IL ^aniiarg (tanusmit 
Mo. 79. 
DEPARTMENT OF THE 
SPECIAL INSPECTION 
OF TOK 
GENERAL HOSPITALS, 
U. S. A., 
THIRD (PRELIMINARY) 
REPORT TO THE COMMITTEE, 
MAY, 1863. 
BY HENRY G. CLARK, M. D., 
INSPECTOR-IN-CHIEF. 
NEW YORK: 
WM. C. BRYANT & CO., PRINTERS, 41 NASSAU STREET, CORNER OF LIBERTY. 
1864 INDEX. 
PAGE 
Report 5 
Appendix 15 
A.-Schedule of the Districts of Inspection, and the Locations of 
the General Hospitals 17 
B.-List of the Special Inspectors 18 
C.-Notes on Spotted Fever, &c 20 
D.-Prof. Post's Report on Bromine 23 
E.-Letter to the Military Governor on the Sanitary condition of 
Washington City. 39 DEPARTMENT OF SPECIAL INSPECTION OF THE 
GENERAL HOSPITALS OF THE ARMY. 
Washington, May, 1863. 
To Wm. II. Van Buren, M. D., 
C. B. Agnew, M. D., 
Wolcott Gibbs, M. D., 
Medical Committee, 
U, 8. Sanitary Commission; 
The undersigned respectfully reports: 
That since January 1st, 1863, the following gentlemen have 
served the Commission as Inspectors in this Department, in the 
Districts* severally set against their names, as follows: 
Dr. Charles V. Bemis, District of Columbia. 
Prof. J. B. S. Jackson, 44 44 
Prof. Geo. Mendenhall, 44 44 
Dr. John Bell, 44 Baltimore. 
Dr. D. D. Slade, 44 44 
Prof. Abram Sager, 44 44 
Dr. S. L. Abbott, 44 Frederick. 
Prof. Chas. A. Lee, 44 Fortress Monroe. 
Prof. H. A. Johnson, 44 Port Royal. 
Drs. Cabot and Gould, Districts of Port Royal and Newbern. 
Dr. John Homans, District of Philadelphia. 
Dr. E. M. Snow, 44 44 
Dr. II. W. Williams, 44 Harrisburg. 
Prof. Theod. S. Bell, 44 New York. 
Dr. C. G. Comegys, 44 'c 
Dr. David Judkins, 44 4 4 
* For a Schedule of the Districts, and the distribution of the Hospitals in 
them, see Appendix A. 6 
Dr. William Hunt, District of New England. 
Dr. David B. Reid, " St. Louis, &c. 
Dr. Thos. Hun, " " 
Dr. M. F. Cogswell, " ' * " 
Dr. C. A. Walker, " Louisville. 
Dr. Edwd. Jarvis, " " 
Dr. T. C. Brinsmade, " Nashville. 
Dr. F. B. Leonard, " " 
Prof. Alfred C. Post, (i Louisville, Nashville, 
Prof. Moses Gunn, " Murfreesboro', &c. 
Prof. T. F. Rochester, " Cairo. 
Prof. James P. White, " " 
Prof. Geo. G. Shattuck, " New Orleans. 
The following reports have been received, viz.: On the Hos- 
pitals in the- 
District of Columbia, by Dr. S. O. Vanderpool. 
" " by Dr. C. V. Bemis. 
" " by Prof. J. B. S. Jackson. 
" " by Prof. G. Mendenhall. 
" Baltimore, by Dr. D. D. Slade. 
(c i( by Dr. John Bell. 
" " by Prof. Abram Sager. 
" Frederick, &c., by Dr. S. L. Abbott. 
" u by Prof. J. W. Draper. 
" Fortress Monroe, by Prof. C. A. Lee. 
Newbern, by Dr. C. A. Terry. 
District of Newbern and 
Port Royal, by Drs. Cabot and Gould. 
District of Port Royal, by Prof. II. A. Johnson. 
" Philadelphia, by Dr. John Homans. 
" Harrisburg, bv Dr. S. W. Mitchell. 
" " by Dr. G. R. Morehouse. 
" " by Dr. II. W. Williams. 
" New York, by Prof. Alden March. 
" " by Drs. Comegys & Judkins. 
. " St. Louis, by Dr. S. Pollak. 
" " by Drs. Hun and Cogswell. 7 
District of Nashville, by Drs. Brinsmade and Leonard. 
" " &c., &c., by Profs. Post and Gunn. 
" Cairo, by Profs. Armor and Pitcher. 
" " by Profs. Rochester and White. 
" New Orleans, by Prof. G. C. Shattuck. 
Partial reports from Drs. Krackowizer and Jacobi have been 
received. Drs. Walker, T. S. Bell, Jarvis, and Snow have not 
yet reported.* 
In addition to the ordinary routine of examination, several of 
the inspectors have been requested to investigate special sub- 
jects, as follows: 
Dr. Reid-Ventilation-St. Louis, Louisville, and Nashville. 
Dr. Slade-Hospital Gangrene-at Annapolis. 
Prof. Jackson-Morbid Anatomy, &c.- Washington. 
Prof. Post-Bromine as a prophylactic, &c.-Tennessee, &c. 
Prof. Gunn-The Surgery of the Hospitals-Department 
of Tennessee, &c. 
Dr. Cabot-The Surgery of the Hospitals-Port Royal 
and Newbern. 
Dr. Gould-Medical Diseases-Port Royal and Newbern. 
Dr. J. Bell-Hygiene of the Hospitals-Baltimore. 
Dr. Snow-Statistics " " at Philadelphia. 
Dr. Jarvis-Hygiene " 11 at Louisville. 
Prof. Shattuck-The Sanitary Condition of New Orleans. 
I have also brief accounts, by letter, from two distinguished 
gentlemen of Philadelphia, on the subject of the so-called 
" spotted fever," for which I have to express to them my thanks, 
and especially as they were not in the service of the Commis- 
sion. The letters accompany this report. 
Some apprehensions in regard to this disease having been ex- 
cited in the minds of many persons who were interested in the 
military hospitals, or in the people living in their vicinity, at 
the suggestion of your General Secretary, I addressed several 
* For a complete list of the Inspectors, see Appendix B. 8 
notes of inquiry on the subject, and obtained in reply the ac- 
counts referred to. Although informally written, they give a 
very clear and comprehensive description of the nature and his- 
tory of the disease, and are quite sufficient to allay any public 
anxiety in regard to its having been originated by the presence 
of the hospitals, or that their inmates have been in any way en- 
dangered by its prevalence in their neighborhood.* 
Five or six cases occurred in Eleventh street, in this city, at 
about the same period, answering precisely to the descriptions 
of Drs. Gross and Jewell. The family was subjected to un- 
favorable hygienic and sanitary conditions ; its members being 
badly fed, and living in an overcrowded, small, underground, 
wooden tenement. Only one case recovered. Two cases of the 
same disease, so far as I can judge from a non-professional account, 
and both terminating fatally, were reported to me from Concord, 
New Hampshire, the following week. Numerous cases are al- 
ready, and others will be, I understand, reported from the army 
hospitals at and about Newbern and the Peninsula. 
Upon the whole, the outbreak of this curious disease at so 
many distinct and distant points, having no possible connection 
with each other, indicates clearly enough the mysterious presence 
of what the older writers used to call the " epidemic constitu- 
tion" of the atmosphere-a condition which is yet wholly beyond 
the comprehension of finite science; and the very names of 
" spotted fever," " cerebro-spinal meningitis," which have been 
applied to the disease, seem to be misnomers, except so far as 
they prove that certain internal or external congestions usually 
take place during its progress, while at the same time they do 
not advance us one step toward a knowledge of its essence. 
