UBGEOI^GEMEaAL'S OFFICE, f m:iiivgto^iv/ JiJivE lOMsas. LAR NO. 1. ALBERT R. MANN LIBRARY New York State Colleges OF Agriculture and Home Economics AT Cornell University RC 131.AlT867"'™""'"-"'™^' "^P°rt on epidemic cholera and yellow fe 3 1924 003 515 875 ft V, Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924003515875 OIROTJL^R ]^^o. 1. WAR DEPARTMENT, SURGEON GENERAL'S OFFICE WASHINGTON, JUNE 10, 1868. REI> O R T ON EPIDEMIC CHOLERA AND YELLOW FEVER II THE ARMY OE THE UNITED STATES, DURINGl THE YEAR 1867. WASHINGTON: GOVERNMENT FEINTING OFFICE. 1868. OIROTJLA.R N^o. 1. WAR DEPARTMENT, SuEGBON General's Office, Washington, D. C, June 10, 1868. The following Report on Epidemic Cholera and Yellow Fever, as they occurred in :he U. S. Army last year, is published for the information of Medical Officers. J. K. BARNES, Burgeon General. REPORT ON EPIDEMIC CHOLERA ASD YELLOW FEYER IN THE AEMY OF THE UNITED STATES, DURING THE YEAR 1867. By Brevet Liieiit. Col. J. J. \roodward, Assistant Surgeon, U. S. A. Surgeon General's Office, May 5, 1868. General : In accordance with your instructions, I have prepared an account of the prevalence of cholera and yellow fever in the army during the year 1867, which I herewith respectfully submit: I.— EPIDEMIC CIIOEEBA. In view of the possible appearance of cholera during the approaching summer, the Surgeon General issued a circular on the 20th of April, 1867, which gave instructions as to precautionary measures, and directed that in case the pestilence should appear among the troops at any post, a special report should be made, giving a statement of the facts, and transmitting the names of all officers and soldiers attacked, together with the nativity, age, rank, regiment, company, length of service, date of attack, and date of recovery or of death, in each case. (See Circular JSFo. 3, Appendix, p. 17.) These reports were made with commendable diligence by the medical officers brought in contact with cholera during the year, and from these, mainly, the following sketch of the epidemic has been prepared. In compiling the statistical tables appended, (Appendix I, pp. 1-15,) the figures con- tained in the monthly reports of sick and wounded have been carefully compared with the lists of names, and all discrepancies inquired into and corrected. It is therefore believed that the figures are worthy of all confidence. These tables show the monthly mean strength at each station mentioned, and the monthly number of cases and deaths of cholera, cholera morbus, acute diarrhoea, chronic diarrhoea, acute dysentery, and chronic dysentery, are presented separately ; the tables also give a monthly total for these diarrhoeal diseases, a total for all other diseases, and an aggregate. VI REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. Wounds, accidents, injuries, and violent deaths are not included under the head of all other diseases, and are not considered in this report. This rule was also followed in con- structing the tables in Circular ISTo. 5, of 186Y, which gave an account of epidemic cholera in the army during 1866. The second part of Appendix I, under the head of extracts from official reports, contains such portions of the special cholera reports elicited by Circular No. 3, and of other official documents, as were thought to possess professional interest. To these the reader is referred for details, a mere outline of the progress of the epidemic being presented in this report. (See Appendix, pp. 16-69.) It is well knowa that cholera prevailed extensively in the army during the year 1866, causing over 1,200 deaths among officers and men.* Circular No. 5, of 1867, giving a detailed account of the epidemic of 1866, was sent to each medical officer", in anticipation of the possible return of the disease in 1867. It will be seen, by consulting that docu- ment, that cholera spread over the country during the year 1866, extending as far westward as Forts Leavenworth, Riley, and Gibson; and in the southwest as far as Texas. In its progress the disease followed the lines of travel rather than any general westward course, and, in the case of the army, it especially followed the movements of bodies of recruits, which were the most irnportant movements from infected points during the year. The compiler of Circular No. 5 drew hence an argument in favor of quarantine, and the Surgeon General, in Circular No. 3, instructed medical ofilcers to endeavor, as far as possible, to protect any threatened command by a proper quarantine. The measures thus adopted, in conjunction with the hygienic precaution's directed in the same circular, undoubtedly saved many lives in the army, for the total number of deaths from cholera during 1867 was but 230, and it cannot be claimed that the disease in itself was less virulent during 1867, for the proportion of deaths to the total number of cases was 1 death to 2.19 cases, while during 1866 it was 1 to' 2.22. In a general way, it may here be said that the experience of the army during 1867 confirms the views in favor of quarantine formed during 1866, and especially confirms the opinions formed with regard to the danger of distributing recruits or other bodies of troops from an infected point to other garrisons. An additional point, however, is also suggested by the experience of 1867, namely : The possibility of cholera reappearing on the following year at places visited by it during an epidemic, if the most stringent hygienic precautions are not adopted. It is believed that an examination of the appended documents will convince the reader that, so far as the troops were concerned, such hygienic precautions were rigidly enforced during 1867. But, as the summer opened, cholera reappeared in the valley of the Mississippi, and to the westward, at a number of the places where it prevailed during the previous year. At most of these points it occurred first among the citizens, and afterwards appeared among the troops ; but it has not always been possible to obtain the date of the first case among the citizens, and hence it is not possible to assert that this was the inva- riable rule, though it is believed it was so. Had the cases thus originating been the only ones, the mortality from the disease would have been comparatively small ; but the unfortunate movement of infected troops * Circular No. 5 reports, page XIII, 2,724 cases, 1,217 deaths. Additional reports from Texas, not received at the date of publication, contain 89 cases and 52 deaths ; making a total of 2,813 cases and 1,269 deaths. BEPOET ON EPIDEMIC CHOLERA AND YELLOW FEVEIt. VII and trains during July carried the pestilence across the plains to every post on the Arkansas river and the Smoky Hill Fork, and three other notable instances of the transplantation of the disease occurred : one on the route between Forts Gribson and Arbuckle, one in the case of the posts in 'New York harbor, the third in that of certain recruits distributed from New York, by way of New Orleans, through Texas. At New Orleans, where cholera had prevailed extensively, during 1866. among both citizens and troops, continuing during the summer and fall, until January, 1867, it reap- peared among the citizens in June. The reports of the Board of Health record 4 deaths during June, and 571 during the following six months. During the same period only six cases and three deaths were reported among the white troops, and but four cases and two deaths among the colored troops. The first of these cases occurred at Jackson Barracks during August, and recovered; the second case, at the same barracks, during September, also recovered. After this, no cases occurred until November. During November and December there were a few cases both at Jackson Barracks and at Greenville, making, in all, but ten cases and five deaths during the six months in a garrison of over a thousand men. Besides these, one case, which recovered, was reported at Jackson Barracks during January, 1868, and two cases of cholera and nine of choleraic diarrhoea during the sq,me month in Company "A," 33d Infantry, which had just arrived from Georgia. In view of the prevalence of the disease among the citizens of New Orleans, this com- parative immunity of the troops must be attributed, to a great extent, to the stringent hygienic measures adopted in view of the approach of yellow fever. These measures are fully recorded in the reports on the yellow fever epidemic. At Fort Jackson, Mississippi, below New Orleans, one case, a colored soldier who recovered, is reported during September. No particulars have been received During the month of June cholera also appeared among the freedmen on various plan- tations in the vicinity of Vidalia, Louisiana. The troops, however, escaped until October. During this month eight cases and three deaths are reported out of a strength of 61 officers and men. At Vicksburg, Mississippi, where cholera had prevailed among the troops during 1866, it reappeared among the citizens during the month of June. The first case among the troops occurred on the 29th of that month and died the same day. There were eight cases and two deaths among the troops during July ; one fatal case during September ; during Octdber two cases, which recovered; in all, eleven cases and three deaths, not including the fatal case during June. The average strength of the command during the six months was 267 officers and men. At Madison, Arkansas, cholera appears to have been introduced by the body of a citizen dead of cholera who was brought from Linden for burial. Shortly afterwards the disease appeared among the troops. Eight cases and three deaths are reported during July; two cases and one death during August; in all, ten cases and four deaths; the average strength for the two months being 75 officers and men. At Newport Barracks, Kentucky, where cases had occurred during 1866, two mild cases are reported during June, both of which recovered. There was also one fatal case during August. The 'average strength of the command during the six months was 509. Oases are said to have occurred in both Cincinnati, Ohio, and Covington, Kentucky, a few days before the first of these cases. VIII REPOKT ON EPIDEMIC CHOLERA AND YELLOW FEVER. At Paducah, Kentucky, four cases and two deaths are reported during August out of a strength of 108. No particulars have been received. At St. Louis, Missouri, where cholera had prevailed during 1866, it reappeared among the citizens during the month of June, 1867. (See St. Louis Medical and Surgical Journal for July and August, 1867, p. 394.) Cases continued to occur with increasing frequency during the summer and fall. Only one case, however, is reported at the St. Louis arsenal out of an average strength of 125. This case occurred during October ; the man recovered. At Jefferson Barracks, near St. Louis, where cholera had prevailed extensively among -the 56th U. S. Colored Infantry during the previous summer. 256 cases and 134 deaths having been reported, one case of cholera and six of cholera morbus occurred during July, all of which recovered. Several fatal cases of cholera were reported, however, among government employes. It may here also be mentioned that, during June, piior to their movement from the post, a considerable number of cases of diarrhoea occurred among the soldiers of the 38th U. 8. Colored Infantry at Jefferson Barracks. To the story of these troops we shall, presently recur. On the 26th of October, Companies "G" and "H," 125 colored volunteers, arrived at Jefferson Barracks fo¥ muster-out. They had marched from Fort Bliss, Texas, across the plains, to Fort Harker, and thence been brought by railroad to St. Louis, where cholera was then prevailing. Two days after their arrival at Jefferson Barracks cholera appeared among them, thirteen cases and five deaths occurring before the close of the month, and two cases and one death during November. At Fort Biley, Kansas, where there had been 59 cases and 27 deaths of cholera, and 641 cases of diarrhcea and , dysentery among the troops during 1866, a quartermaster's employe was attacked June 22d, 1867, and died the same day. Company " K," of the 38th Infantry, which left Jefferson Barracks June 9th, and reached Fort Riley June 12th, had moved for Fort Harker on the 19th; and companies " D" and " F," which left Jefferson Barracks on the 19th for Fort Riley, also left that place for Fort Harker on the 22d, arriving on the 25th. All these troops were suffering much from diarrhoea, and Companies "D" and " F" left behind them, when they moved, a number of men sick with diarrhoea. After this, however, no cases of cholera occurred at Fort Riley, where the most stringent hygienic means appeared to have been adopted, until July 11th, when an employ6 of the Pacific Railroad was attacked.and died the same day. He had just arrived from the vicinity of Fort Harker, where cholera was then prevailing. No other cases occurred until Novem- ber, when two colored recruits for the 10th Cavalry were attacked; one of them recovered; the other died December 1st. Of these men, the first had arrived two days before his attack from St. Louis, Missouri, where he had been taken sick with diarrhoea. No par- ticulars have been received with regard to his comrade. These two cases are