh air to meet the physiological requirements of respira- tion and health should be indelibly impressed upon every mind. Better that all substances at present employed as disinfectants and deodorants were at once prohibited by the Medical Department than that such agents should practically tend to be regarded as substitutes for a pure atmosphere. But the necessities and privations of army life, the multi- plied agencies of disease, and the vitiating conditions attendant upon wounds and sickness, create necessities for the employment of chemical and other artificial agencies to mitigate, and, in some measure, prevent the otherwise inevitable contamination of the local atmosphere of crowded hospitals, transports, and quarters; and it is only such necessary demands for the employment of disinfectants that justify even the occasional allusion we have made respecting them in preceding pages. They are simply aids in restoring and preserving healthful purity, and not substitutes for cleanliness and pure air. For the convenience of persons who may have occasion to refresh the memory with the more practical facts relating to special disinfectants, and the best method of their application, the following notes are added in reference to this subject: The principal disinfecting agents may be classified as follows: ~\ Charcoal, Absorbents and retainers ofnox- } gulphate of Lime (Plagter Paris)) ious effluvia, particularly the am- Y gulphite of Lime, moniacal and sulphuretted gases. J gi]icate of Alumina (Porous Clay). Absorbents of moisture; chemical "j Quicklime, agents that act upon organic matter, Sulphuric Acid, and re-combine some of the elements | Hydrochloric Acid, of noxious effluvia. J Nitric and Nitrous Acids. 30 Soluble salts that are particu- ") . . 7 7 ., ,, , .. ,' Is 1 trate of Lead, larly available for arresting pro- \ „,, ., „ „. J . , J ... */. Chloride of Zinc, cesses of decomposition, and for 1 ' . 77. , j, .. , , 7 r Proto-Chlonde of Iron. controlling phosphuretted and sul- ' , .. ■, I Proto-Sulphate of Iron. phuretted gases. J ^ Antiseptics that act diffusively and ~) Chlorine Gas, rapidly, though less permanently \ Hypochlorite of Soda [Labarra- than some others. Active in destroy- j que's solution]. ing compound gases. J Chloride of Lime. The most prompt and efficient antiseptic known. Bromine. Antiseptic, and of great power \ as an oxidizer, and as an available j. Permanganate of Potassa. source of ozone. - j Antiseptic and deodorant; capable ~\ of a great variety, extent, and econo- ! Carbolic Acid and Coal-tar com- my of applications, and acting with \ pounds. considerable energy and permanency. J Destructive of contagious virus and all transportable infections. Heat. Destructive of Yellow Fever 1 miasma, and of the malaria that v Frost. produces the " Paludal Fevers." \ Considered theoretically, we may regard all disinfecting agents under the following heads, and perhaps this would be the more scientific ar- rangement of them:—1. Absorbents of moisture and of noxious effluvia ; 2. Oxidizers [ozone the most active], and Deoxidizers; 3. Other chemical agents that break up noxious compounds ; 4. Agents that form indestruc- tible compounds with putrescent materials ; or that destroy cell-life and the cryptogamic and infusorial organisms. But as the present state of chemical and medical knowledge only enables us to make such general statements respecting the theoretical action of disinfectants, we will follow our first classification by a few practical statements concerning each of the articles mentioned. Charcoal.—Freshly burned and broken, this substance will absorb from 10 to 14 per cent, its own weight of gases and moisture from the atmosphere during the period of 24 hours; and it is capable of absorbing 90 times its own volume of ammonia, or 55 times its own volume of sulphuretted hydrogen. Properly applied, charcoal is an arrester of pu- trefaction, and, as such, it is worthy of more extensive employment in 31 the better preservation of animal food when served out in an un- wholesome state by the regimental quartermasters. As a disinfectant or deodorant for extensive use in masses of putrescent material, and for local purification, fresh charcoal is of acknowledged value. The British Sanitary Commission, in the Crimea, ordered whole ship-loads of peat charcoal, which they used in the progress of their work of purification in the hospitals, barracks, or camps in the East. A Keport of that Commis- sion states that " perhaps the best deodorizing compound was one used by the inspectors in all their works. It consisted of one part of peat char- coal, one part of quicklime, and four parts of sand or gravel." It should be remembered that the preservation of the disinfecting power of char- coal powder depends upon its being both fresh and dry. Sulphate of Lime, Sulphite of Lime, and Porous Clay.—All these sub- stances are valuable absorbents of ammoniacal and sulphuretted effluvia, and they constitute exceedingly convenient vehicles and auxiliary men- strua for some of the more potent and expensive antiseptics. The much vaunted French disinfectant, known as the disinfecting powder of Messrs. Corne & Demeaux, consists of about 94 per cent, of finely ground gypsum and 5 or 6 per cent, of coal-tar or the " heavy oil of coal-tar." McDougall's powder, and the Ridgewood disinfectant, consist of carbolic acid com- bined with the sulphate of lime and porous silicate of alumina, respect- ively, as will be noticed upon a subsequent page. Hypo-sulphite of lime possesses the property of absolutely arresting fermentation or the catalytic processes. The several substances of this first class, and their compounds, particularly those with carbolic acid or coal-tar, are among the most valuable disinfectants, especially when large quantities of cheap and effectual articles of the kind are required. Quicklime.