On the 27th of February, Dr. C. A. Walker addressed me, 
from Louisville, in the following terms: * * * * 
" I desire to call your attention to the use of Bromine as a 
prophylactic and remedial agent in erysipelas, hospital gangrene, 
pyemia, diptheria, and all diseases consequent upon animal 
poison. I have seen such remarkable results here, and hear 
such reports of its efficacy in the above diseases from men of 
established professional reputation, who do not state facts loosely, 
* See Appendix C. 9 
that in my judgment the matter demands the most careful and 
thorough scientific investigation for the sake of the army, and 
the advancement of medical science everywhere." 
" It is through the influence of Dr. M. Goldsmith, acting 
medical director, that the experiments have been made in the 
face of determined opposition." 
The attention of the Surgeon-General was early called to the 
subject, and subsequently Surgeon Brinton,' U. S. V., was sent 
to investigate it. At the suggestion of the committee, Professors 
Post, of New York, and Gunn, of Detroit, visited the district of 
tlie Tennessee together. Dr. Post has made a very full report, 
all the parts of which relating to this subject, I have had copied 
and append herewith.* Dr. Gunn, who was requested to inves- 
tigate another matter, gives his opinion of its value as follows: 
• " Without discussing the merits of his (Dr. Goldsmith's) 
theory, and certainly without being prepared to endorse it, I 
propose to simply state my observations of the treatment 
adopted'in that one of the conditions which falls usually within 
the range of a strictly surgical report. As a remedy in hos- 
pital gangrene, the testimony in its favor, in the hospitals of 
Louisville, is quite unanimous. In Nashville and in Murfrees- 
boro' it is conflicting. It also appeared evident, that when a 
want of confidence in the potency of the agent was felt its ap- 
plication was not thorough. I witnessed its application in 
several instances, in three of which, for three successive days, 
we watched the impression made by the agent. Judging from 
these cases alone, in which, by the treatment, the disease was 
completely arrested, I should accord to it all that has been 
claimed. In other instances, however, for reasons that seemed 
obvious, and which do not detract from the merit of the agent, 
its effect was less satisfactory. As the report of Prof. Post will 
minutely detail all these observations, I propose to give evidence 
simply to four points : 
" 1. Without being highly escharotic in its effect on the living 
* Appendix D. 10 
tissue, when applied to the gangrenous mass, and made to com- 
pletely saturate it, a thoroughly disinfectant effect is at once 
produced; and whenever it penetrates through the mass, and 
comes in contact with living tissue, it produces intense pain, the 
severity of which is not, however, of long duration. 
" 2. The gangrenous mass, when thus thoroughly disinfected, 
ceases to exert its deadly influence upon the adjacent and sub- 
jacent living tissues, and in these tissues there commences at once 
the ulcerative process by which the dead mass is thrown off. 
" 3. When the gangrenous condition is once arrested, the con- 
stitutional symptoms disappear with wonderful rapidity. 
114. When the atmosphere of the ward is disinfected by the 
vapor of bromine, the tendency of the disease to spread is, at 
least, greatly lessened, if not wholly overcome." 
To these judicious observations of Professor Gunn upon the 
bromine treatment, I must add the " closing judgment " of his 
report: " Viewing the surgical history of the army of the Cum- 
berland, during the late campaign as a whole and with critical 
intention, I am constrained to say that, considering the season 
of the year, tlie exposure of the wounded men, the scanty sup- 
plies at the time of the battle, the great number of the wounded, 
and the constitutional condition of the men previous to the 
injuries received, the surgeons have fully sustained the character 
of American surgery. If, at the battle of Murfreesboro', and in 
a few other instances, ' conservative surgery ' has not exerted its 
full influence, it is but justice to say that none are more keenly 
sensible of the fact than the surgeons who there gained experi- 
ence, and who now officiate in the army of the Cumberland. 
Should another general engagement occur, I predict that the 
record these gentlemen will make will be alike honorable to 
themselves, and conservative of life and limb."* 
I have now on file a large mass of valuable manuscript mate- 
rial-the reports of our special inspectors already received cover- 
* MSS. Reports, fol. XXX., Prof. Moses Gunn. 11 
ing more than 2,500 folio pages, and this to be further increased 
by reports not yet received. They contain full, accurate and 
intelligent descriptions of all the general hospitals of the army, 
and are replete with the evidence of the acute observations, the 
sound opinions, and the practical suggestions we should have 
expected from such a corps of inspectors as ours, nearly all of 
them being active members of a profession which they all honor 
and adorn. I have endeavored always so to assign them as to con- 
sult their convenience, and, at the same time, by detailing some 
of them to special duty out of the ordinary inspection routine, to 
secure to the Commission the advantages of their peculiar 
talents as experts, in the various departments to which they 
were known to have especially devoted themselves. 
With this end in view, 1 had requested the distinguished ven- 
tilator, the late Dr. D. B. Reid, of Scotland, who had made this 
country his home, to visit, examine and report upon, the army 
hospitals of the Western Department of the Army, in regard to 
their systems of ventilation. 
This work, in part accomplished, was suddenly interrupted by 
his untimely death. 
lie had labored with great zeal and interest up to the last 
hour of his life, although suffering extremely, at times, from the 
heart affection, of which he died. Ue had, in compliance with 
my request, given much useful advice, and made many valuable 
suggestions, to the surgeons of the hospitals at the West, most 
of which he had visited, while there; and although he was 
never able to write out his notes, yet I hope to avail myself of 
some of the manuscript material which his son has placed in 
my hands. 
As a lecturer, Dr. Reid united, to the most thorough knowl- 
edge of any man living of the science of ventilation, a manner 
which was dignified, instructive and pleasing; and, with the 
regrets which so properly follow his death, it is a satisfaction to 
feel that his last labors were given to that great cause which 
had his earnest sympathies, and that he was able in so congenial 
a way to return, with almost youthful enthusiasm, to studies, 
from the pursuit of which he had been, by various " adverse 
fates," so long separated. 
It was originally proposed by the medical committee to con- 12 
tinue their special inspection of the general hospitals of the army 
until the first of May. 
It has been actively thus continued, with the aid of the 
able corps of inspectors whose services have been at our disposal, 
in a most thorough manner; and, so far as I can judge, it has 
accomplished perhaps all that could have reasonably been ex- 
pected of it. The inspection has given to the Commission, to the 
inspectors themselves, and, through both, to the friends of the 
numerous inmates of the hospitals, the materials for a complete 
knowledge of this department of the army, with the assurance, 
to them and to us, as far as this knowledge extends, of entire 
confidence in its general good conduct. 
I hope at another time, and after I shall have made myself, 
by personal inspection, familiar with the hospitals them- 
selves, to embody, in a more formal and general report to you, 
with my own observations, the substance of those contained in 
the extensive reports of the special inspectors. I am afraid 
that even then, save by an entire reproduction of very large 
portions of them, I shall fail to do them more than partial 
justice. 
There are important subjects connected with the hospitals, 
which will need for their satisfactory determination still further 
investigation, such as : 1. The expediency of delaying or hasten- 
ing the removal " en masse " of large numbers of sick and 
wounded men from the field to the general hospitals, and es- 
pecially what are the circumstances of season or situation which 
are favorable or otherwise to such detention or removal. 
2. The best modes of administering or "running" general 
hospitals, whether by the combination, or otherwise, of military 
and medical authority. 