included in table 10, Appendix I, p. 6; but the garrison of Fort Riley, averaging for the six months 26 white and 197 colored troops, wholly escaped. At Fort Harker, Kansas, the disease appeared shortly after the arrival of Companies "K," "D," "F" and ''H," of the 38th Infantry. There were three cases and one death among the colored troops in June; fifteen cases and ten deaths during July and August. Among the white troops, twenty-eight cases and twenty deaths are reported during July and August. The average strength of the command for July and August was 84 white and REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. IX 197 colored troops. There were also at the post over four hundred quartermaster's employes, among whom were many deaths. The hygienic condition of the fort and its vicinity is reported to have been very bad at the date of the outbreak of the epidemic. Company " K," of the 38th Infantry, reached Fort Harker June 22; Companies "D" and "F" arrived on the 25th ; Company " H" on the 27th. Companies " A" and " B" had been stationed there since May 16th, and Company "G" since May 17th. The first case among the troops at Fort Harker was a soldier of Company " H," who was taken sick June 28th and sent to the post hospital. On the same day, but a little earlier in the day, a citizen in the employ of the beef contractor was attacked. He lived in a dug-out on the bank of the river, near the slaughter-pen, a mile and' a half from the fort, and half a mile from the camp of the detachment of the 38th. Stress has been laid on this case in some of the appended reports, as showing that cholera was not introduced at Fort Harker by the 38th Infantry; but the dates of the arrivals of Companies " D," " F," " H," and "K," above given, perfectly accord with the theory that the detachments of the 38th Infantry brought the germs of the disease with them from Jefferson Barracks ; and it has not been shown that the beef contractor's employ6, living so near their camp, did not com- municate freely with the newly arrived troops. At all events, the first cases among _the troops at Fort Harker- were soldiers of the 38th Infantry, who welre carried from their camp to the post hospital ; and it was not till a nurnber of these cases had occurred that the disease began to spread among the garrison of the post. But whatever question may be raised as to the introduction of cholera at Fort Harker by the 38th Infantry, there is no doubt of the mode in which the pestilence, once estab- lished at that post, was, unfortunately, carried thence across the plains. On the 28th of June, the same day on which cholera appeared at Fort Harker, a detachment of the 38th Infantry, consisting of Companies "D" and "F," Brevet Lieutenant Colonel H. C. Merriam in command, and Brevet Lieutenant Colonel George McGill, Assistant Surgeon, U. B. A., in medical charge, left Fort Harker to march by the Arkansas River route to New Mexico. At the close of the first day's march they reached Plumb creek, and shortly after going into camp a case of cholera occurred among the men. The command marched next day, but cases continued to occur daily until it reached Fort Lyon, Colorado Territory. The posts visited on this route were Fort Zarah, Fort Larned, and Fort Dodge, and the arrival of the detachment at each of these stations was. promptly followed by the appearance of cholera. The death of Dr. McGill, July 20th, has prevented the receipt of the usual monthly report of sick and wounded for this detachment ; but it appears from the appended letter of Colonel Merriam that twenty-nine enlisted men were attacked, and ten died, out of a mean strength of 232 enlisted men. With the exception of Dr. McGill and his wife, the officers and their families escaped. The headquarters of the 38th Infantry, with Companies "A," "' H," and " K," remained at Fort Harker until the 20th of July. The first case of cholera among the troops at Fort Harker, already mentioned as occurring June 28th, was a soldier of Company "H;" on the 29th another case occurred in the same company, on the 30th another; July 1st five cases were reported, July 2d three. All these cases are included in the statistical table for Fort Harker. July 4th there B X REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. were two cases ; July 5tli and 7tli each one case. After this no more cases occurred in this command for some days, although the disease still prevailed among other troops at Fort Harker and among the quartermaster's employes and other citizens. July '20th, Headquarters, with Companies "A" and " K," started across the plains with 12 officers, 220 men, 44 quartermaster's employes, and 37 ladies, children, and servants. After crossing the Smoky Hill Fork they were joined by the sutler of Fort Sumner with a family of ten persons, making in all 324 souls. July 21st, on the march, a soldier was attacked with cholera and cases continued to occur until July 30th, when the command had reached a camp a few miles west of Fort Dodge, after which no more cases occurred among the troops. Up 'to this time there had been forty-six cases and seventeen deaths, all enlisted men ; the rest of the party escaped, with the exception of the wife of one of the officers, who was taken sick after the command reached Fort Lyon and recovered. The case reported during August was a man who had been detached with the mail between Forts Larned and Harker, and who was brought sick to camp. In making this march the command avoided communication with the posts along the route, and, after the ■25th of July, avoided the route taken by Col. Merriam's detachment. Two detachments of the 38th Infantry are thus shown to have carried cholera with them across the plains by the Arkansas River route. It was by the first of these that it was distributed to the military stations on the way. On the first of July Colonel Merriam's detachment of the 38th Infantry arrived at Fort Zarah, and on July 2d or 3d at Fort Larned, going into camp within 500 yards of the fort, and remaining there for forty-eight hours. July 6th the first case occurred in the garrison at Fort Larned, and subsequently cases occurred at both this post and Fort Zarah. Fort Zarah being occupied as a picket post of Fort Larned, the cases at both posts are included in the monthly reports of sick and wounded of Fort Larned, and are included in tables 15 and 16, (Appendix, p. 8.) In all, there were five cases and four deaths of white troops during July ; of colored troops, one fatal case during July and one during August. There were quite a number of cases among the quartermaster's employes. According to Brevet Major C. S. De Graw, Assistant Surgeon, U. S. A., Colonel Merriam's command arrived at Fort Dodge on the afternoon of July 7th and went into camp a mile from the post, remaining forty-eight hours. An unsuccessful attempt was made to isolate the command when it was understood that cholera was prevailing in it. During the evening of July 11th a government employ^, living about three hundred yards from the garrison, was attacked ; on the 14th another ; and diarrhoea became very prevalent among the citizens about the post. On the 18th several trains arrived from Fort Harker with supplies for the post, and a man accompanying one of these trains was found to have cholera. On the 21st a soldier of the garrison was attacked while on guard duty some distance from the post and brought to the post hospital. This was followed by other cases, and during the rest of July and the early part of August, twenty-five cases and fourteen deaths occurred among the troops. The mean strength for the two months was 226 officers and men. There were also a number of cases among the citizens. The pestilence did not extend on this route to posts west of Fort Dodge. Returning now to the neighborhood of Fort Harker, we find that Company " G,'' 10th Colored Cavalry, moved from Fort Harker July 16th, leaving behind three or four EEPORT ON EPIDEMIC CHOLERA. AND YELLOW FEVEE. XI men sick of choleraic diarrtoea ; they went into camp at Wilson's creek, about 15 miles from Harker, where, during the rest of the month, they had fifteen cases of cholera, eight of which died during July and one in August. The command subsequently went to Fort Hays and became a part of the garrison of that post. Company "F," 3d Infantry, in camp near Cow "creek, Kansas, at the terminus of the Pacific Railroad not far from Fort Harker, reports seven cases and four deaths during July and one case during August, out of a strength of 68 officers and men ; the disease was brought from Fort Harker. Company "C," 10th Colored Cavalry, at Camp Grierson, Kansas, on the Little Arkansas river, reports seven cases and four deaths during July, and ten cases and four deaths during August, the mean strength for the two months being 78 men ; the officers escaped. The disease is reported to have been brought to the camp by one of the messengers from Fort Harker. Leaving, now, the vicinity of Port Harker, we find cholera transported along the route of the Smoky Hill Fork, towards Denver, as far west as Fort Wallace. The posts on this route are Fort Hays, Downer's Station, Monument Station, and Fort Wallace. The first case at Fort Hays was a citizen, who had just arrived from Salina, whither the cholera had extended from Fort Harker. On the same day, July 11th, a colored soldier of the garrison was taken sick, and died next day. During July, August, and September, thirty-three cases and twenty -three deaths are reported among the colored troops, whose mean strength during the three months was 215 men. September 1st, a white soldier was attacked, but recovered; the rest of the white troops, averaging, during the three months, 34 in number, escaped. Free communication had existed with Fort Harker previous to the appearance of the first cases, and trains with escorts of troops were continually passing from Fort Harker, by way of Fort Hays and the other posts on this route, to Fort Wallace, and back again. Notwithstanding the free passage of such trains, however, the detachment at Downer's Station, Kansas, escaped until August 9th, when a supply train en route from Fort Harker to Fort Wallace, accompanied by a detachment of Company "B," 38th U. S. Infantry, encamped at Grinnell Springs, a small stage station about 20 miles from Downer's, and guarded by a party from that post. The day after the arrival of the train, two of the men at the stage station were taken sick, and were sent to the hospital at Downer's Station for treatment. One of them recovered, the other died. The mean strength of the command at Downer's Station during August was 91 officers and men, but no other cases occurred. Company "I," 38th Infantry, which had been stationed at Fort Hays since May 25th, left that place June 24th and established a post at Monument Station, Kansas. During July three cases and one death of cholera are reported in this detachment, the strength being reported at 115 men. No particulars have been received. June 1st, 1867, a detachment of the 7th U. S. Cavalry left Fort Hays on an expedi- tion to the Platte river, and, after marching over 700 miles, subjected to great hardships, went into camp July 13th, near Fort Wallace. A second detachment of the 7th left Fort Hays on the 12th of July, the day after the first cases of cholera had appeared at that post, and, marching directly to Fort Wallace, went into camp, July 18th, with the first detachment. July 22d, the first case of cholera occurred, and was rapidly followed by XII REPORT ON EPIDEMIC CHOLKRA AND YELLOW FEVER. others, seventeen cases and eleven deaths being reported during July and August, besides a number among the citizen employes. The mean strength of this detachment during July and August was 220 officers and men. It is reported that most of the cases occurred among the soldiers and employes who were debilitated and exhausted by the exposure of the Platte River expedition. Notwithstanding the proximity of the camp of the 7th U. B. Infantry to Port Wallace, the garrison of the latter place wholly escaped, intercourse being restricted, though not wholly prevented. On the 8th of August, a detachment of the 5th U. S. Infantry arrived at Port Wallace from New Mexico and encamped about a mile west of the fort. The command is said to have been healthy on the road, with the exception of diarrhoea, after leaving the Arkansas. Seven days before reaching Port Wallace, they passed, without halting, a camp of colored troops, among whom cholera was prevailing. On the day -of their arrival at Port Wallace a case occurred, followed by others, making in all twenty-five cases and eleven deaths during the month. A quarantine hospital was established on the 10th, in which all the cases were treated. These cases were wholly confined to the detachment of the 5th U. S. Infantry, which, at the time of its arrival, numbered about 343 officers and men. Eone of the original garrison of Port Wallace were attacked ; as, however, a part of this detachment remained at Port Wallace, these cases are included in the tabular statement for that post. (See Appendix, table 26, page 11.) Turning, now, from the plains to the route into Indian Territory, the record will be found equally instructive. One