—With sulphuretted and with phosphoretted effluvia, and with humid vapors, freshly burned lime unites with great avidity, and as an absorbent of moisture and a chemical base for many acids, it is of peculiar value; but lime also eliminates or sets free the ammoniacal gases, and, like the acids of our second class of disinfectants, it is of less permanent value than some other agents. It is one of the most convenient antiseptics, and for local applications, as in whitewashing, sprinkling, desiccating damp surfaces or putrescent substances, and for temporarily arresting putrefaction, it is invaluable. Lime should be used dry and . unslacked, except it be for the special purpose of combining with car- bonic acid gas; for the latter object it should be reduced to a creamy hydrate, and, in overcrowded wards and barracks, it may be usefully employed in this way, distributed in shallow plates. Distributed in like manner, sulphuric acid may be employed for diminishing the humidity of the atmosphere in a closed and damp apartment; but for this pur- pose it is usually better to resort to strong currents of air, by means of through and through ventilation, when practicable. 32 The topical applications of the acids, particularly of the nitric acid, in arresting gangrene, are well understood by surgeons. Nitrous acid is a valuable antiseptic, and the production and application of its fumes con- stituted the famous disinfecting process of Dr. Carmichael Smyth. The fumes of nitrous acid that so long had fame for disinfecting pur- poses in the barracks, hospitals, and navy of Great Britain may be readily produced by heating a mixture of nitrate of potassa and sulphuric acid in an iron or porcelain dish. Persons who resort to this method of fumigation, should bear in mind the fact that strong fumes of nitrous acid are dangerously irritating to the throat and lungs. These fuming acids are powerful oxidizers, but their avidity for water, together with their peculiarities of chemical affinity, render their value as disinfectants somewhat uncertain. Nitrate of Lead.—Practical considerations place this salt at the head of odorless disinfecting salts most available for certain local applications, such as deodorizing a close apartment, and the bedding, etc., of sick per- sons, by means of a solution distributed on shallow vessels or upon saturated cloths. The nitrate of lead is the basis of " Ledbyen's liquid." The permanganate of potassa is far the most efficient salt of this kind, and its cost alone should limit its employment. It is a chemical agent of different and far greater powers than any of the metallic salts in this third class. Cliloride of Zinc.—Though more powerfully antiseptic than nitrate of lead, it is not as valuable a deodorant. It is most to be valued for its property of promptly arresting putrefactive processes. As " Sir Wm, Burnett's disinfectant," it is widely known. Both this salt, and that of lead, last mentioned, may be employed to delay decomposition in a corpse, in the absence of an embalmer. This is best accomplished by wrapping the dead body in a folded sheet that is saturated with either of these salts. The Proto-cWoride and tht Proto-sulphate of Iron.—These are valuable and very cheap agents for aiding in the control of ammoniacal and sul- phuretted effluvia. Being soluble, and very cheap, these salts are capable of varied and convenient applications, separately, or in combination with other deodorizing materials. Chlorine and its alkaline compounds.—The common preparations of chlorinated soda and chloride of lime act with great efficiency when the carbonic, sulphureted, or ammoniacal gases are brought into contact with them. As their special uses require no explanation in this place, we simply append brief directions for generating chlorine gas where it may be required more immediately and copiously than it would be given off by the alkaline chlorides or hypochlorites. 33 Ready method.—Pour dilute hydrochloric, sulphuric, nitric, or acetic acid upon chlorides of lime, zinc, or soda. This may be done gradually by means of a glass or lead syphon, or by the capillary syphon of lamp-wick, dropping the acid upon the chloride, if desirable to evolve the chlorine steadily for many hours. Cheap method.—Mix 6 parts of peroxide of manganese with 8 parts of table salt (chloride of sodium) in a lead or iron vessel, which should be set freely within another vessel of larger capacity; pour upon the mix- ture of manganese and salt 13 parts of sulphuric acid, which may be diluted with water to abate the rapidity of the evolution of the gas. Heat the vessel containing this mixture by means of hot water or steam, if more rapid evolution of the gas is required. Ordinary method.