3. The best mode of constructing general hospitals, and a 
general discussion of all matters connected with the form, 
size, materials, and organization, of temporary or permanent 
structures. 
I am now engaged in making a collection, as I can obtain 13 
them, of the plans and elevations of the army hospitals, and 
have the prospect, with the aid of Mr. Richards, my clerk, 
who is an excellent draughtsman, and by the politeness of those 
who have the originals in charge, of making it sufficiently com- 
plete to give the data for the plans of one or more which 
shall unite their known good qualities with an avoidance of 
their known defects. So many of the principles which enter 
into the construction of hospitals are now definitely settled, 
that if the desired result is difficult of attainment, its accom- 
plishment may be, nevertheless, hopefully essayed. 
During my residence in Washington, the subject of its 
sanitary condition, especially in connection with its-large hos- 
pital population, was in many ways forced upon my attention; 
and on this account I was glad of the opportunity offered me, in 
February last, to bring it distinctly to the attention of the 
authorities, in a note addressed to the military governor.* 
I am happy to say that some interest has been taken in the 
subject by the War Department, and that initiatory steps have 
been taken, under the direction of a competent medical officer, 
to improve the sanitary condition of this city, and that there is, 
therefore, a fair prospect that the discreditable and dangerous 
neglect in which it has so long suffered, will now be changed 
to an intelligent activity in the right direction. 
I now propose, with the approbation of the committee, as 
I understand it to be their desire, to continue the inspection 
in a way which, while it can be carried on with a small staff of 
inspectors, and without implying the constant residence of the 
Inspector-in-Chief at Washington, will keep the Commission 
well advised of the general status of the hospitals, and of the 
changes that will follow them in the ebbings and flowings of 
the tide of war ; of the difficulties they may continue to 
encounter ; of the improvements with which they are favored ; 
and in fact of all matters which concern their condition, tlfat 
of t' ei? inmates, and of the advancement of medical science as 
connected with them. 
In adding my sincere regrets that I have not been able, in 
the conduct of this inspection so far, to have attained to the 
* See Appendix E. 14 
requirements of the standard I had proposed to myself, you will 
allow me to express my most grateful thanks for the confidence 
so cordially reposed in me, and for the uniform support of the 
members and officers of the Commission, during these past 
months of pleasant labor. 
Very respectfully, 
Henry G. Clark, 
Inspector-in-Chief. AHE MIX. 17 
(A.) 
Inspection Districts, with the Location of the Hospitals. 
Districts. 
I. Columbia. ?. .Washington, Georgetown, Alexandria. 
II. Baltimore. .. Baltimore, Annapolis, A. Junction. 
III. Frederick. Frederick City, Harper's Ferry, Antietam. 
IV. Fortress Montroe Yorktown, Norfolk, Suffolk. 
V. Newbern Newbern, Beaufort, Portsmouth. 
VI. Port Royal Hilton Head, Beaufort. 
VII. Philadelphia Philadelphia, West Philadelphia, Chester, 
Wilmington. 
VIII. Harrisburg Cumberland, Harrisburg, York, Reading, 
Clarysville. 
IX. New York New York City and Islands, Newark, Albany. 
X. New England. .. .New Haven, Newport, Boston, Burlington, 
Brattleboro'. 
XI. St. Louis Quincy, Springfield, Keokuk, Chicago. 
♦ 
XII. Louisville ... .Cincinnati, Covington, New Albany. 
XIII. Nashville. . Lexington, Bowling Green, Danville. 
XIV. Cairo Evansville, Paducah, Mound City, Memphis. 
XV. Nbw Orleans Baton Rouge, New Orleans, Carrolton. 
XVI. California t Humbolt, San Francisco. 
2 18 
(B.) 
LIST OF THE SPECIAL INSPECTOES 
or the 
GENERAL HOSPITALS OF THE ARMY, 
From September 1, 1862, to May 1, 1863. 
Henry G. Clark, M.D., Surgeon of Maas. Gen. Hospital, Boston, Inspector-in-Chief. 
Abbott, Samuel L., M.D., Mass. General Hospital Boston. 
Armor S. G., " Prof. Univ. Michigan Ann Arbor. 
Ayer, James, " Boston. 
Bell, John, " Philadelphia. 
Bell, Theod. S., " Prof. Theor. and Pract. Univ .Louisville. 
Bemiss, Charles V., " Medford, Mass. 
Bowditch, Henry I., " Physician Mass. Gen'l Hospital Boston. 
Brinsmade, T. C., " Troy, N. Y. 
Buck, Gurdon, " Surgeon N. Y. Hospital .New York. 
Buckingham, C. E., " Cons. Physician City of Boston Boston. 
Cabot, Samuel, Jr., " Surgeon Mass. Gen'l Hospital Boston. 
Coale, Wv. Edw., " Boston. 
Cogswell, M. F., " Albany. 
Comegys, C. G., " Cincinnati. 
Draper, John W., " Prof. Chemistry. Univ. N. Y New York. 
Ellis, Calvin, " Pathologist, <fcc., Mass. Gen'l Hospital Boston. 
Flint, Joshua B., " Prof. Clin. Surgery, University Louisville. 
Foster, S. Conant, " ...« New York. 
Fowler, Edmond, " Montgomery, Ala. 
Gay, George H., " Surgeon Mass. Gen'l Hospital Boston. 
Gould, Aug. A., " Physician Mass. Gen'l Hospital Boston. 
Gunn, Moses, " Prof. Surgery, Univ., Michigan Detroit. 
Hodges, Rich'd M., " Surgeon Mass. Gen'l Hospital Boston. 
Homans, John, " Ex-President Mass. Medical Society Boston. 
Hun, Thomas, " Albany. 
Hunt, William, " . Philadelphia. 
Jackson, J. B. S., " Prof. Morbid Anat., Mass. Med. College, &c. .Boston. 
Jacobi, A., " Prof. Infantile Pathology, drc. Med. Col... Acto York* 
Jarvis, Edward, " Member of American Statistical Society... .Boston, 
Johnson, H. A., " Prof. Physiology and Histology, Univ. Lind. Chicago. 19 
Judkins, David, M.D., Cincinnati. 
Krackowizer, E., " yew York. 
Lee, Charles A., " Prof. Mat. Med., Med. School of Maine. .Peekskill, 
Leonard, F. B., " Lansingburg. 
Lewis Winslow, " Consulting Surgeon Mass. Gen'l Hospital... .Boston. 
March, Alden, " Prof. Surgery Medical College .....Albany; 
Mkndenhall, G., " , ...Cincinnati. 
Minot, Francis, " Physician Mass. General Hospital Boston. 
Mitchell, S. Weir, " i ....Philadelphia. 
Morehouse, G. R., " Philadelphia. 
Morland, Wm. W., " Boston. 
Pitcher, Z., " Emer. Prof. University, Mich Deeroit. 
Pollak, S., " Surgeon Eye and Ear Infirmary St. Louis. 
Post, Alfred C., " Prof. Surg. Univ., N. Y., &.a., &c .. .New York. 
Reid, David B., " St. PauVs. 
Rochester, T. F., " Prof. Clin. Medicine, University Buffalo. 
Sager, Abram, " Prof. Obstetrics, Univ., Michigan Ann Arbor. 
Shaw, Benj. S , " Supt. Mass. Gen'l Hospital Boston. 
Shattuck, G. C., " Prof. Theor. and Prac. Med. College, &c Boston. 
Slade, Daniel D., " Boston. 
Smith, Stephen, " Prof. Surg. and Surg., Bellevue Hospital, New York. 