fatal case of cholera was reported at Little Rock, Arkansas, during July. The patient had been intoxicated, and the case is admitted to have been a doubtful one. (See Appendix, page 56.) It is not, therefore, included in the statistical tables, of this report. At Fort Smith, Arkansas, where cholera had occurred during 1866, it reappeared among the citizens August 28th, 1867. The precautions taken to prevent the disease from extending to a company of troops stationed at the post (see Appendix, page 56) were so effectual, that but two cases occurred — -the first September 16th, the second September 21st; both proved fatal. At Port Gribson, Indian Territory, where cholera also prevailed during 1866, it reappeared towards the close of June, 1867, among the Indians and Negroes. These people,- who were surrounded by the worst hygienic conditions, suffered severely till the close of July, when a nest of negro huts, where the disease had been most virulfent, was burned, and the survivors removed to a camp in the open prairie, after which the disease abated, The troops, encamped in wall tents on elevated ground near the fort, escaped, having but two cases — one, a negro soldier, attacked July 18th, died July 23d ; and the other, a white soldier, attacked August 18th, died next day. The mean strength of the command at Port Gibson during the six months was 159 white and 80 colored troops. Towards the close of June, just after the appearance of cholera among the Indians and Negroes near the post, Company "D," 10th U. S. Cavalry, left Port Gribson for Port Arbuokle; had much diarrha^a on the road, and one man died July 1st witli symptoms of cholera. The company, bringing with them the dead body of their comrade for interment, arrived at Port Arbuckle July 2d. Immediately after their arrival three cases of cholera occurred in this company, and five cases and four deaths followed, during July, among the white troops stationed at Fort Arbuckle, 166 in number. REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. XIII On the 11th of June two companies of the 6th U. B. Infantry left South Carolina for Indian Territory, and going by way of Memphis and Fort Smith, set out to march from the latter post to Fort Arbuckle. On the 8th of July a messenger from Fort Arbuckle passed their camp, who reported the existence of cholera at Forts Gibson and Arbuckle ; they prevented his intercourse with the detachment, but, unfortunately, followed the road just passed over by Company "D," of the 10th U. S. Cavalry, and did not avoid their camps. July 14th, cholera appeared among them in their camp on Sandy creek, and before the close of the month forty cases and sixteen deaths occurred out of a command of 129 officers and men. At Fort Columbus, New York harbor, there were thirty-five cases .of cholera and eighteen deaths during August and September. The first case occurred on the 21st of August. The patient was a recruit who had arrived the evening previous with a detachment of recruits from St. Louis, Missouri, where cholera was prevailing. One man had died on the road with symptoms similar to cholera, and the man attacked on arriving at Fort Columbus had been in attendance upon him. Another recruit, who had also been in attendance on the first patient, was sent to Fort Wood, Bedloe's island, and was attacked by cholera shortly after his arrival there. No additional cases occurred at Fort Columbus until the 31st of August, an interval of ten days, when ten new cases were admitted to hospital, four of these cases occurring among a fresh, detachment of recruits who had arrived on the 28th of August, three days previous. At Fort Wood, Bedloe's island. New York harbor, there were ten cases of cholera and four deaths during August and September. The first case occurred August 25th, the last September 24th. Of these cases, six were recruits, two belonged to the permanent party of the post, and two to the band. The first case was the recruit from St. Louis, already mentioned. One fatal case is reported at the Plattsburgh Barracks, New York. The patient had just returned from Governor's island, where he had been sent for trial by court martial. He was attacked the night of his return, August 31st, and died September 2d. On the 23d of November, a detachment of several hundred recruits left New York harbor, by steamer, for Texas. On the 30th another large detachment sailed. The first detachment went on the steamer Raleigh, and reached New Orleans Decem- ber 2d without sickness. Here 110 men were disembarked, but the detachment for Texas was kept on board, and learning that cholera was prevailing among the citizens of New Orleans, an attempt was made to keep them isolated. December 3d, this detachment was transferred to the steamer W. G. Hewes, and sailed for Galveston. During the 4th a ■number of cases of diarrhoea with rice-water discharges were observed, and in one case there were cramps and collapse, but none died. December 6th, the vessel arrived at Gal- veston, the men were disembarked and placed in tents, but after three days, on account of bad weather, were transferred to the barracks of the 17th Infantry at that post. December 11th, the second detachment of recruits which had left New York Novem- ber 30th arrived at Galveston, and, after remaining a day, sailed for Indianola. This detachment had also stopped a day at New Orleans, and after leaving that place cholera appeared among them. One death had already occurred. This detachment left at Galves- ton a number sick with choleraic diarrhoea or actual cholera ; altogether, twenty -two cases XIV EEPOET ON EPIDEMIC CHOLERA AND YELLOW FEVER. of cholera and eighteen of choleraic diarrhoea were admitted to the post hospital at Galves- ton from these detachments; five of the cases of cholera died. Three men of the 17th Infantry, into whose barracks the first party of recruits were received, were also attacked, but all recovered. On the 13th of December a party of the recruits from Galveston arrived at Hemp- stead, Texas, where fifteen cases of cholera occurred among them, with, however, but one death. The detachment that went to Indianola reports thirteen -cases and two deaths of cholera at that post, but the disease did not extend to the garrison. Finally, a party of these same recruits were quarantined at Onion creek, near Austin, December 24th, where nine cases and one death are reported during December, and one fatal case during January in the same detachment, then at Indianola on their way to Brownsville, Texas. The extreme mildness of the cases among these recruits cannot escape attention ; there were among them, in all, sixty-three cases and but nine deaths. This happy result, which is attributed, by the medical officer at Galveston, to the use of tannin in large doses, was observed also at Hempstead, where reliance appears to have been placed on camphor and opium pills; and at Onion creek, where calomel was employed in large doses. The foregoing brief statement will serve to indicate the movements of cholera in the army during 1867. The general summary on page 15 shows that the total number of cases among the white troops during the year, including the month of June, was 317, of whom 139 died; among the colored troops, 187 cases and 91 deaths. The mortality was, therefore, 1 to every 2.28 cases for white ; 1 to every 2.05 for colored troops. A comparison with the data of Circular No. 5 shows that the mortality during 1866 was, 1 to every 2.5 cases for white; 1 to every 1.9 cases for colored troops. The proportion of deaths to cases during 1867 was, therefore, rather larger for white and rather smaller for colored troops than during 1866. The list of names already referred to gives a distinct record of 308 of the above cases among the white troops, and of 153 among the colored troops. From these lists the following tables have been compiled, showing nativities, ages, length of service, and duration of recoveries, and of fatal cases : WHITE TROOPS. 1. NATIVITIES. United States Canada England Ireland Scotland Wales Germany CiVSES. Deaths. 145 58 12 2 14 7 65 29 4 2 1 48 24 Hungary . . Sweden Denmark . . France Switzerland Not stated . Total. Cases. 308 Deaths. 129 BEPOKT ON EPIDEMIC CHOLERA AND YELLOW FEVER. 2. AGES. XV Cases. Deaths. Cases. Deaths. 20 years or under 20 to 25 years ... 25 to 30 " .. 30 to 35 " .. 35 to 40 " .. 45 141 44 19 15 10 45 25 10 10 40 to 45 years Over 50 " Not stated — Total.... 2 1 41 308 29 129 3. LENGTH OF SERVICE. SES. Deaths. 40 17 29 6 15 4 39 21 91 36 Cases. Death. 1 month or under . , 1 to 3 months 3 to 6 " 6 months to 1 year 1 to 2 years 2 to 3 years . Over 3 years Not stated . . Total.. 11 21 62 308 5 8 32 129 4. DURATION OF CASES WHICH RECOVERED. No. OF DAYS. Cases. No. OP DAYS. Cases. No. OP DAYS. ■ Cases. No. OP DAYS. Cases. 1 20 10 5 . 19 2 31 1 2 13 11 5 20 1 32 2 3 11 12 3 21 2 34 1 4 7 13 3 22 1 38 1 5 15 14 5 23 1 40 1 6 10 15 8 26 2 Not stated. 15 7 8 13 8 16 17 1 4 27 28 2 1 9 11 18 2 30 2 Total 179 5. DURATION OF FATAL CASES. No. OP DAYS. Deaths. No. OP DAYS. Deaths. No. OP DAYS. Deaths. 1 2 3 4 90 16 4 7 5 6 8 10 3 3 2 1 21 Not stated. Total 1 3 129 XVI REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. (COIiORED TROOPS.) 1. AGES. Cases. Deaths. Cases. 1 3 55 Deaths. 6 73 14 1 3 26 8 1 35 to 40 years *. . 20 to 25 years 40 to 45 " 1 39 25 to 30 " 30to35 " Total 153 78 2. LENGTH OF SERVICE. 1 month or jinder. 1 to 3 months 3 to 6 " 6 months to 1 year Cases. Deaths. 1 1 * 36 12 27 10 6 4 1 to 2 years - Over 3 years Not stated 1 . Total.. Cases. Deaths. 2 1 15 6 66 44 153 78 3. DURATION OF CASES WHICH RECOVERED. No. OF DATS. Cases. No. OF DAYS. Cases. No. OP DAYS. Cases. No. OF DAYS. Cases. 1 1 7 7 14 1 21 3 2 2 8 11 15 2 22 1 3 7 9 8 16 1 24 2 4 7 10 5 17 2 Not stated. 1 5 6 2 2 11 13 3 2 18 19 3 2 Total 75 4. DURATION OF FATAL CASES. No. OF DAYS. Deaths. No. OF DAYS. Deaths. No. OF DAYS. Deaths. 1 2 3 4 39 15 8 5 5 6 7 9 • 4 2 1 1 Not stated Total 3 78 The following medical ofiB^ers fell victims to cholera during the year: Brevet Lieu- tenant Colonel George McGill, ABsistant Surgeon, U. S. A., died July 20th, 1867, near Old Fort Lyon, Colorado Territory ; Acting Assistant Surgeon Algernon M. Squires, died July 29th, 1867, near Fort Larned, Kansas. REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. XVII Brevet Colonel L. A. Edwards, Surgeon, U. S. A., chief medical officer of the Bureau of Refugees, Preedmen, arid Abandoned Lands, has comrdunicated the following facts with regard to cholera among the freedmen during the period embraced in this report: 179 cases of cholera were reported to him, among this class, of whom 97 died, or one to every 1.81 cases. The places at which cases are reported were, New Orleans, where the first case was reported July 10th ; Algiers, where the first case was reported July 20th ; Lauderdale, Mississippi, where the first case was reported July 16th ; Vicksburg, Mississippi, where the first case was reported July 1st ; and Louisville, Kentucky, where the first case was reported June 30th. The following table gives the number reported for each month : Cases of Cholera reported among the Freedmen during 1867. Places. July. August. Septembbk. October. November. December. Total. m m O CD o o I» 03 0) ft o 1 m 0) o i i DO 1 OS 1 2 CO o O New Orleans, La 16 7 25 44 1 8 1 17 23 1 22 2 8 7 12 1 4 6 3 4 2 23 4 18 1 5 7 73 20 33 51 1 41 5 21 29 1 Lauderdale, Miss Vicksburg, Miss Louisville, Ky 3 Total 93 50 39 23 3 4 2 27 19 12 178 97 Note.— One case was admitted to hospital, Louisville, Ky,, June 30th, 1867, and died July 2d, 1867; date of attack not given. II.