—Mix four parts of fuming hydrochloric (muriatic) acid with one part of coarse powder of peroxide of manganese, adding water, as may be desired, to abate the rapidity of evolution. Apply moderate heat. The vessel may be of a kind to permit the use of the acid and the heat. The heat, however, by this method, is not indis- pensable. A very neat method of evolving chlorine in hospitals and transports, is to put a few ounces of the black oxide of manganese into a stout glass bottle of large size, rig a bulbous pipette to a perforated cork or stopper, and fitting an india-rubber bulb upon the headless bulb of the pipette, fill the pipette with muriatic acid, and evolve the chlorine at pleasure by occasional pressure upon the elastic cap. Bromine and its compounds.—This most powerful antiseptic has re- cently been brought into requisition in the military hospitals as a special disinfectant and arrester of gangrene. It is applied both topically and dif- fusively. Bromine is exceedingly penetrating and energetic in its action, and consequently is to be manipulated and applied with proper caution. It is principally employed in its pure liquid form, or in combination with bromide of potassium. Special caution should be used not to respire the strono- fumes or any pulverized compound of bromine, as its effects when inhaled are suffocating. The following concise statement of the best methods for applying this potent disinfectant, we quote from Dr. M. Goldsmith, Medical Director of Military Hospitals at Louisville. Ky., to whom the medical profession is largely indebted for its successful intro- duction as a topical and prophylactic agent for the control of hospital gangrene and erysipelas: Directions for Use. 1 For Fumigation.—-Place vessels, containing one ounce of the solu- tion at different points of the ward, and in number sufficient to secure in the latter the constant presence of the odor of bromine. 34 It should be borne in mind that, if the vapor of bromine comes in contact with the vapor of water, hydro-bromic acid is formed; there- fore, when there is much of the vapor of water disengaged in the apart- ment, the quantity of the vapor of bromine must be correspondingly increased. 2. Topical Application of the Vapor.—A piece of dry lint is to be placed over the diseased part; over this is to be placed another piece of lint, moistened with the solution of bromine ; over this, a third piece spread with simple cerate ; the whole to be covered with oiled silk and bandage, so arranged as to retain the vapor in contact with the diseased surface as long as possible. The solution is to be removed as often as it becomes exhausted by evaporation. 3. The Solution, in Substance, as a direct Application, in Hospital Gan- grene, Diphtheria, Gangrene of the Tongue, and other diseases of this nature:—The parts are first to be dried by the application of charpie; then the sloughs, if thick, should be trimmed out with forceps and scis- sors as much as possible, for the thinner the slough the more effective is the remedy. The parts having again been dried, the solution is ap- plied by means of a mop, or a pointed stick of wood, in quantity sufficient to saturate the sloughs. If the sloughs undermine the skin, or dip down into intermuscular spaces, the solution must be made to follow, with the printed stick, or by means of a glass syringe. If the application has been effectual, all odor from the diseased surface ceases, and the sloughs become somewhat hardened. The remedy should be re-applied every second hour, as long as any odor of putrefaction is present, or as long as the sloughs appear to be diffluent. It is not always necessary, especially when the sloughs are diffluent and thin, to use the solution in its full strength; it may be weakened by the addition of water, as the disease subsides. The points to be especially attended to, in the use of the solution of bromine, are two: 1. The solution should be applied in strength and frequency sufficient for the impregnation of the whole of the sloughs ; 2. To secure this end, the application should be made by the surgeon him- self and never be trusted to a nurse. If the sloughs are thick and cannot well be trimmed, the bromine may be introduced into the thickness of the slough by means of a hypodermic syringe. After the topical application of the solution, the parts, when so situated as to render it practicable, should be subjected to the influence of the vapor. (See par. 1.) Surgeons will do well to bear in mind that bromine is a new remedy for the purposes indicated above. The directions for its use, given here, are those followed in the military hospitals of this city; it may be found advisable to modify them as experience with the remedy accumulates. It is, therefore, earnestly recommended that the subject be studied dili- gently, that the effects of the remedy be carefully watched, and that the application be varied as new facts are developed in its use. The investigation of the evidences respecting the antiseptic and prophy- lactic powers of this new disinfectant has reasonably confirmed the opinion of its great utility. But to secure its beneficial effects, its ap- plication should be made with proper care and thoroughness. It claims to arrest the destructive progress of gangrene, erysipelas, etc., and utter- ly to destroy the personal and the diffused virus of such maladies. To accomplish this effectually, the bromine must be applied to every mole- 35 cule of the virus, and this is to be effected by means of the pipette synnge, the pointed stick, the scissors, and the solution, for local appli- cations ; and by its pungent and volatile vapors in wards and other in- fected places. This disinfectant certainly promises to be a great boon to our military hospitals. Permanganate of Potassa.