Snow, Edwin M., " Health Officer, <tc Providence, R. I. 
Terry, Charles A., " Cleveland. 
Vanderpool, S. 0., " Late Surgeon-General, N. Y Albany. 
Walker, Clement, A., " Supt. Lunatic Asylum Boston. 
Ware, Charles E., " Physician Mass. Gen'l Hospital Boston. 
White, James P., " Prof. Obstet., University of Buffalo. 
Williams, H. W., " Boston. 
"Wyman, Morrill, " Cambridge. 20 
(C.) 
NOTES ON SPOTTED FEVER. 
Notes from Prof. S. D. Gross and Dr. Wilson Jewell, of 
Philadelphia, on the subject of the so-called " spotted fever," 
or " cerebro-spinal meningitis." 
Philadelphia, April 28th, 1863. 
Dear Sir,-I regret it is not in my power to give yon any- 
thing like a satisfactory account of the singular disease which 
has prevailed for some time past at Manayunk, Norristown, and 
Frankford. The first cases, so far as I have been able to learn, 
broke out at the former place a little upwards of a month ago, 
and most of them rapidly proved fatal. Since then a number 
of other cases ha^ e perished. At Norristown it appeared nearly 
at the same time, and has also been quite fatal. The cases at 
Frankford appeared at a somewhat later period. Some cases 
have also been noticed in this city, but their number has been 
comparatively fewer than at the other places. Of the entire 
number of cases that have occurred at these different points, I 
am unable to give you any information. 
What the nature of this malady is, has not been ascertained. 
In many respects, if not in all, it strongly resembles the 
" spotted fever," of Vermont, and other New England States, 
so well described by Gallup, and other writers of the early part 
of the present century. The seizure is usually very sudden, and 
without any decided premonition, the victims being apparently 
perfectly well in the morning, and fatally ill in the afternoon or 
evening. Death, in some of the cases, has occurred as early as 
the twelfth hour, and few survive beyond the second or third 
day. 
The most prominent symptoms of the disease are, excessive 
prostration, livid spots upon the body, intense distress in the 
head and extremities, great jactitation, violent thirst and 
delirium, speedily followed by coma. Gastric irritability has 
also been noticed, as a prominent phenomenon in quite a num- 21 
her of cases. The bowels in general are costive, or but slightly 
affected. The hands and feet are constantly cold from the 
beginning of the attack. 
No very satisfactory post-mortem examinations have been 
made. In general, the most prominent phenomena have been 
those* simply of profound congestion of the principal viscera, 
with evidences of a dissolved state of the blood. In a case, the 
particulars of which were briefly communicated to the Philadel- 
phia County Medical Society, at its last meeting, by Dr. Lamb, 
of Frankford, there was not only great congestion of the brain, 
but more or less deposit of serum and lymph. 
The subjects of this disease have hitherto, for the most part, 
been persons in the lower walks of life, of both sexes, and of 
different ages. I do not learn that the disease manifests any 
special tendency to spread. In most of the cases hitherto wit- 
nessed, it has occurred in several members of the same family. 
With kind regards, I am, very truly, your friend, 
S. D. Gross. 
Dr. Henry G. Clark, . 
Sanitary Commission. 
420 North Sixth street, ) 
Philadelphia, April 29th, 1863. j 
Henry G. Clark, M. D.: 
My Dear Doctor,-Your note of the 27th was received in duo 
course of mail. 
I wish it was in my power to furnish you information, satis- 
factory to myself, as to the true character of the anomalous 
fever which has been prevailing in several neighborhoods of our 
city and vicinity, during the last and present months. 
The cases have been numerous and fatal, equal to fifty per 
cent., speaking within bounds. The deaths have been certified 
to under various names ; as, malignant typhus, malignant scar- 
let, spotted and congestive fevers; while the most frequent title 
given it has been congestion of the brain. This arises from the 
fact that all the cases are accompanied with cerebral symptoms, 
and all the autopsies that have been made, present intense con- 
gestion of the brain. 22 
Drs. LaRoche, Gerhard, Stewardson, Packard and myself, 
have seen and carefully examined many of these cases, in differ- 
ent stages of the disease, without being able to identify it with 
any of the known forms of idiopathic or exanthematous fevers. 
It bears some resemblance to several, but cannot be classified 
with either, in form, grade, or type. It may be said, however, 
to be asthenic or adynamic in character, and presents a malig- 
nant type. None of -us believe it to be contagious, and I have 
heard no physician call it " plague." 
It has appeared in several neighborhoods remote from each 
other, and in rural and healthy districts of our city. At first 
it attracted notice at the falls of Schuylkill; then at Morristown, 
8 or 9 miles north of it, in Montgomery county; next, it was 
found at Frankford, 4 miles east of the falls; then we hear of it 
at Manayunk, between the fallsand Norristown ; next at Rich- 
mond, on the Delaware, and now in an adjoining district, called 
Kensington. All these points are north of our city centre, 
while here and there to the south of the centre, we hear of a 
few cases and deaths occasionally. 
Nearly all the cases are accompanied with an eruption, from 
a few isolated patches in some, to a more diffused redness in 
others. They are not petechia, nor vibices, nor the rash of 
scarlatina or rubeola, or the eruption of variola. 
The eruption resembles more the appearance presented by 
measles when it first comes out, but soon loses the florid color 
and inclines to a purplish hue. After death, I have seen in some 
of them the eruption looking like blood-bruises, while in others 
it is scarcely perceptible. 
The deaths that have occurred have all been within four days 
from the first attack, while many have died within 16, 24 and 48 
hours from the commencement of the disease. It spares neither 
sex nor age. 
Our college transactions will cont ain some account of it, and 
if I can spare a few hours I will give you a more particular ac- 
count of the symptoms and appearances, pathological, that have 
been observed in the post-mortems, if you desire it. 
Excuse the haste of this letter, pardoning all inaccuracies, 
and believe me, 
Yours truly, 
Wilson Jewell. EXTRACTS FROM PROF. POST'S REPORT 
ON THE 
hospitals of ^onisbille, 
% 
CONTAINING HIS NOTES AND OBSERVATIONS ON THE 
USE OF BROMINE. 
Note.-Prof. Alfred C. Post having been detailed to visit the General Hos- 
pitals of the army, and some of the hospitals in the field, in the towns of Louisville, 
Nashville and Murfreesboro', made a full report of his inspection at those places. 
From this report are extracted the notes and observations which follow upon the 
use of Bromine, and its compounds, in the prevention and treatment of various 
diseases, of which Hospital Gangrene is the chief. It is the most complete 
resumd of the facts we have yet had, and his judgment thereon is most clearly 
and candidly stated. « 
H. G. C. 25 
(D-) 
SPECIAL REPORT ON BROMINE. 
By Prof. Alfred C. Post, M. D., of New York.* 
At Louisville, Hospital No. 19, 
Under the charge of Dr. Keifer, Surgeon 50th Regt. Ohio Vols. 
It is situated in the open country, about two miles S. E. of 
Louisville, on a hill which is elevated about a hundred feet 
above the surface of the oTiio River. 
This Hospital is devoted exclusively to the treatment of ery- 
sipelas, cases of that disease being sent to it from different hos- 
pitals in and around Louisville. 
There were twenty-nine patients under treatment at the time 
of our visit. Most of the cases were idiopathic, not being 
connected with any wounds in the vicinity of the affected parts. 