— YELiI^OW FEVER. On hearing of the outbreak of yellow fever last summer at Indiariola, Galveston, and New Orleans, the Surgeon General instructed the Medical Director to require from each post at which it should appear an account of the epidemic, and a list of patients similar to that required for epidemic cholera by Circular No. 3, already referred to. These instructions were cheerfully complied with, and very complete information with regard to the circumstances attending the epidemic at every garrison in which it appeared was thus collected. Appendix II contains statistical tables presenting the facts for each post, and such extracts from official reports as appeared to possess practical value. The statistical tables (Appendix, pp. 71-80) present for each month, separately, the number of cases and deaths of yellow fever, typhoid fever, typho-malariat fever, remittent fever, intermittent fever, diarrhoeal diseases, and all other diseases, with a total for all diseases except yellow fever, and an aggregate; wounds, accidents, and injuries are not embraced. XVIII KEPOET ON EPIDEMIC CHOLERA AND YELLOW FEVER. These tables were prepared from the monthly reports of sick and wounded ; after which they were carefully compared with the lists of names furnished, every discrepancy being investigated and corrected, as was done in preparing the cholera tables. Some of the appended extracts from official reports give figures differing from the tables by one or two cases. The editor has not felt at liberty to change their text, but believes that in all such instances the corrected tables prepared under his supervision will be found to be accurate. The extracts from official reports are quite voluminous, (Appendix, pp. 81-156,) but, it is thought, will be found full of interest. From them the following brief history of the epidemic has been prepared. The more thoroughly the facts connected with the spread of yellow fever in the army during 1867 are known, the more strongly they appear to favor the theory of the exotic origin of epidemic yellow fever in the United States. It is believed that a careful study of th'e documents here presented will satisfy the reader that the experience of the_ medical staff of the army last year furnishes *many facts favorable to the doctrine of the portability and transmissibility of the disease, and favor- able, therefore, to the establishment of an efficient quarantine in the case of vessels or persons coming from infected places. In this the experience of last year agrees with the general tenor of the experience of the medical staff of the army during the late war. In addition to this important practical point, the events of last year will serve to direct the attention of medical men and commanding officers to the importance of promptly removing any command exposed to this pestilence to some healthy rural site ; and this with every hope of avoiding the spread of the disorder to any serious extent, even if the removal has been delayed until cases have occurred among the men. These practical conclusions appear the more important because the ordinary hygienic precautions were not found so effectual against yellow fever as experience had shown them to be against cholera, and because therapeutic endeavors have proved comparatively fruitless. The reports indicate clearly two foreign sources from which the disease was imported into the United States last year — Vera Cruz, Mexico, and Havana, Cuba. From Mexico it was brought to Indianola, and thence to other points in Texas. At all other stations it seems to have been brought directly or indirectly from Havana ; and it is worthy of remark that the cases here indicated as of Mexican origin were more fatal than those of Cuban origin, two out of every five cases of the former dying, while the mortality of the latter was but two out of seven. The ratio of deaths was 400 per thousand cases for the first of these groups, 284 per thousand for the second. From Indianola the pestilence was carried to Galveston, and from each of these points it spread towards the interior of the State, along the chief routes of travel, being carried from Indianola to Victoria and Goliad; from Galveston to Houston, Hempstead, Brenham, and Austin. At Ptinggold Barracks and at Brownsville it was more' directly of Mexican origin, as will be presently shown; and at Jefferson, Texas, in the northeastern portion of the State, where there were but two cases, one was a man who had just come up the Red river from ISlew Orleans, the other was his attendant. , The fever was first introduced at New Orleans from Havana. It spread from New Orleans to Ship island, to Baton Rouge, and to* all the other places in Mississippi, Alabama, REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. XIX and Tennessee where cases are reported. At Key West and at Port Jefferson, Tortugas, it was introduced directly from Havana. The following paragraphs present a sketch of the facts attending the appearance of the disease at each of these posts : In the latter part of the month of May, an infected schooner from Vera Cruz, Mexico, arrived at Indianola and landed bedding and other articles; four days afterwards, two of the workmen who handled these effects were taken sick with yellow fever; both died. The disease subsequently spread among the citizens ; at first in the neighborhood of the wharf at which the schooner landed, afterwards extending from house to house up Main street. The company of troops on duty at the post was stationed to the southwest of the town, and escaped until the 16th of June, when two men who had been employed guarding quartermaster's property in the town were taken sick, and communicated the disease to the camp. During July other _cases occurred, a'nd the medical officer in charge. Acting As- sistant Surgeon 8. Santoire, recommended the removal Qf the command to .Green Lake, twenty-two miles distant. This was done July 28th, leaving but a small detachment at Indianola, composed chiefly of men who had had the fever. Two cases occurred at Green Lake shortly after the detachment reached there, but none subsequently. Towards the close of October, a detachment of the S.^th Infantry, who had broken up their camp at Victoria, Texas, on account of the prevalence of yellow fever, arrived at Indianola; their arrival was followed by four cases and one death. There were in all 29 cases and 14 deaths among the troops near Indianola.* The epidemic at Indianola was at first imagined to be bilious remittent fever, as has so often happened on the first appearance of epidemic yellow fever. The appearance of yellow fever at Indianola was speedily followed by its outbreak at Galveston. There was unobstructed, almost daily communication between the two places, and the Morgan line of steamships made regular trips between Indianola and New Orleans, always stopping at Galveston both going and returning. Brevet Major Samuel Adams, Assistant Surgeon, U. S. A., states, in a letter dated August 13th, (see Appendix, page 83,) that the first case of the fever which occurred at Galveston was brought from Indianola about June 26th, and died, two days afterwards, at one of the boarding-houses in the lower part of the city. He asserts that the introduction of the disease was the result of gross negli- gence on the part of the city authorities, who did not attempt to establish quarantine until after this fatal case had occurred. Brevet Major Gyrus Bacon, Assistant Surgeon, U. S. A., who arrived in Galveston September 17th, after the death of Dr. Adams, has contributed an interesting report of the epidemic at Galveston. In this paper he states, on the authority of a local physician, that a man from New Orleans had been admitted to the City hospital June 22d with yellow fever, and recovered. The details of the history of this case have not been communicated, and the well-known accuracy of Dr. Adams, who was on the spot at the time of the occurrence of these cases, leads the writer of this report to look upon his statement with regard to the first unmistakable case of yellow fever as being substantially correct. The Galveston and Texas Medical Journal of February, 1868, contains an excellent account of the epidemic in this city, by Dr. 8. M. Welch, a resident of Galveston. The writer gives an account of the introduction of yellow fever, which perfectly agrees with the story of Dr. Adams, although he mentions the alleged case of June 22d, which he * *The foot note to table I, Appendix, page 71, says, erroneously, "there were, besides, two cases in June.". It has since been observed that the July list of names duplicates these cases, so that the text above is accurate. XX REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. admits would take precedence, "if there was no mistake as to its character." The first case among the troops at Galveston occurred July 1st; the disease subsequently steadily spread among them, and cases continued to occur during August, September, and October, the last case proving fatal November 1st. In all there were one hundred and ninety-nine cases, of whom seventy-nine died. Three medical officers perished at this post; there were, besides, five cases and two deaths in a small detachment of colored troops temporarily at the post. The total number of cases exceeds the mean strength of the command, which, of course, was much reduced by the number of. deaths during August and September. The list of names, however, leaves no doubt that the number of cases is accurate, and that it does not include relapses or second attacks. The number of deaths among the citizens of Galveston is estimated by Dr. Bacon at 1,180; by Dr. Welch, in the article above referred to, at 1,150. From Indianola the pestilence was carried up the road towards San Antonio, to Lavacca, Victoria, and Goliad. There were no troops stationed at Lavacca, and no detailed account of the epidemic there has been received. At Victoria, cases appeared among the citizens during the month of August, but did not extend to the troops till a month later. During the latter portion of September and the early part of October there were eighteen cases and four deaths out of an average mean strength of 74 men. About the middle of October the post at Victoria was aban- doned and the command removed to Indianola. From Victoria the fever was carried to Goliad, between which place and Victoria uninterrupted communication existed. Goliad is situated on high ground, with no swamps or stagnant water in the vicinity ; it is noted for its health. There were twenty-five deaths among the citizens of this town. The troops, encamped only a quarter of a mile from town, were isolated by quarantine; only five cases are reported among them, all of whom recovered. These cases occurred during the month of October, the strength of the command being 43. Returning to Galveston, it will be found that the pestilence was carried thence towards the interior along the chief route of travel. During the third week of August it became epidemic among the citizens of Houston, cases having been brought the week before from Galveston. The first case among the troops occurred September 7th. The patient was a soldier on duty as a teamster, who visited the city daily. There were, in all, seventy-one cases and twenty-five deaths, out of an average strength, for the six months, of 72 officers and men. The last case appeared on the 3d of November. At Hempstead, the first case was a citizen named Vorhees, who arrived some time in August, and died shortly afterwards. This eyent was followed by the appearance of other cases among the citizens of the place. On the 6th of September one of the officers of the . garrison was attacked, and towards the middle of the month cases began to occur among the enlisted men. In all fifty-five cases and twenty-nine deaths are reported out of an average strength of 110 officers and men. The last cases occurred early in December. At Brenham, some little distance beyond Hempstead, on the road to Austin, yellow fever was introduced from Galveston by an attach6 of the Freedmen's Bureau, who arrived August 8th, and was taken sick next day. The disease subsequently spread among the citizens of Brenham, but the troops almost wholly escaped ; only two cases were reported among them — the first, that of Lieutenant Lambert, who had just arrived from Houston, REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. XXI where he undoubtedly contracted the disease ; the second, the man detailed to nurse him ; both cases proved fatal. The troops were encamped in the town, and Acting Assistant Surgeon 0. E. Warren on duty with them, attributes their escape to the use of white mus- tard seed as a prophylactic. He also denies that Lieutenant Lambert's attendant. had the fever, but it is thought that the facts recorded in his letter of April 6, 1868, (see Appen- dix, page 96,) do not accord with this interpretation. At Austin, a short distance beyond Brenham, there were but two cases. The first occurred during September, and proved fatal ; the patient was a prisoner just arrived from New Orleans, where the fever was prevailing. The second case occurred during November, and recovered ; the patient was a soldier who came from Galveston a fortnight previously. Notwithstanding the introduction of these two cases, the disease did not, however, extend to the troops at Austin. At Brownsville, on the Rio Grande, yellow fever appeared among the citizens about the 1st of October. It is difficult to fix the precise date, as the earHest cases were not recognized. Assistant Surgeon E. Cowles, U. S. A., on duty at this post, recounts the efforts made to protect the place by quarantine, and states that he was unable to obtain any evidence of the importation of the disease. It appears from his own report, however, that the first cases known to him were Austrians recently belonging to Maximilian's army, and not long before arrived from Vera Cruz. The report of Dr. Francis Barnes (see Appendix, page 120) shows that a detachment of the same disbanded army, en route from Vera Cruz to New York, suffered from yellow fever on the way, and there appears to be little doubt that it was from this source the pestilence was introduced at Brownsville, the prevalence of yellow fever at Vera Gruz being well known. The troops stationed at Browns- ville, averaging 76 white and 395 colored troops, were isolated, and intercourse with the citizens prohibited ; as a result, no cases occurred among them. The four cases reported were officers who lived in the town, and came in contact with the disease there ; all, fortunately, recovered. There were 130 cases of remittent fever reported among the men, but all recovered. At Ringgold Barracks, some distance further up the Rio Grande river, it is reported, by Acting Assistant Surgeon C. 0. Furley, that no cases occurred among the colored troops stationed at