—A. special order from the Medical Bureau at Washington [Circular, No. 12], calls the attention of medical officers to " the virtues of permanganate of potassa as a disinfectant and deodo- rizer." This is a soluble substance peculiarly convenient of application and remarkably certain and efficient in its effects as a disinfectant. Its employment as a deodorizer and prophylactic is limited mainly to topical applications, to gangrenous parts or putrescent materials, and to general effect opon the atmosphere of contaminated apartments, by means of evaporating cloths saturated with a strong solution of the permanganate. The oxidizing and antiseptic effects of the permanganate of potassa upon organic and putrescent matter are remarkable. It is the most sensitive test for the presence of organic matter, which it oxidizes with won- derful facility. [See remarks upon this subject in Hammond's Hygiene.'] As this is an expensive and delicate substance, it is to be employed economically, upon saturated cloths or in dilute solutions upon plates. For purifying offensive water for purposes of beverage, etc., a standard solution should be dropped into the vessel of water, until the tinge of the permanganate begins to appear. The rapid and effectual oxidation of the organic {putrid) elements of impure water and other substances, even of the atmosphere itself, when brought in contact with solutions of this salt, and the consequent and almost instant deodorization of such impurities, render this disinfectant of priceless value for practical pur- poses. And as all preparations of manganese are therapeutically tonic, probably the minute quantities of this salt that would be taken in drink- ing the water purified as above described, would only act beneficially. " Condy's Disinfectant," " Darby's Fluid," and all the vaunted prepara- tions of " Ozonized water," etc., are but solutions of permanganates. The salts are cheaper and more reliable than such nostrums, and are now supplied by all medical purveyors in the army. Coal-tar Compounds—Carbolates.—The carbolate of lime has been employed to some extent in our camj^ and hospitals. McDougall's powder consists of carbolate of lime, sulphite of lime, quick-lime, etc. The Ridgewood disinfectant consists of carbolic acid, proto-chloride of iron etc. combined with fullers' earth. Either of these, which are fur- nished by the medical purveyors, appear to be quite as valuable as the more expensive article of M. M. Corne and Demeaux's, which is used at the Imperial Camp at Chalons, and was found highly serviceable by Bar- ron Larrey, after the great battles of the late Italian campaign. Coal tar, in almost any form, is available for disinfecting sewers, etc., and in the 36 dry powders mentioned, it is available for delaying the process of decom- position, whether in a corpse, or in refuse material. Carbolic acid has the antiseptic powers of creasote, and is largely sold for that article. The antiseptic properties of coal-tar, its effect upon mephitic gases and putrescent material, the permanency of its operation, and the cheapness of the article, render it available for extensive application in neutralizing and arresting cloacal and noxious effluvia in the processes of animal de- composition. A distinguished Medical Inspector of our army, when cut off from ordinary medical supplies, effectually and quickly abated the nuisances pertaining to an extensive old fortress, by means of an extemporized mixture of coal-tar, procured from the gas-works upon the premises. For use in chamber vessels, close-stools, etc., a neat fluid preparation may be made, after the formula of M. Demeaux, by mixing equal parts of coal-tar, alcohol, and hot soft soap. With the progress of knowledge respecting the chemistry of coal-tar and other hydro- carbons, the precise value of this class of disinfectants will be better understood. Coal-tar certainly has remarkable efficacy in arresting putresence and controlling its effluvia. Heat.—As a means of immediate disinfection of contaminated gar- ments, bedding, and even of close apartments, ships, etc., heat is at once a cheap and most effectual method. The boiling of infected clothing, etc., is admitted to effectually destroy any contagious poison. And prac- tically, upon a large scale in such work, experience proves it is best to employ steam as the means of heating. Upon this subject, see remarks and plans of M. Baudens [Hospitals and Health of Troops, Am. ed., pp. 238-204]; also, a Report on Heat as a disinfectant, in the Transactions of the National Sanitary Convention, 1860. It is probable that no cir- cumstance contributes more directly to the perpetuation and spread of the typhus poison, than the accumulation and bad management of con- taminated clothing, etc., that ought, under all circumstances, to be puri- fied as soon as it leaves the patient or the bed. Frost or Lota Temperature, when continued a sufficient length of time, will effectually destroy both the miasma that produces yellow fever, and the paludal malaria that produces intermittent and remittent fevers; but such low temperature has no effect to arrest those fevers in the persons suffering them. *It is worthy of note, that a freezing tem- perature does not appear to mitigate the activity of the personally infec- tious poisons, or contagions; though, with certain exceptions, it arrests putrefaction and the catalytic or fermentative processes. For the Commission: ELISHA HARRIS, M. D.