The greater part of the cases were examples of simple erysipe- 
las of the head and face. No fatal case has occurred within 
two months. All the cases of erysipelas in this hospital had 
been treated by the topical application of the compound solu- 
tion of bromine, lint moistened with the solution being placed 
over the surface, and then covered with oil-silk. The internal 
treatment was tonic and stimulating, except during the stage of 
active excitement. The tincture of the muriate of iron, and 
sulphate of quinine, were chiefly employed, together with whis- 
key and porter, in moderate doses. Bromine is the only 
deodorizing agent employed within the building, the nurse of 
each ward holding an open bottle of pure bromine in his hand, 
and walking around the ward twice a day, occupying about five 
minutes in each fumigation. 
* MSS. Report*, Fol. XXXIX. 26 
Louisville, Hospital No. 20. 
Hospital No. 20, under charge of Dr. Nelson R. Morris, U. S. 
Contracting Surgeon. 
The present number of patients is 23. 
This Hospital, like No. 19, is designed exclusively for the 
treatment of erysipelas. Most of the cases are idiopathic, the 
disease occurring chiefly about the scalps and face; about one- 
quarter of the cases are traumatic, occurring chiefly in the 
limbs. All the cases now under treatment are convalescent. 
All the cases of erysipelas in this hospital, as in No. 19, are 
treated by the local application of compound solution of 
bromine. 
Mode of application, same as in No. 19. Internal treatment 
-quinine and iron, brandy, whiskey, and wine-diet, milk, 
eggs, chocolate, fresh beef, &c. No use made of beef-tea. The 
erysipelatous inflammation has ceased to spread, on an average, 
within twenty-four hours. Dr. M. says that in no case has it 
continued to spread beyond thirty-six hours. From the first of 
March to the ninth of April, there were six deaths in this hospi- 
tal. Some of the fatal were nearly moribund when received, 
and all of them were in a state of great exhaustion. 
There was one case of alleged hospital gangrene, but the 
diagnosis was to me entirely unsatisfactory. It appeared to me 
to be a case of phlegmonous erysipelas, with sloughing of the 
areola tissue. It appeared to Dr. M. to be more benefitted by 
the use of liquor soda chlorinata than by that of bromine. The 
whole number of patients under treatment during the month of 
March, was 32. Four were discharged cured during the month. 
Louisville, Hospital No. 7. 
This is a large establishment, in charge of Dr. W. W. Gold- 
smith. 
There have been treated in this hospital about 30 cases of 
hospital gangrene, in all of which there have been topical appli- 
cations of bromine, and none of which have been followed by a 
fatal result. There have been treated at this hospital 20 cases 27 
of hospital gangrene, in all of which bromine has been em- 
ployed. I saw several of the cases: among these was a recent 
one, situated upon the posterior part of the thorax, a little to 
the right of the medium line. The sore was of a circular form, 
about four inches in diameter, and covered with a very thick 
mass of soft slough. The integument around the sore was of a 
livid red color, and the edges were undermined to the extent of 
one-third of an inch. Bromine was first applied to this sore the 
day before my visit. The effect seems to have been salutary. 
At the time of my visit, there was very little foetor, and the 
slough seemed to be loosening. Dr. Goldsmith then took hold 
of the slough with forceps, and dissected it out with scissors, 
leaving the surface nearly clean. lie applied pure bromine 
beneath the undermined edges, by means of a very small 
syringe, and then filled up the cavity with lint, moistened with 
a weak solution of bromine. 
My first visit to this patient was on the 11th of April. I saw 
him again on the 21st April, when I made the following note: 
" The sore has doubled in size, and the mortification is still 
spreading." After my return to New York, I received a letter 
from Dr. Goldsmith, informing me that on the 22d, the day 
succeeding my last visit, every part of the sore was covered with 
healthy granulations. 
Among the twenty cases of hospital gangrene treated in this 
institution, two have died. One was a case of gunshot wound 
of the knee joint, in which there was disorganizing inflamma- 
tion of the joint. The other was a case of gunshot wound of 
the thigh, followed by the formation of an enormous abscess. 
Doctors Irish and Octerlong say that they have had under 
treatment a considerable number of cases of erys'pelas of the 
head and face, all of which have been treated by the topical ap- 
plication of bromine, and none of which have been followed by 
a fatal result. They also say that recovery has been more rapid 
on an average than under other treatment. They also speak of 
large abscesses with fetid discharge, where benefit has been de- 
rived from injections of a solution of bromine. 28 
Hospital No. 11. 
The building was crowded, and badly ventilated. Two or three 
hundred cases of erysipelas have occurred-and many of them 
were fatal. After the bromine treatment was introduced, the 
disease soon ceased to prevail, and no fatal cases occurred. 
Dr. Strew has had under treatment in this hospital four 
cases of hospital gangrene. Of this number, three have recov- 
ered. The fourth is now in the house. The sore is situated 
upon the upper third of the right leg. The sloughs came away 
two weeks since. The surface is now covered with exburant 
granulations. It is about four inches in diameter. The cases 
have all been treated by the use of bromine. Dr. Strew is well 
satisfied that, in all the cases, the bromine had a happy effect. 
He has used chiefly the compound solution. Dr. Strew also 
bears testimony to the benefit resulting from bromine in the 
treatment of erysipelas. 
Dr. W. W. Goldsmith informed me that he had charge of the 
hospital for eruptive diseases more than a year ago, when erysip- 
elas broke out among the men to a considerable extent. After 
about fifty cases had occurred, bromine vapor was used in the 
wards as a prophylactic, and no new cases occurred after that 
time. It is proper to remark that the floors were cleansed, and 
the ceilings whitewashed at the same time. 
I made a cursory visit to Hospital No. 12, where I saw four 
cases hospital gangrene, one of them affecting the stump of a leg, 
one, the stump of a thigh, and two, the dorsum of the foot. All 
had been treated with bromine. That on the stump of the thigh, 
and one of those on the dorsum of the foot, were advanced towards 
recovery. In the one affecting the stump of the leg, the prog- 
ress of the disease had been nearly arrested, but the patient 
seemed likely to die from exhaustion, an immense suppurating 
surface being exposed. The other case on the dorsum of the 
foot was still extending by phagedemic ulceration at the margin, 
and the result seemed very doubtful. 
On my return to Louisville from Murfreesboro' and Nash- 
ville, I visited this hospital again. The sore on the stump of 
the leg was granulating throughout, and the condition of the 29 
patient appeared quite hopeful. In the case of gangrene upon 
the dorsum of the foot, I found that the disease had spread con- 
siderably beyond its former bounds, and a new gangrenous spot 
had broken out upon the leg. I regarded the prognosis as 
decidedly unfavorable. # 
Doctor Stamford, the surgeon-in-charge of this hospital, has 
treated cases of hospital gangrene with bromine, and with the 
exception of the foot case above alluded to, the disease has in 
all of them been promptly arrested. lie attributes his bad 
success in this case to the want of pure bromine, which he could 
not obtain for several days. 
I also made a cursory visit to Hospital No. 1, where I saw a 
case of hospital gangrene on the leg, where bromine had been 
imperfectly applied by an unskillful assistant, by means of a 
wooden spatula. Directions were given to make a more 
thorough and efficient application. On the 21st of April, I saw 
this case again, and found that the sore was free from sloughs, 
and in full granulation,, except at a point about as large as a 
thumb nail, at the lower part, where the slough was not yet 
detached. Dr. Worthington, the surgeon-in-charge, has treated 
12 cases of hospital gangrene with bromine, and has been suc- 
cessful in all of them. He makes the application twice a day' 
to such cases as require it. 
There are no wounds more recent than those which were 
inflicted at the battle of Stone's rive q on 31st December, 18i62. 