that post. The average strength for the six months was 222 men. These troops were protected by a rigid quarantine from contact with the citizens in the vicinity, who suffered much from yellow fever. The fever was introduced among the citizens by an ambulance from Corpus Christi, which made a detour around the quarantine station and carried into Rio Grande City several fatal cases. As already stated, the colored troops escaped, but Dr. Furley, who had been exposed to several cases of the fever, especially to that of a quartermaster's employ6 named Forbes, was attacked September 30th ; he recovered. On the 18th of November Acting Assistant Surgeon William Savage, who had just arrived from Brownsville, was attacked, and died on the 21st. These were the only cases at Ringgold Barracks among the officers, the men escaping, as before mentioned. The cases of Colonel Shaffer and his attendant, mentioned by Dr. Furley, both of whom recovered, were, probably, not cases of yellow fever. Dr. Cowles, who was at the time the chief medical officer of the District of the Rio Grande, controverts several of Dr. Furley's statements, and doubts whether the disease at Rio Grande City was really yellow fever, and whether Dr. Furley's case was one of that XXII EEPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER disease. He admits that Dr. Savage's case was probably one of yellow fever. It is difficult to decide between sncb differences of opinion, the details of which will be found in the appended papers ; but if it be admitted that the disease at Brownsville was yellow fever, and of this there appears to be no doubt, it is at least highly probable that the very similar epidemic at Rio Grande City partook of the same nature. The case of Dr. Purley is, therefore, here recorded as yellow fever. At Jefferson, in the northeastern portion of the State of Texas, two cases and one death are reported during October. The fatal- case was a sergeant who had just arrived by steamer from New Orleans. The other case was one of his attendants. The fever did not, however, estend to the little garrison. Yellow fever was introduced among the citizens at New Iberia, Louisiana, by people flying from the pestilence at Galveston. It prevailed extensively during August and September, but the detachment of colored troops stationed at that place, having been removed to a camp some 15 miles distant, wholly escaped. The mode in which the pestilence was introduced at New Oideans possesses great interest, on account of the conflicting stories which have been received with regard to the origin of the disease in former years. As early as May 29th, ^the general commanding the Fifth Military District announced, in a letter to the commander of the District of Louisiana, that yelloAv fever was prevalent at Havana, and that, as the proper authorities had failed to establish quarantine regulations, he feared it would, ere long, be introduced into the city, and thence communicated to the troops. This apprehension was, unhappily, fully realized. Free communication existed not only with Havana, but with Vera Cruz. During May twelve vessels arrived from the infected port of Havana, and two from the infected port of Vera Cruz, no quarantine having been exacted ; during June eleven vessels from Havana, and one from Vera Cruz ; and during July eight from Havana. In the absence of a vigilant board of health, the precise details of the first outbreak of the pestilence will, probably, never be known ; but, so far as can be learned, the first case was a man named John Cowarts, who had been engaged in unloading the cargo of the bark Bessie, recently from Havana, and had been at work in the hold several days when he was taken sick, June 5th; was carried to the City hospital June 7th, and died Avith black vomit June 10th. On the 23d of June the bark Florence Peters arri\'ed at Algiers, opposite New Orleans. This vessel left Havana June 3d ; no cases occurred during the voyage, but on the day of her arrival the captain's wife was attacked with, yellow fever; she died June 30th. June 25th her sister was attacked, and June 26th her infant daughter. About the same date the second mate fell a victim ; he died, July 8th, in the Charity hospital. The vessel was now ordered to be cleaned and fumigated, but she had previously twice changed her position to different points on the New Orleans side of the river. The first case reported among the troops was Lieutenant Orville Dewey, of the 4th Cavalry; he was attacked June 23d, and died June 30th, at the St. Charles Hotel. Lieu- tenant DeWey had just arrived from Indianola, Texas, where yellow fever was prevailing at the time, and where he undoubtedly contracted the disease. ITis room in the hotel was disinfected and fumigated, and tliere is no evidence that any persons were infected by him. The first case reported among the troops constituting the garrison of New Orleans was taken sick at Jackson Barracks July 1st, tlie second at Jackson Barracks July 11th; REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. XXIII altogether four cases and three deaths in July. The disease became epidemic in the city, of New Orleans during August, and continued to prevail until December. During this period, out of an average mean strength of 761 white troops, six himdred and fifty-nine cases and one hundred and ninety-five deaths are reported, with one hundred and sixty- three cases and twenty-three deaths, out of an average mean strength of 313 colored troops. Besides the above, sixty-six white seamen, of whom fifteen died, and fifteen colored seamen, all of whom recovered, were treated at the post hospital. Among the patients were fourteen medical officers, two of whom died. Over-three thousand deaths were reported among the citizens of New Orleans. The fever having become epidemic at ISTew Orleans, subsequently spread thence to various points between which and New Orleans unrestricted water communication existed. At Baton Rouge, La., it appeared among the citizens about the 10th of September. Brevet Lieutenant Colonel W D. Wolverton, Assistant Surgeon, U. S. A., says that his recollection of the cases- that occurred among the citizens at that place during the season is, that they were traced from New Orleans. There were, however, but three cases among the troops. The first was admitted to hospital July 31st; he had been on duty, from June 12th to July 11th, on the west bank of Red river, near its mouth, where yellow fever was reported to exist among the citizens. The second patient was attacked September 24th and died September 29th ; he contracted the fever in Baton Rouge, where the disease was then prevailing. The third was attacked November 9th and died next day ; he also contracted the fever in Baton Rouge. There were no other cases in the detachment statioiled at Baton Rouge, the average mean strength of which was 222 officers and men. This immunity is ascribable to the fact that the command was moved away from the town to Camp Coe, about six miles from the river, shortly after the first case occurred. At Vidalia, La., Acting Assistant Surgeon E. Alexander reports three cases, during August, in Company "K," 20th Infantry; neither of these cases proved fatal. One fatal case, during October, is attributed by him to the receipt by the patient of infected docu- ments from New Orleans. The soldiers stationed at Vidalia were in full communication with Natchez, on the opposite side of the river, where the disease prevailed among the citizens. At Natchez, Miss., on the opposite side of the river from Vidalia, two cases are reported -during September in the detachment there stationed; both of these cases recovered. The disease had previously prevailed among the citizens, and these cases are believed to have been contracted on quarantine guard. At Vicksburg, Miss., the first case among the troops occurred October 15th, the last, December 21st; in all, thirteen cases and four deaths; mean strength of the command for the six months, 267. Before the fiist case among the troops, the disease had broken out among the citizens of the town, and most of the cases among the troops were men who were on duty in the city at the time of their attack. At Jackson, Miss., one fatal case is reported during October, out of a mean strength of 278. A number of cases had previously occurred among the citizens at Byram's Station, some nine miles from Jackson, and a few among the citizens of Jackson. At Memphis, Tenn., the disease also prevailed among the citizens, but the troops escaped, with the exception of Assistant Surgeon W. S. Tremaine, in charge of a detach- ment, and the man detailed to nurse him. Dr. Tremaine had visited citizens sick of the fever during the month of October. XXIV REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. One fatal case is reported at Opelousas, La., during October, in a detachment of cavalry numbering 79 men ; no particulars have been reported. At Alexandria, La., on the Red river, there were two cases and one death during October, and two cases and one death during November; two of these were men admitted from steamers ascending the river from Baton Rouge; the third was Acting Assistant - Surgeon J. F. M. Forwood, on duty at the post, who had been visiting cases among the citizens ; the fourth was the commanding officer of the post, who had been with Dr. Forwood during his attack, and who had also visited the first of the two cases of yellow fever brought by steamer to the place. The case of Dr. Forwood was, unfortunately, overlooked in preparing table 26. (Appendix, page 80.) The company of the 20th Infantry stationed at this post was removed to camp eight miles from the town and wholly escaped. The citizens of Alexandria, however, suffered severely, the disease having been imported among them from New Orleans during September. At Shreveport, La., still higher up the Red river, the disease appeared about the 24th of August, and, between that time and the close of December, 124 deaths are reported among the citizens. Communication between the troops and the town being forbidden, the command stationed here escaped. From New Orleans, also, the fever was carried to Ship island, about the 14th of Septem- ber, by a white prisoner and his guard of colored soldiers. The prisoner died, and three of the guard were attacked, but recovered. During October two other white prisoners were attacked and died. Three companies of colored infantry were at this time stationed at Ship island, with seventy-five white and twenty colored prisoners, but the disease did not spread. Company "K," 24th Infantry, was stationed at Pass Christian, Miss., where yellow fever made its appearance about the first of October, being introduced from New Orleans by one of the brothers of the Christian Association, who was attacked shortly after returning from New Orleans. October 11th the command was moved to Winchester, Miss., where they arrived October 13th, leaving three sick and a guard of five men at Pass Christian. Four of the guard took the fever, and a few cases occurred after the command reached Win- chester. In all, there were fourteen cases and five deaths out of a command of 64 officers and men. Yellow fever was brought to Fort Morgan, Mobile bay, by Lieutenant J. K. Heslep, of the Engineers Corps, who was ta"ken sick August 9th, having just previously arrived from New Orleans, where the disease was prevailing; he died August 13th. An officer who roomed with this patient, and the physician who attended him, were attacked on the 23d, and, subsequently, others of the command; in all, twenty -four cases and twelve deaths out of a mean strength of 55. The command was removed during September from the post to a camp about four miles distant, with the apparent effect of checking the further ])rogress of the disease. At Fort Gaines, on the opposite side of the entrance to the harbor, there was but one case reported in Decxiinber out of a moan strength of 79. This man had just -returned from Mobile, whore the disease was still prevailing. There is nothing positive to show how yellow fever was introduced at Mobile, but as officers and others appear to have passed freely between the city and Forts Morgan and Gaines, there can bo l)ut little doubt as to the source of infection. At all events, the first REPORT ON EPIDEMIC CHOLEHA AND YELLOW FEVER. XXV case among the troops at Mobile was that of Major Tracy, attacked September 17tli, nearly a month after the fever began to prevail at Port Morgan, at the mouth of the harbor. About the same time the disease appeared among the citizens of Mobile. September 18th the troops at Mobile were moved to Stark's Landing, on the eastern shore of the bay, about ten miles from the city ; a few cases occurred, however, among the troops thus moved, as well as among the few left behind; in all, there were twenty-two cases and seven deaths out of an average mean strength of 306. At Barrancas, Fla., one fatal case is reported. The patient was taken off a quarter- master's steamer from New Orleans. The disease did not extend to the command. That the escape of the troops at Barrancas was due to the mode in which they were isolated, and not to the absence of the conditions which favor the development of the disease in persons exposed, is shown by the history of the epidemic among the citizens of the adjacent town of Pensacola and the naval station at that place. At the naval station 161 cases and 34 deaths occurred. The details are presented in the interesting report appended. (See Appendix, page 147.) At Key West, Florida, yellow fever was imported directly from Havana. The first case among the troops at Key West occurred August 22d; in all, there were seventeen cases and two deaths, the last cases occurring in October. The disease was introduced by the Spanish frigate Francisco de Assiz, which, followed a few hours later by the English steamer ISTarva, arrived at Key West July 31st, for the purpose of laying the submarine cable between Key West and Cuba. The Francisco de Assiz had been lying for some time in the harbor of Havana, where she had many cases of yellow fever on board. The health officer's wish to quarantine these ships was overruled by superior authority, and free communication permitted between the ships and shore. Shortly after the arrival of the two ships, yellow fever appeared on the Narva. Her sick, officers and men, were brought on shore and treated in the principal hotel, in the Marine hospital, and in private dwellings, where many of them died. Up to this time there had been no yellow fever at Key West, but shortly after cases began to occur among both the citizens and the troops. According to the report of a board of officers appended, (Appendix, page 153,) the first case of yellow fever at Fort Jefferson, Toftugas, appeared August 19th; and, in all, one hundred and eighty-six cases and thirty-two deaths occurred among the troops, the last cases being in October. There are, besides, thirty-six cases and two deaths reported among the white prisoners at the post, and two cases, not fatal, among the colored prisoners. The report of the board does not account for the introduction of the disease. The schooner Matchless, which arrived on the 25th of August, is said to have brought a case ; but as five had occurred previously, the original introduction of the fever remained unaccounted for It has, however, been ascertained, quite recently, that a case had occurred before the first mentioned in the report of the board, which fully explains the inode in which the disease was introduced. An officer who had visited Havana returned to Fort Jefferson on the 3d or 4th of July; on the 18th he was attacked with yellow fever; he recovered and went north, convalescent, August 3d. The death of the medical officer in charge at the time undoubtedly accounts for the omission of this important fact in the original report. Finally, at Tallahassee, Florida, two cases and one death are reported during the month of October out of a strength of 92 officers and men. Acting Assistant Surgeon XXVI REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. T. Artaud says of the fatal case, that the patient was brought from Madison; Florida, but he states that yellow fever was not existing either at Madison or at Tallahassee. The foregoing summary statement exhibits the chief facts of the epidemic so far as known. For details the reader is referred to the documents presented in the Appendix. A numerical summary of these facts shows that there were 1,349 cases and 428 deaths of white, 171 cases and 25 deaths of colored troops, including the cases in June; the mor- tality being 317 deaths per thousand cases, or one death to every 3.15 cases for the white, 146 deaths per thousand cases, or one death to every 6.84 cases for the colored troops. The mortality for the whole number, including both white and colored, was 298 per thousand, or one death to every 3.36 cases. It will be observed, on comparing the ratios above given, that the number of cases and the ratio of deaths to cases among the colored troops is considerably smaller than among the white. Since, however, the whole number of colored troops exposed was much smaller than that of the white, the comparison will be most fairly made if we take the figures for New Orleans, (see Tables 11 and 12, pp. 74-75,) where white and colored appear to have been exposed. Here it will be- clearly seen that the proportion of cases and deaths to strength, and also of deaths to cases, is much greater among the white troops. Of these there were 866 cases and 256 deaths per thousand average mean strength for the six months, while of the colored troops, for the same time, the ratio was but 521 cases and 73 deaths per thousand of strength. The relation between cases and deaths was as follows : For white troops, 296 deaths per thousand cases, or one death to every 3.38 cases; for colored troops, 141 deaths per thousand cases, or one death to every 7 cases. The weekly progress of the epidemic is well shown in the following tables for Gal- veston, Houston, jSFew Orleans, and Fort Jefferson, which are the places where the largest number of cases occurred : 1. WEEKLY MOVEMENT OF YELLOW FEVER AT GALVESTON, TEXAS. Week. Cases. Deaths. _ Week. Cases. Deaths. Week ending July 6th " " 13th 2 2 1 4 3 13 8 13 32 1 1 1 1 1 5 7 Week ending Sept. 7th " " 14th 32 29 23 19 8 6 2 2 13 19 12 7 5 3 1 " 20th " " 22d " " 21st " " 28th Aug. 3d " Oct 5th " " 10th " " 12th " 17th " " 19th " " 24th " " 26th " " 31st " Nov. 2d 2 Total 199 79 EEPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. 2. WEEKLY MOVEMENT OF YELLOW FEVER AT HOUSTON, TEXAS. XXVII Week Week. ending Sept. ' a Oct. 7th 14th 21st 28th 5th 12th Cases. 1 Deaths. 1 5 3 .3 12 15 Week. Week ending Oct. 19th " 26th " Nov. 2d 9th Total Cases. 20 6 5 1 71 Deaths. 25 3. WEEKLY MOVEMENT OF YELLOW FEVER AMONG WHITE TROOPS AT NEW ORLEANS, LA. Week. Cases. Deaths. Week. Cases. Deaths. Week ending June 30th 1 2 1 1 135 57 27 12 9 6 4 1 2 2 1 41 22 14 6 6 4 3 " July 6th ' Opt fith " 13th " 20th 2 " 12th ' " 19tb " 27th 1 2 13 29 25 39 43 98 150 1 " 26th Aug. 3d ' Nov 2d " 10th 5 4 8 14 12 11 40 ' " 9th " 17th ' " 16th " " 24th ' " 23d '' 31st ' " 30th 1 1 " Sept. 7th ' Dec. 7th " 14th f rotal " " 21st 660 196 4. WEEKLY MOVEMENT OF YELLOW FEVER AMONG COLORED TROOPS AT NEW ORLEANS, LA. Week. Cases. Deaths. Week. Cases. Deaths. 3 2 6 4 13 24 29 20 32 Week ending Oct. 12th 12 5 6 7 6 2 1 " " 17th " " 19th " " 24th 2 " " 26th " " 3lBt " Nov. 2d " Sent 7th 1 3 1 5 ■ 1 " " .9th " " 14th " 16th " " 2lst " " 23d " " 28th " 30th 1 " Oft ?,\\\ Total 163 23 XXVIII EEPOET ON EPIDEMIC CHOLERA AND YELLOW FEVKE. 5. WEEKLY MOVEMENT OP YELLOW FEVEE AT FORT JEFFERSON, TORTUGAS, FLA. Week.. ''ee k ending Aug. 24tli " 31st ' Sept. 7th " 14th " 2ist " 38th Cases. 3 9 25 58 25 28 D r. ATHS. 1 1 * 5 7 4 10 Week. Week ending Oct. 5th " " 12th " " 19th " " 26th Unknown Total Casks. 1:3 4 3 1 17 186 Deaths. 32 Thus, at Galveston, Texas, tlie greatest number of cases were reported during the weeks ending August 31st and September 7th; the greatest number of deaths during the week ending September 14th. At Houston, Texas, the greatest number of cases during the week ending October 19th; the greatest number of deaths during this week and the next. At iSTew Orleans, La., the. greatest number of cases among the white troops were reported during the week ending September 21st ; the greatest number of deaths during this week and the next. At the same place, among the colored troops, the greatest number of cases during the week erLcling October 5th ; the greatest number of deaths during the following week. At Fort Jefferson, Tortugas, the greatest number of cases were reported during the week ending September 14th; the greatest number of deaths during the week ending September 28th. Still further comparisons^may be made from the monthly tables in the Appendix: thus, at Indianola, the greatest mlmber of cases and deaths occurred during July ; at Gralveston, during September; at Victoria, Houston, and Plempstead, during October ; at New Orleans, during September; at Vicksburg, during October and November; at Fort Morgan, Mobile harbor, during August; at Mobile, during October; at Key West, during September and October; at Fort Jefferson, during September. Such facts strongly favor the belief that the period of maximum intensity corresponds to the date of the introduction of the disease, rather than to any supposed controlling influence of season or climate. The Hsts of patients already referred to at the commencement of this report have rendered it possible to construct the following tables, showing the nativities, ages, and length of service of the patients, and the comparative duration of the disease in the cases that recovered and in fatal cases : '■ (WHITE TROOPS.) 1. NATIVITIES. Cases. Deaths. Cases. Deaths. Cases. Deaths. United States... Canada 572 29 50 275 11 1 180 165 14 13 68 4. 1 64 Hungary Poland 2 1 3 7 2 1 7 1 1 2 3 1 Switzerland 8 3 1 2 49 2 1 England Ireland Scotland Wales . Russia Sweden Denmark Belgium France East Indies 1 27 Not stated Total Germany 1,204 368 EEPOKT ON EPIDEMIC CHOLERA AND YELLOW FEVEE. 2. AGES. XXIX Cases. Deaths. Cases. Deaths. 20 years or under 237 538 233 80 29 71 163 70 26 4 8 2 3 75 2 1 1 30 20 to 25 years 45 to 50 " 25to.30 " Over 50 " 30 to 35 " Not stated 35 to 40 " Total 1,204 368 3. LENGTH OF SERVICE. Cases. Deaths. Cases. Deaths. 15 30 61 173 448 10 11 25 C4 125 . 82 C6 329 24 10 99 1 to 3 months 3 to 6 " Over 3 years .- 6 months to 1 year Total - 1,204 368 4. DURATION OF CASES WHICH RECOVERED. No. OP DAYS. Cases. No. on DAYS. Cases. No. OF DAYS. Cases. No. OF DAYS. Cases. 2 2 ! 16- 17 30 5 46 5 3 16 1 ^'' 29 31 10 47 3 4 14 18 19 32 9 50 3 5 23' 19 22 33 7 53 4 6 35 20 21 34 6 58 4 7 48 21 19 35 8 . 62 6 8 47 22 19 36 1 64 2 9 55 23 12 37 3 67 1 10 48 24 10 38 3 72 5 11 47 25 11 39 2 ■ 75 1 12 3-3 26 14 40 2 85 1 13 33 27 11 41 1 91 1 14 . 15 40 21 28 29 11 10 42 44 7 Not stated. Total 41 83a XXX REPORT ON EPIDEMIC CHOLERA AND YE1.L0\'5^ FEVER. 5. DURATION OF FATAL CASES. No. OF DAYS. 1 Deaths. No. OF DAYS. Deaths. No. OF DAYS. Deaths. No. OF days. Deaths. 1 . 1 28 10 13 19 1 33 2 43 11 7 20 34 'l 3 61 12 21 37 1 4 55 13 22 51 2 5 46 14 23 1 54 1 6 30 15 25 Not stated. 3 7 23 16 30 8 18 17 3 31 9 ' 12 18 2 32 Total 368 (COLORED TROOPS.^ 1. AGES. 20 years or under 20 to 25 years... 25 to 30 years... 30 to 35 years Cases. 33 109 14 7 Deaths. 4 18 2 1 35 to 40 years. Not stated Total Cases. 166 Deaths. 25 2. LENGTH OF SERVICE. Cases. Deaths. Cases. Deaths. 1 Tnonth or under 4 76 13 30 1 13 2 4 1 to 2 years 35 6 2 3 1 1 1 to 3 months Total 166 25 REPORT ON EPIDEMIC CHOLEEi AND YELLOW PEVEK. 3. DURATION OP CASES WHICH RECOVERED. XXXI No. OK Days. No. OF Cases. No. OF Days. No. OF Casbs. No. OF Days. No. OF Cases. 4 1 19 4 34 1 5 4 20 3 36 4 6 8 21 2 37 4 7 6 22 2 38 2 8 8 23 5 39 5 9 6 24 2 40 1 10 2 25 2 41 1 11 , 5 26 2 45 1 la 5 27 2 54 3 13 7 28 5 57 1 14 8 29 4 67 1 15 6 V 30 1 Not stated. 1 16 3 31 2 17 18 5 3 32 33 2 1 Total 141 4. DURATION OP PATAL CASES. No. OF Days. No. OF Deaths. No. OF Days. No. OF Deaths. No. OF Days. No. OF Deaths. 1 2 3 4 5 6 1 2 2 '2 6 7 9 11 12 2 2 1 1 4 16 32 Total 1 1 25 The lists of patients from which the foregoing tables were constructed, show that second attacks of the same patient, during the same epidemic, occasionally occur ; fourteen such cases are reported at New Orleans and six at Fort Jefferson. Of the medical officers exposed, by.their duty, to the epidemic, thirty-one contracted the disease, and of these ten died, as shown in' the following list : LIST OP MEDICAL OFFICERS, U. 8. ARMY, WHO DIED OP YELLOW FEVER. 1. Surgeon George Taylor, Brevet Lieutenant Colonel, died August 5, 1867, at Galveston, Texas. 2. Assistant Surgeon C. H. Rowe died September 5, 1867, at Galveston, Texas. 3. Assistant Surgeon J. Sim Smith, Brevet Major, died September 8, 1867, at Port Jefferson, Florida. XXXII REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER 4. Assistant Surgeon Samuel Adams, Brevet Major, died September 9, 1867, at Galveston, Texas. 5. Acting Assistant Surgeon B. S. Reilly died September 28, 1867, at Rio Grande City, Texas. 6. Acting Assistant Surgeon Lucius Smith died October 21, 1867, at Hempstead, Texas. 7. Acting Assistant Surgeon W. E. Savage died November 21, 1867, at Ringgold Barracks, Texas. 8. Acting Assistant Surgeon C. M. Dickerson died July 7, 1867, at Columbus, Miss. 9. Acting Assistant Surgeon E. D. Grinder died November 25, 1867, at New Orleans, La. 10. Acting Assistant Surgeon G. W. Shields died August 10, 1867, at New Oileans. Louisiana. LIST OP MEDICAL OFFICERS, U. S. ARMY, ATTACKED WITH YELLOW FEVER WHO RECOVERED. 1. Surgeon B. A. Clements, Brevet Lieutenant Colonel, attacked September 15, 1867, at New Orleans, La., recovered October 3, 1867. 2. Assistant Surgeon C. B. White, Brevet Major, attacked September 20, 1867, at New Orleans, La., recovered October 13, 1867. 3. Assistant Surgeon H. E. Brown, Brevet Major, attacked October 28, 1867, at New Orleans, La. 4. Assistant Surgeon M. J. Asch, Brevet Major, at St. Louis during September. 5. Assistant Surgeon E. A. Koerper, attacked September 15, 1867, at New Orleans, La., recovered October 7, 1867. 6. Assistant Surgeon H. McL. Cronkhite, attacked September 23, 1867, at Galveston, Texas, recovered October 12, 1867. 7. Assistant Surgeon Edward Cowles, attacked October 15, 1867, at Brownsville, Texas, recovered November 7, 1867. 