There have been five cases of hospi a' g ngrene, of which none 
have died. All have 1een treated by the use of bromine ap- 
plied to the part. The compound solution, pure or diluted, has 
been ejected under the skin, and the sore filled with picked lint 
moistened with the bromine solution. 
When the solution was weak, it did not seem to produce 
much effect. When the compound so ution was of full strength, 
the effect was prompt and marked. 
Several cases of pyaemia, some of them with thoracic wounds, 
the bromine solution was ejected, it corrected the factor, and 
was followed by some improvement in the general symptoms. 
These cases died. The inference which Dr. Goldsmith drew 
from these cases was, that the bromine exerted a controlling 
influence over the prox er pyaemia or septaemia symptoms, and 30 
that it would have been followed by recovery, but for the 
thrombi, and the metastatic abscesses which had already 
formed. He did not, however, furnish any evidence on this 
point which was satisfactory to me. 
About fifteen cases of hospital gangrene have been treated in 
this hospital. Several of them are still under treatment. The 
sores are all granulating, and some of them nearly cicatrized. 
From the reports and appearances, I suppose that they have 
been genuine cases. Bromine has been used in all the cases. 
Only one has died, and his death was attributed to chronic 
diarrhoea. In all cases, in which the application reaches 
throughout the sloughy parts, the foetor ceases at once. In 
some cases, several days elapse, before the spread of the gan- 
grene is arrested. In most cases, the gangrene ceases to spread 
very soon after the application is made, and within three or four 
days, the sloughs are usually thrown off. The constitutional 
treatment is supporting ; ale being the stimulant chiefly used. 
The diet is generally solid, consisting of beef, chickens, eggs, 
&c. During the spreading stage of the gangrene, some of the 
patients suffered considerable pain ; others, not. Opium was 
given in moderate doses for the relief of pain ; e. g., half a grain 
of sulph. morphise at bed-time. 
Park Barracks, 
Now used as a convalescent hospital, having about 170 beds. 
Before Dr. Keefer went there, erysipelas was very prevalent, 
and very fatal. lie commenced the use of bromine solution 
as a disinfectant, and from that time no cases occurred, except 
in one room where the disinfectant was not employed. 
Dr.* Cummings, Demonstrator of Anatomy in the Kentucky 
School of Medicine, in the early part of March had a patient, 
thirty years of age, a blacksmith, who was affected with dip- 
theria. There was a thick deposit on the velum, tonsils, and 
posterior wall of the pharynx, complicated with inflammatory 
swelling of the tongue. Ue could not swallow, and his respira- 
tion was difficult. Dr. Cummings dissolved forty drops of 
bromine in an ounce of alcohol, and put it into a quinine bottle ; 
he inserted a bent tube into the cork, and caused the patient to 31 
inhale the vapor frequently, for an hour or two at a time. 
There was a marked improvement at once; the patient was 
able to swallow within twelve hours, and he rapidly recov- 
ered. 
Dr. Branders, a German practitioner, in Louisville, informed 
me that he had treated two very severe cases of scarlatina ma- 
ligna by the vapor of bromine diffused through the room, 
lie dropped pure bromine on the floor, a number of times in the 
course of the day. Great improvement was observed within 
twelve hours, and speedy recovery followed. Dr. Branders also 
informed me, that he had treated four cases of diptheria in 
patients of the age of four, nine, eleven, and fifteen years; they 
were all bad cases. Twenty drops of the compound solution of 
bromine was diluted with an ounce of water, and the liquid 
applied by means of swabs three times a day. There was well 
marked and immediate improvement in all the cases, followed 
by rapid recovery. 
On the 21st of April, I visited the Hospital Prison, No. 2, 
at Louisville. I saw there a confederate soldier, who was 
.wounded on the 31st December, 1862, at Stone's Biver. Pri- 
mary amputation of the right leg was performed on the battle- 
field. He was admitted in the hospital on the 14th March, at 
which time his stump was nearly healed. Hospital gangrene 
attacked the stump on the 12th April. Hemorrhage occurred 
on the 16th, and Dr. Weeks tied the posterior tibial artery 
which was exposed at the bottom of the sloughy surface. Bro- 
mine was applied immediately afterwards, and since that time 
the application has been repeated three times a day. Pure 
bromine was applied during the first two days, and after that 
time, the compound solution. The sloughing is arrested 
throughout nearly the whole surface; it continues at one of two 
points. The ligature came away on the 20th April, and there 
has been no hemorrhage since it was applied. 
Dr. Goldsmith informed me, that this was the fourth case in 
which arteries had been tied, in the midst of parts affected with 
gangrene, and in which bromine had subsequently been ap- 
plied. He stated that complete success had followed the 
application in all these cases. 
Dr. Kyle, one of the assistant surgeons who accompanied me 32 
in my visit to the wards of this hospital, showed me a very 
formidable case of what had been hospital gangrene, involving 
the anterior part of the shoulder and chest, where he had used 
bromine during the sloughing stage, and the sloughs had been 
thrown off very speedily. He had applied lint wet with the 
compound solution of bromine. lie also showed another case, 
on the leg, which he had treated successfully by means of nitric 
acid. Dr. Kyle is not prepared to express an opinion as to the 
relative merits of bromine and nitric acid. He thinks that 
the inhalation of bromine vapor is very irritating to the lungs ; 
he has found it so in his own case, and Dr. Seymour was very 
unpleasantly affected by it. 
I saw in this hospital four cases of hospital gangrene. The 
first case was in connection with a gunshot fracture of the thigh. 
The gangrene began to show itself day before yesterday. Bro- 
mine has been applied three times a day. The swelling has 
began to subside ; a line of demarcation is forming ; the foetor is 
corrected, and evidently a favorable change is taking place. The 
second case is one involving the stump of the right thigh ; am- 
putation was performed oh the 3d March, and the patient was 
doing well until the 2d April, when the stump was attacked 
with hospital gangrene, and was opened throughout nearly its 
whole extent. Under the application of bromine, the slough 
was speedily separated, and the sore began rapidly to granulate. 
The third case involved the stump of the left thigh. Amputa- 
tion was performed on the 21st March, and the stump was 
attacked by hospital gangrene, five days afterward. Bromine 
was applied, and the gangrenous process waS at once arrested. 
The fourth case was on the site of a gunshot wound of the neck. 
Secondary hemorrhage occurred, and was arrested by the appli- 
cation of persulphate of iron; two weeks afterwards, hospital 
gangrene occurred, and was promptly arrested by bromine. 
There is now a granulating surface, about three inches in diam- 
eter, over the lower part of the neck, the upper part of the 
sternum and the inner part of the left clavicle. 
Dr. Bacon, one of the assistant surgeons, has been in the 
hospital two months, and has treated fifteen cases of hospital 
gangrene ; he considers bromine as the remedy par excellence. 
There have been in this hospital ten cases of hospital gangrene, 
some of them of great severity; they have all been treated with 33 
bromine. Dr. Bill and his assistants haye regarded bromine as 
preferable to all other applications. I saw one of the cases, pre- 
senting a very large chasm, exposing four or five inches of the 
tibia, whose surface was in a state of necrosis. In that case, the 
patient was convalescent from pneumonia, and had had no wound 
of the leg, but a small vesicle formed on the surface, and gan- 
grene rapidly made its appearance, although, at the time, there 
were no cases of gangrene in the ward. The bromine was ap- 
plied as soon as it could be obtained, viz., after the lapse of three 
or four days, and it promptly arrested the extension of the gan- 
grene. Dr. B. has had no experience in the treatment of 
erysipelas with bromine. 
The surgeon has had, in all, six or eight cases of hospital gan- 
grene, of which three have been treated with bromine, -and the 
remainder with nitric acid. He thinks that nitric acid has been 
more efficacious than bromine. Dr. W. has had twelve or fifteen 
cases of erysipelas, of which none have been treated with bro- 
mine. 
There have been but three cases of hospital gangrene, and one 
of pyaemia. 
I saw, also, at my visit to the hospital, a case in which there had 
been hospital gangrene; the sore is now in a state of granula- 
tion. It is situated on the inner side of the left thigh, below its 
middle. On the first January, the patient received a flesh 
wound, and, about the 10th February, a gangrenous spot ap- 
peared, and was treated with bromine until the 20th March, the 
disease not being fully arrested during all that time. The pa- 
tient was then put under the influence of chloroform ; the leg 
was covered with adhesive plaster, except immediately over the 
sore, a quantity of simple cerate was placed around the edges of 
the sore, the edge thoroughly scarified, and concentrated nitric 
acid applied to the surface of the sore, and injected with a glass 
syringe under its margin in all' directions. A solution of bicar- 
bonate of soda was then poured upon the sore, and an alkaline 
poultice applied for twenty-four hours. In three days, the whole 
of the diseased part sloughed out, and from that time there has 
been no recurrence of sloughing, and steady progress has been 
made towards recovery. 
Dr. Gunn and myself were both of the opinion that the appli- 
cation of bromine had not been made with as much care and 
3 34 
thoroughness as that of the nitric acid. We stated that opinion 
to the surgeon, and he acknowledged that it was as we rep- 
resented it. There have been two other cases of hospital gan- 
grene treated in this hospital; in both of these, the bromine 
treatment was ineffectual, and in both, amputation was resorted 
to, and was followed by a fatal result. Within three months 
there have been forty-three cases of erysipelas, of which one 
case proved fatal. Many of the cases were treated with bromine, 
and many without it, and with equal success. Whether bromine 
was used or not, the muriated tincture of iron was given inter- 
nally, and great importance was attached to it as a remedy. 
Chlorine was chiefly used as a disinfectant. Bromine was em- 
ployed, to some extent, for the same purpose. 
Since .my return from New York, I have received a letter 
from Dr. Ewing, dated April 26th, informing me that he had 
been led to review the unfavorable opinion which he had formed 
as to the efficiency of bromine in the case of hospital gangrene. 
He had, within the preceding week, employed the remedy in a 
bad case, applying it carefully, by means of a syringe, to every 
part of the diseased surface, and renewing the application morn- 
ing and evening. Within two days, healthy granulations ap- 
peared, and then he made the application only to those parts 
which were not granulating. He concludes his account of this 
case by saying, " the sore-a very extensive one-is rapidly fill* 
ing up, and I have no doubt of a speedy recovery." Dr. Ewing 
mentions that he had seen and heard of other cases, during the 
week, treated successfully with bromine. 
There had been, in this hospital, six well-marked cases of 
hospital gangrene. In two cases the patients have recovered, 
two died, and in the remaining two cases, amputation was per- 
formed. Bromine has been applied in all the cases, but no benefit 
seems to have been derived from its use. There have been a 
number of cases of erysipelas. Idiopathic and traumatic cases 
have been about equally numerous. The bromine solution has 
been applied in some cases, but it has not been regarded as of 
any special utility. There have been no cases of pyaemia. 
The surgeon-in-charge has seen bromine used in the treat- 
ment of hospital gangrene and erysipelas. As a local applica- 
tion in hospital gangrene, he thinks that it has been beneficial, 35 
but less so than Maunsell's solution of persulphatic of iron, 
which has removed all the sloughs by three applications. He is 
of the opinion that bromine is of no service in erysipelas. 
He is satisfied that it does not prevent the spread of erysipelas 
in the wards, and that it overtakes the bronchial mucous mem- 
brane. The surgeon has had but one case of hospital gangrene; 
it was successfully treated by the local application of nitric acid, 
and by the internal use of tonics and stimulants. He has had 
no experience of the bromine treatment. 
There have been three cases of erysipelas, of which two 
were idiopathic and one traumatic. They all did well, being 
treated with tonics and stimulants. He attaches no importance 
to local applications. 
Dr. Woodward, the surgeon, has been in charge since March 
7th. At that time, there were thirteen cases of hospital 
gangrene, in most of which the sloughs had begun to separate. 
There have since been introduced eight cases which were in an 
active state, viz.: 1 on March 20th, 1 March 24th, 3 April 1st, 
and 3 April 12th. The three which were admitted on the 12th 
April I saw to-day (April 15th). 
One of them presented two large gangrenous sores near the 
upper part of the thigh, viz., one on the anterior surface, and 
the other on the outer and posterior surface, with a bridge of 
skin from two to three inches*wide between them. The gan- 
grene, in this case, had attacked the orifices of a gun-shot wound, 
penetrating the fleshy part of the thigh. 
In the second case there were two gangrenous sores near the 
Upper part of the leg, in connection with compound fracture of 
the tibia, occasioned by a bullet passing through the limb. The 
two gangrenous sores were connected with each other by a deep 
sinus passing through the fractured bone. 
The third case was one of gangrene, involving the outer part 
of the stump, in a case of amputation below the knee. 
These were all well marked and severe cases of hospital gan- 
grene. When I saw these cases on Wednesday, the base of the 
sore in each case was nearly free from slough, but the edges were 
undermined, and presented a sloughy and undermined appear- 
ance. They had all been treated by the surgeon with the 
bromine solution since their admission on the preceding Sunday.- 36 
On Wednesday I saw his manner of dressing them. He first 
cleansed the sores by allowing water from a sponge to trickle 
over them. He then injected water beneath the margin, so as to 
wash away all the offensive fluids from the surface of the sore. 
Then he filled a small glass syringe with the compound solution 
of bromine, and carefully injected it beneath the margin in all 
directions, and into all the sinuses communicating with the sores. 
The patients complained of a severe burning pain, which, after 
a few minutes, diminished; but they informed me that, on 
former occasions, they had suffered more or less all night. The 
surgeon states that in all cases which he has treated with bromine, 
the sloughing process has been checked within two or three 
days, and that, within a week, in every instance, the sore has 
been in full granulation. After the application, he uses a poul- 
tice of flaxseed, mixed with tartaric acid and bicarbonate of soda, 
so as to secure the evolution of carbonic acid; he also adds yeast 
when it can be obtained. Dr. W. also gives bromine internally, 
until the constitutional symptons begin to amend. He gives one 
to one and a half drops of pure bromine with a drachm of gly- 
cerine, once 4, 5, or 6, hours. He also attends to the details of 
the treatment himself, and does not trust to assistants. He has 
compared the bromine treatment with that by nitric acid and 
other means, and is satisfied that the bromine treatment is by far 
the most effectual. On Thursday, April 16th, I saw again the 
three cases hospital gangrene. There was an improvement in all 
of them since the previous day. But in the second case, the one 
connected with compound fracture of the tibia, there was an of- 
fensive odor, evidently proceeding from the sinus passing through 
the fractured bone. Dr. Gunn passed an eye probe through this 
sinus, and then Dr. Woodward drew through the sinus a narrow 
strip of bandage, whose extremity had been dipped in the bromine 
solution. < 
On Friday I saw these three cases for the last time. In the 
second case, the offensive odor which had been observed on the 
previous day, had entirely ceased, and this, as well as the case, 
appeared entirely free from gangrenous and phagedenic action. 