8. Assistant Surgeon W. S. Tremaine, attacked October 31st, 1867, at Memphis, Tenn., recovered November 24, 1867. 9. Acting Assistant Surgeon William Deal, attacked September 16, 1867, at New Orleans, La., recovered September 27, 1867. 10. Acting Assistant Surgeon J. J. Auerbach, attacked September 16, 1867, at New Orleans, La., recovered September 30, 1867. 11. Acting Assistant Surgeon F. A. W^illmahs, attacked September 30, 1867, at New Orleans, La., recovered October 11, 1867. 12. Acting Assistant Surgeon Orsamus Smith, attacked September 23, 1867, at New Orleans, La., recovered October 2, 1867. 13. Acting Assistant Surgeon Samuel Santoire, attacked July 3, 1867, at Indianola, Texas, recovered July 16, 1867. 14. Acting Assistant Surgeon 0. G. Furley, attacked September 30, 1867, at Ring- gold Barracks, Texas, recovered October 7, 1867. 15. Acting Assistant Surgeon J. F. M. Forwood, attacked October 2, 1867, at Alex- andria, La., recovered October 25, 1867. REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER XXXIII 16. Acting Assistant Surgeon L. Reynolds, attacked August 25, 1867, at Port Morgan, Ala., recovered August 30, 1867. 17. Acting Assistant Surgeon Heber Smith, at New Orleans, La ; no date given. 18. Acting Assistant Surgeon Henry Smith, at New Orleans, La.; no date given. 19. Acting Assistant Surgeon J. T. Payne, at New Orleans, La.; no date given". 20. Acting Assistant Surgeon J. Ridgely, attacked during September at Victoria, Tex. 21. Acting Assistant Surgeon Z. P. Doebuler, at New Orleans, La.; no date given. To the foregoing summary statement of the progress of yellow fever in the axmy during the year 1867, it has been thought desirable to add a brief account of the circum- stances attending the limited occurrence of this disease among our armies during the war of the rebellion. The interesting reports and documents from which this account is drawn will, it is hoped, be presented in full in the second volume of the medical history of the war. All that can here be attempted is an outline of the most striking facts. The strict blockade maintained for military purposes during the rebellion appears to have served to protect our armies from yellow fever. The troops at New Orleans and throughout the Department of the Gulf wholly escaped, and the disease appeared elsewhere to but a limited extent during the years 1862 and 1864. In July, 1862, yellow fever broke out at Key West, having been imported from Havana by the bark Adventure. It subsequently extended to Port Jefferson, Tortugas, and to Hilton Head, South Carolina, though at both these places the number of cases was comparatively small. From the quarterly reports of Surgeon E. S. Hoffman, 90th New York Volunteers, and appended documents, it appears that on June 17, 1862, the bark Adventure cleared from Havana and put into Key West, in distress, about the 20th, was quarantined ten days, and lay at quarantine three days after that time had elapsed. On the third day, or about sixteen days after leaving Havana, the first and second mates were taken sick with yellow fever. Two days later, or about the fourth or fifth of July, these patients, and two others of the crew, also sick with the fever, were taken on shore and placed in the Marine hospital, where the first mate died two days after, and the others ultimately recovered, one of them after a sickness of eleven days. July 27th, a soldier of the 90th New York was attacked, and the disease subsequently spread through the garrison with the results shown in the following table : Month ■--.. .... - JULY. AUGUST. SEFTEMBEE. OCTOBER. TOTAL. 448 447 385 382 415 2 2 153 30 137 32" 39 7 331 71 Deaths The treatment generally pursued is stated to have been a hot mustard bath, followed by a purge of calomel and castor oil, and subsequently by large doses of sulphate of quinia. E XXXIV REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. At this time a detachment of the 90th ■ New York volunteers garrisoned Fort Jeffer- son, Tortugas, the medical officer being Assistant Surgeon J. Chapman, of that regiment. Eleven cases of yellow fever and four deaths are reported by him during the month of October. He, moreover, reports that there were a number of cases amongst the workmen employed by the Engineer Department, and that two of them died. Dr. Chapman denies that the disease was imported, and states that all vessels arriving from infected ports were quarantined from seven to fourteen days. It hence appears that vessels did arrive from infected ports, probably from Key West, where the greater part of the regiment was stationed ; and as the time of quarantine allowed was insufficient, it ' "'is, probably, from Key West that the disease was introduced on this occasion. The treat- ment employed is not reported. At a still earlier period the epidemic was carried from Key West to Hilton Head, 8. C. The report of Assistant Surgeon J. E. Semple, U. S. A., dated January 1, 1863, states that the steamer Delaware, with a detachment of the 7th New Hampshire Volun- teers, arrived from Key West early in September, and, after a short quarantine, landed her passengers at Hilton Head September 8th. Shortly after several of them were taken sick and eight died, the last of the fatal cases terminating September 17th. Assistant Surgeon General C. H. Crane, then Medical Director at Hilton Head, expresses his belief that unreported cases had occurred during the passage of the Delaware from Key West. On the 9th of October a quartermaster's employe was attacked, and subsequently several officers and soldiers. All these cases occurred in the vicinity of the wharf where the Delaware had landed her passengers, and where, also, the hygienic conditions are reported to have been bad. There were at this time about ten thousand soldiers at Hilton Head and Beaufort, but the disease did npt spread among them; and in the general hospital, where most of the fatal cases were treated, the physicians, attendants, and patients sick of other diseases, escaped. Including the passengers by the Delaware, the whole 'number of cases at Hilton Head was as follows: September, ten cases, eight deaths; October, twenty cases, eight deaths; November, ten cases, nine deaths: total, forty cases, twenty-five deaths. In the treatment, reliance appears to have been placed chiefly on calomel and quinine. The whole number of cases reported during 1862 at Key West, Tortugas, and Hilton Head, was 382, with 100 deaths. It is interesting to mention, in this connection, that yellow fever occurred during 1862 among the citizens of Charleston, S. C, and Wilmington, N. C. Dr. Hand, in the reports to be presently referred to, states that at Charleston a small number of cases were reported during September and October, and that there can be Uttle doubt that the disease was introduced by blockade runners, several of them having been quarantined with yellow fever on board. At Wilmington the number of cases was much larger. Out of 3,000 inhabitants, white and black, who remained in the city, 1,200 are reported to have died. August 6th, just before the outbreak of tlie epidemic, the steamer Kate, blockade runner from Nassau, arrived at Wilmington with yellow fever on board. Dr. W. T. Wragg, in an article published in the Confederate States Journal, February, 1864, states, on the authority of a Dr. Schonwald, that other cases had previously occurred. Dr. Hand found. REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. XXXV upon inquiry, that Dr. Bchonwald was an empiric, in whose statements no confidence can be placed. Yellow fever was prevalent at Nassau at this time. Yellow fever did not again appear in the army during 1863, but during 1864 Key West was again visited, and the disease became epidemic among the troops stationed at Newbern, North Carolina. At Key West, Surgeon A. E. Stocker, United States Volunteers, reports sixty-four cases of yellow fever and seventeen deaths in the "District of Key West and Tortugas" for July, 1864; fourteen cases and four deaths for August. No particulars have been reported, but most of these cases are understood to have occurred at Key West. At Newbern, N. C, the fever appeared about the first of September of the same year, • and continued until towards the end of November. Seven hundred and five cases and two hundred and eighty-eight deaths were reported among the white troops in North Caro- lina, chiefly at Newbern, and thirty-eight cases and fifteen deaths among colored troops at same place. There were at this- time about seven thousand white troops in North Carolina. Sur- geon D. W. Hand, United States Volunteers, at that time Medical Director of the District of North Carolina, was authorized by the Surgeon General, January 16, 1866, to visit Newbern, N. C, and such other points as might be necessary, in order to collect such facts with regard to this epidemic as could be obtained at that date. Especial interest attached to the subject on a'ccount of the assertion that the fever had been introduced by infected clothing from the West Indies, sent via Halifax under the auspices of Dr. Blackburn. On this subject Dr. Hand has made a special report, dated April 1, 1866, in which he recounts his inquiries on the subject, and concludes, that although the infected clothing reached Washington, D. C, and was sold there, no evidence exists to render it probable that any of it reached Newbern. This source of importation excluded, and the rigid nature of the blockade enabling Dr. Hand to make the statement that no vessel was admitted from an infected port, it must be supposed either that the disease originated at Newbern, or that it was brought overland from Charleston, 8. C, where it became epidemic a month earlier than the first case at Newbern. The following are the facts bearing on this question as collected by Dr. Hand: Yellow fever appeared in Newbern about the first of September, 1864, and was at the time reported by Dr. Hand to Surgeon C. McCormick, the Medical Director of the department, as an epidemic of hepatic remittent fever of a fatal character. The real nature of the disease, however, was soon recognized. Dr. Hand enumerates the initial cases as follows : "Private 0. Pollock, 3d N. Y. Artillery, clerk at District Headquarters, corner of Union and East Front streets, was admitted to Foster hospital September 2d and died September 6th. "Private F. Coates, 3d N. Y. Cavalry, orderly at District Headquarters, had been sick several months ; returned to duty August 23d, from Morehead City general hospital ; admitted to Foster hospital September 1st and died September 6th. "Private G. C. Lillie, U. S. Signal Corps, was admitted to Foster hospital September 4th, from Signal Corps ofiice, on opposite corner from District Headquarters, and died September 6th." XXXVI EEPORT ON EPIDEMIC CHOLEEA. AND YELLOW KEVEE. " Mrs. Wilcox, a white refugee, corner of George and Soutli Front streets, had chills for a month or more ; taken quite sick September 1st ; had black vomit ; turned yellow, and died September 7th. This woman had lived in that house one month, and in Newbern eight months. "A Mrs. Prudence Kice, whom I did not see, died September 6th, in the next house to Mrs. Wilcox, with what was probably yellow fever. "Sergeant M. Kogers, 15th Connecticut, jailer at Confederate prison corner of George and Pollock streets, was taken September 7th ; admitted to regimental hospital the same evening; had black vomit, and died September 9th." It will be seen, from the above extract from Dr. Hand's report, that Mrs. Wilcox was taken sick on September 1st, which is the same date as the earliest case reported among the troops ; that her neighbor, another woman, had the same disease, and died September 6th, the date at which she was taken sick being unknown ; nor is it possible now to know how many other cases, unobserved and unreported, may have occurred among the refugees at an earlier period. It has been suggested that refugees from Wilmington, North Carolina, may have intro- duced the fever; but Dr. Hand's inquiries would appear to show that the epidemic at Wilmington broke out at a later date than at Newbern ; and he relates that although a few refugees came in during August, none of them are known to have come from Wilmington. On the whole. Dr. Hand is of the opinion that the disease at Newbern was of local origin, and he recounts the various unfavorable hygienic influences which he supposes may have contributed to its production. After the existence of the disease was recognized, soldiers and citizens were sent rapidly away from Newbern to Morehead City, Beaufort, Hatteras, Roanoke island, and elsewhere. To this fact Ave must undoubtedly attribute the large proportion of the troops who escaped. In a number of instances individuals were attacked with the fever among those thus sent away; but, according to Dr. Hand, the disease nowhere spread to others, except at Beaufort, where it prevailed to a limited extent. Beaufort is described as being deficient in police and crowded with refugees from Plymouth and Little Washington. The following was the monthly number of cases and deaths among the white troops : September, 174 cases, and 70 deaths. October, 493 " " 200 November, 38 " " 18 Total, 705 " " 288 This