There was then applied to their margins a mixture of one part of 
compound solution of bromine with parts of glycerine. The first 
case wa$ also greatly improved, but some parts of the margin 37 
were still somewhat undermined and sloughy. There seemed to 
me to be a good prospect that the disease would rapidly yield to 
the treatment. < 
The surgeon of this hospital has used bromine as an applica- 
tion in erysipelas, both in its pure state and in the form of com- 
pound solution. He is well satisfied that it stays the progress of 
the disease, hastens its cure, and diminishes its mortality; also, 
that it arrests the progress of the disease in the wards of a hos- 
pital. He has treated six cases of diptheria in an aggravated 
form by the use of bromine, and with entire success. One of 
these cases was attended with extreme dyspsena, and with 
absolute inability to swallow, the patient being threatened with 
instant death. In that case he thrust into the throat a whale- 
bone probang, the sponge of which was moistened with pure 
bromine. The immediate effect was to produce terrible spas- 
modic coughing, speedily followed by separation of the deposit, 
and great relief of the symptoms. Within half an hour he was 
in a pleasant sleep, and he W'as soon convalescent. He inhaled 
the vapor of bromine, and took the remedy internally for two or 
three days. The other five cases were treated by the inhalation 
of bromine vapor, and swabbing the throat with the compound 
solution. I regret to hear that the surgeon of this hospital has 
been removed from the charge of the hospital, and ordered back 
to his regiment, as there are scarcely any of the surgeons in 
charge of our military hospitals who understand the use of 
bromine as well as he does,rand who take as much interest in 
investigating its effects. 
I have recently received a letter from him, dated April 30th, 
in which he informs me that there had been no return of the 
sloughing process, in either of the three cases of hospital gan- 
grene which I have above alluded to, and that the two worst 
cases, viz., that involving a flesh wound of the thigh, and the 
one connected with a compound fracture of the tibia, were both 
rapidly healing. The other cases, involving a stump of limbs ampu- 
tated below the knee, had become complicated with hemorrhage, 
by which the patient's strength had been much reduced. 
Before closing this report, I beg leave to present a brief sum- 
mary of the fhcts and opinions which I was able to collect with 
regard to the efficacy of bromine and its compounds as a pro- 38 
phylactic therapeutic agent, in the treatment of hospital gan- 
grene, erysipelas, and pyaemia. As far as my personal observa- 
tion went, hospital gangrene was the only one of these diseases, 
in which I was able to subject the alleged virtues of this reme- 
dial agent to the scrutiny of my own senses. I had ample op- 
portunity of satisfying myself that the disease denominated 
hospital gangrene in the hospitals which I inspected, was fully 
entitled to that appellation, possessing all the leading characters 
which are everywhere recognized as belonging to that disease. 
I had also abundant evidence from my own observations, that 
bromine exerted a prompt and well-marked curative influence. 
As far as the testimony of others on this subject is concerned, I 
found a remarkable discrepancy of opinion. But I was satisfied, 
from the investigations which I made, that those surgeons who 
were most skeptical as to the curative power of bromine, had 
had a very limited experience in its use, or had not properly 
learned the mode of employing it. I am not prepared to say 
with absolute confidence, that bromine will more promptly, more 
safely, and more certainly arrest the progress of hospital gan- 
grene, than any other remedy. But I do express the confident 
opinion, that it is an agent of great power ; and if I were suffering 
myself from hospital gangrene, my present impression of the 
virtues of bromine is such, that I would prefer the employment 
of bromine to that of any other application with which I am 
acquainted. 
With regard to the use of bromine in erysipelas, I have had 
scarcely any opportunity of observing for myself its prophylac- 
tic or curative power. But the weight of testimony which I 
have collected is decidedly in its favor. 
The power of bromine as a deodorizer is very obvious. I am 
inclined to think that it exceeds that of any other known agent, 
I have had no opportunity of observing the effects of bromine 
in the treatment of pyaemia and of diptheria. The testimony 
of others on this point, which I have been able to collect, is also 
very limited. There are, however, a few facts stated in the 
report, which lead me to believe that the remedy is worthy of 
further trial." 
A. C. P. 39 
(E.) 
LETTER TO THE MILITARY GOVERNOR 
ON' THE 
SANITARY CONDITION OF WASHINGTON. 
SANITARY COMMISSION, 
Department of Special Inspection of the General Hospitals of the Army, 
Washington, February 16, 1863. 
Brigadier-General Jno. H. Martindale, U. S. Army, Governor 
of the Military District of Washington. 
General,-By request of your Adjutant-General, Capt. Ed- 
ward G. Parker, I respectfully submit to you some suggestions 
in regard to the sanitary condition of this district, and of the 
danger that the approaching season may develope to the detri- 
ment of the very large civil, military, and hospital population 
now accumulated in it, not only the diseases incident to the 
climate and season, but also those which ordinarily follow a ne- 
glect of the well known laws of health. The principal sources 
of danger are the following : 
1st. The accumulation of large numbers of men and animals 
in confined locations. 
2d. The accumulations of filth, such as vegetable and animal 
offal, consequent on the above. 
3d. The entire neglect of cleansing operations in the yards, 
lanes, and streets of the city, especially the very deficient 
drainage. 
4th. The nuisance of a shallow, and neglected, and filthy 
canal in the heart of the city, a receptacle of the sewers, and a 
place of deposit for dead horses, &c. 40 
5th. The marshy and stagnant water in many vacant lots, 
some of them-as in North Capitol street-near large hospitals, 
the want of drainage of which have rendered many parts of the 
city, as that near the President's house, malarious spots, pro- 
ducing intermittent, remittent fevers, and jaundice. 
6th. The accumulation of the sick in large numbers is a very 
powerful means, unless proper sanitary measures are taken, of 
intensifying all the ordinary and extraordinary causes of disease. 
As most, if not all of these sources of disease may be either 
removed, or their power of mischief materially curtailed, by 
efficient sanitary measures intelligently and persistently en- 
forced, I respectfully suggest the adoption to that end of any or 
all of the following, viz.: 
1st. To establish, lay out, and construct, by competent en- 
gineers, a complete and thorough system of underground drain- 
age, capable of being flushed by the water of the aqueduct or 
by the rains ; beginning with every house and terminating only 
in the deep water of the Potomac. 
2d. That the yards, lanes, courts and streets of the city 
should be effectively cleansed, and the debris carted away; this 
operation to be repeated often enough to keep all its parts 
clean. 
3d. The canal should be no longer used as a great drain or 
cesspool, and should be discontinued, and filled up so far as is 
not necessary to the uses of commerce; the rest should be 
deeply dredged, fitted up with tide gates, and kept as a full 
basin. 
4th. The unpaved streets and swampy lots should be filled up 
to a proper drainage level by some dry material, such as sand, 
ashes, or gravel; and the streets, when practicable, should be 
paved with stone. 
5th. The vicinage of the great hospitals should be well 
" policed," the drains especially cared for, and no accumulation 
of filth allowed upon the neighboring grounds. 
6th. The knackers yards, stables and barracks, common lodg- 
ing houses and hotels, should be frequently inspected, and no 
accumulations of offal or overcrowding permitted in them. 41 
7th. The civil and military patrolmen, or police, should be 
made responsible for the cleanly condition of their respective 
precincts. 
8th. These regulations should be enforced by a competent 
health officer, who should also have power to abate, summarily, 
any nuisance; and to call upon the appropriate departments to 
aid him in the execution of the same. 
Very respectfully, 
Henry G. Clark.