gives the proportion of one death to every 2.4 cases, or about two to five. At the Poster general hospital there were treated, besides, thirty-eight colored soldiers, of whom fifteen died, and forty-one quartermaster's employ6s, of whom twenty-six died. In a letter dated October 31, 1864, Dr. Hand states that sixteen medical officers had been attacked up to that date, and eight had died. The treatment regarded best was a cathartic dose of calomel, followed by repeated small doses of the same medicine, not, however, pushed to ptyalism. Precise data as to the prevalence of the disease among the citizens of Newbern and the refugees are not attainable. REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. XXXVII Surgeon C. A. Cowgill, U. B. Volunteers, in charge of tlie Foster general hospital, Newbern, contributes a report to accompany his monthly report of sick and wounded for November, 1864, which contains some interesting statements. It appears that 292 cases were admitted to that hospital during the epidemic; that 118 convalescents and attendants were attacked ; making, in all, 410 cases and 181 deaths of white troops. Dr. Cowgill states, on the authority of Surgeon Mayer, of the 15th Connecticut Volunteers, that after a number of cases of the fever had been brought to the hospital, the disease appeared among the inmates of the hospital, convalescents from malarious diseases being first attacked, then convalescents from other diseases, and finally the attendants. Dr. Cowgill further states, that during August and the early part of September remittent and intermittent fevers were the prevailing types of disease, but that these dis- appeared during the prevalence of the epidemic. Previously to the outbreak of yellow fever at Newbern, it had made its appearance, as already stated, at Charleston, South Carolina. The first case was that of Mr. Dallas, living on Calhoun street near the citadel ; he was taken sick July 27th, and died nine days afterwards. Two weeks later the disease appeared in several parts of the city. It is known that the steamer Druid, blockade runner, came into port a few days after Mr. Dallas was attacked, with yellow fever on board ; but Dr. Hand could not learn of the arrival of any other blockade runner for several weeks before, and could obtain no evidence that any previous ones had fever on board. The disease spread extensively in Charleston, and Dr. Hand estimates the number of cases at 2,000, with a mortality of thirty-five per cent. At Wilmington, N. C, according to the inquiries of Dr. Hand, the fever of 1864 did not appearuntilOctoberlOth. He states that about the last of August the blockade runners Clyde and Coquette lay at the quarantine grounds, three miles below the city, with cases of yellow fever on board. This fact excited alarm, and the quarantine was removed from that point to Smithville, near the mouth of Cape Fear river. Here, on October 1st, fourteen blockade runners lay in quarantine, and on all of them the mortality from yellow fever was great. At this time the fever spread from the ships to the shore, the first cases occurring in the houses nearest the quarantine fleet, and nearly one-half the citizens of Smithville died of it. Goods are known to have been smuggled on shore at Smithville, and it is quite probable that some of them were carried overland to Wilmington. During the summer and fall of 1864, a number of cases occurred, also, on the naval vessels lying before New Orleans. As usual, the disease has been said by some to have originated on the spot, and the bad hygienic condition of certain of the iron-clads has been indicated as furnishing the necessary conditions. But the Spanish ship Pizarro, with yellow fever on board, had been sent to the quarantine station July 4th, and it is believed that, if a full account of all the facts of the case could -be obtained, it would be found that the naval epidemic of 1864 would prove no exception to the general rule. After the epid-emic at Newbern, no considerable number of cases occurred in the army until the summer of 1867. During August, 1865, sixteen cases, none of them fatal, are reported in the District of Key West and Tortugas, without particulars. A few cases occurred, also, during 1866. One death is reported at Fort Jefferson during September; three deaths at New Orleans, one during September, one during October, and one during XXXVIII REPORT ON EPIDEMIC CHOLERA AND YELLOW FEVER. November ; one death at Brownsville, in November, the patient being an officer who had just arrived from New Orleans. Finally, six cases and one death of colored soldiers at Indianola, Texas, in October. It is known that during the summer and fall of 1866 yellow fever prevailed among the citizens of New Orleans. In conclusion, a few words may be said with regard to the relations of the facts set forth in this report, and in the appended documents, to the prevention of yellow fever. It is to be regretted that the experience of the army throws no more satisfactory light on the treatment of the disease, but it must be admitted that it is most instructive with regard to measures of prevention. Besides those general hygienic precautions which are so important in the prevention or mitigation of all epidemic diseases, two simple and effective measures would appear to be specially indicated by the experience of the army during the war and subsequently. The first is quarantine, as a means of preventing the introduction of the disease ; the second is the prompt movement of the command to some rural site on the appearance of the fever among the citizens of the town at which it is stationed, or even aftfer the disease has appeared among the men of the command itself. With regard to quarantine, it is well known that a great difference of opinion exists among civil physicians; nor is this surprising, since, in populous cities, approached by many routes of travel, a foreign disease may readily be imported by persons eluding an imperfect quarantine. In such a case it may be quite impossible for the physicians of the jalace to determine the circumstances, naturally concealed by those who have broken the laws or regulations on the subject. In the case of military detachments, however, especially" during times of peace, the movements of individuals being so much more readily known, the mode in which such diseases are introduced can very generally be recognized ; and hence it is not surprising that recent distinguished English writers on subjects connected with military medicine — Dr. Aitkin, in his Practice of Medicine, and Dr. Parkes, in his Hygiene — are advocates of the doctrine of importation. Dr. Parkes expresses the opinion that the incubative period is longer than is usually supposed, probably often fourteen or sixteen days. Several facts set forth in the appended documents would seem to show that, in certain cases, the disease may be delayed as long as three weeks after exposure. The minimum period of an effective quarantine against yellow fever may then be set down at about twenty days. Twenty-five or thirty days would be better if attainable. • Should the disease, unhappily, be introduced through neglect to provide an efficient quarantine, it becomes the imperative duty of the medical officer to recommend the imme- diate removal of the command to some healthy rural site. On this subject the reports here discussed are explicit. At the only places at which any large number of cases occurred during 1867 — at Galveston, at Houston, at Hempstead, at New Orleans, at Fort Jefferson — the troops faced the pestilence, and at each the greater portion of those exposed were attacked. On the other hand, the troops moved on the approach of the disease to camp in the country, escaped almost wholly at New Iberia, Baton Rouge, Alexandria, Shreveport, &c.; while at Indianola, Mobile, Pass Christian, &c., the command being moved after the disease had appeared among the men, almost all those thus removed escaped. The Newbern epidemic afforded a similar experience. After the disease had fairly broken out among the troops, the greater part of them were moved away from the town, and nearly all thus moved escaped. When a command is thus moved, it should be encamped on a dry and elevated site, not EEPOET ON EPIDEMIC CHOLERA AND YELLOW FEVER. XXXIX previously used for camping purposes ; the men should be sheltered by tents, should not be crowded, and should be surrounded by the best hygienic conditions attainable. The views here expressed agree with the opinions formed by the -Surgeon General upon the basis of the army experience of 1867 and of previous years. Accordingly, on the 15th of April, 1868, he recommended to the commanding general of the army that a quarantine should be established along the entire southern seaboard as early as the 1st of May of the present year, and advised the prompt removal of troops from points threatened with infection. I have the honor to be, General, your most obedient servant, J. J. WOODWARD, Brevet Lieutenant Colonel, and Assistant Surgeon, U.S.A. Brevet Major General J. K. Bakwes, Surgeon General, United States Army. APPENDIX I. STATISTICAL TABLES AND EXTRACTS FROM OFFICIAL REPORTS EEFEEEING TO CHOLERA. 11. STATISTICAL TABLES AND EXTRACTS FROM OFFICIAL REPORTS EEFEEEING TO YELLOW FEVER. APPENDIX I.— CHOLEEIA. A. STATISTICAL TABLES. 1. VIDALIA, LOUISIANA. JULY OCTOBER. NOVEMBER. 1 Mean strengi;h 47 64 64 61 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera 8 3 8 3 Cholera morhus Acute diarrhoea Chronic diarrhoea 20 6 4 1 8 2 34 6 1 Acute dy sentery 1 1 1 1 Total 20 36 1 10 55 1 1 11 43 8 18 3 2 49 152 5 3 All other diseases Aggregate r 56 1 65 2 54 26 5 201 8 2. VICKSBUEG, MISSISSIPPI. Months ... JULY. AUGUST. SEPTEMBER, OCTOBER. NOVEMBER. DECEMBER. TOTAL 17 1 196 198 282 377 379 267 Cases. Deaths. Gases. Deaths. Cases. Deaths. Cases.* Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 8* 2 1 1 2 11 3 Acute diarrhcea Chronic diarrhcea 21 2 16 4 7 3 16 2 4 15 3 2 1 17 3 2 1 3 2 88 16 15 4 1 Total 31 40 2 1 30 63 23 69 1 23 155 2 22 137 1 4 5 69 1 134 533 4 8 All other diseases Aggregate 71 3 93 92 1 178 2 159 5 74 1 667 12 '•' Also one fatal case in June. STATISTICAL TABLES. 3. MADISON, ARKANSAS. Month DECBMBEK. TOTAL. - 83 67 53 46 45 45 57 Cases. Deaths. Cases. Deaths. bases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera. 8 7 15 1 3 2 1 14 1 10 9 33 1 4 Cholera morbus Acute diarrhcea Chronic diarrhcea 1 3 Total 31 30 3 17 49 1 1 45 3 47 52 228 4 3 All other diseases Aggregate 2 38 19 61 3 66 1 46 50 2 38 19 280 6 4. NEWPORT BARRACKS, KENTUCKY. JULY. AUGUST. SEPTEMBER. OCTOBER. NOVEMBER. DECEMBER. TOTAL. 434 463 494 590 540 530 509 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 5 44 1 1 26 1 1 7 113 2 14 1 Cholera morbus Acute diarrhoea 1 12 2 1 10 13 8 Acute dysentery 2 5 4 1 1 Total 51 28 33 45 1 1 14 48 1 16 66 14 68 1 9 71 137 326 1 3 All other diseases 79 78 2 62 1 82 82 1 80 463 4 * Two cases are reported in June, both recovered. 5. PADUCAH, KENTUCKY. 131 108 99 101 101 108 108 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 4 2 4 58 8 18 2 2 Cholera morbus Acute diarrhoia ChTOnio diarrhcea Acute dysentery Chronic dysentery 1 17 6 3 1 3 5 1 11 7 1 3 10 8 1 3 1 2 2 5 28 68 15 54 2 10 57 12 64 13 68 1 17 63 95 374 2 1 All other diseases Aggregate 96 09 2 07 76 • 81 1 80 409 3 CHOLERA. 6. ST. LOUIS AESENAL, MISSOURI. 5 Mouths DECEMBER. TOTAL. 114 133 134 129 129 139 135 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1 1 11 102 1 11 Cholera morbus Acute diarrhoea Chronic diarrhcea 7 36 1 13 3 10 23 17 4 1 3 Acute dysentery Chronic dysentery 4 2 3 Total 47 47 13 35 13 56 26 69 20 52 7 41 126 300 All other diseases Aggregate 94 48 69 95 72 48 426 7. JEFFERSON BARRACKS, MISSOURI. 131 133 142 148 143 138 139 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1 6 24 1 9 85 1 Cholera morbus.^, Acute diarrhoea 1 19 1 31 1 1 10 6 5 Acute -dysentery 1 1 7 1 5 4 19 Total . 32 29 31 32 29 44 1 12 44 11 52 9 32 114 233 1 All other diseases Aggregate 61 53 73 1 56 63 41 347 1 8. JEFFERSON BARRACKS, MISSOURI. (Colored Troops.) AUGUST. SEPTEMBEK. OCTOBER. NOVEMBER. DECEMBER.* TOTAL. 3 o 4 114 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 13 5 3 1 15 6 Acute diarrhcea 2 2 25 3 33 1 1 3 1 1 3 3 1 1 3 1 39 4 5 5 1 50 8 6 All other diseases Aggregate i 3 4 43 5 5 1 58 6 1 1 " 1 * No repc rt. STATISTICAL TABLKS. 9. FOET RILEY, KANSAS. MoDths JULY. AUGUST. SEPTEMBEn. OCTOHEK. NOVESIBER. DECEMBER. TOTAL. 87 31 9 10 10 11 26 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Acute dian'hoea 4 4 8 Total' All other diseases 4 5 1 4 2 8 8 1 1 9 1 6 1 16 1 1 10. FORT RILEY, KANSAS. ( Colored Troops. ) 4 96 176 179 253 473 197 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera 2 ' 1 2 1 13 20 17 2 17 69 1 1 1 1 1 1 Total 13 42 21 73 1 17 61 2 4 53 1 18 122 1 1 73 353 2 4 All other diseases 1 1 55 94 1 78 2 57 1 140 2 425 6 11. FORT HARKER, KANSAS. JULY. AUGUST. TOTAL. 74 94 262 300 211 234 196 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. [Deaths. Cases. Deaths. Cases. Deaths. 28 19 1 30 1 28 1 157 20 1 Cholera morbus Acute diarrhcea Chronic diarrhoea 33 1 65 21 6 2 Acute dysentery Chronic dysentery 1 1 3 1 3 8 1 22 o Total 62 6 19 31 37 2 1 65 71 23 43 9 29 1 5 12 1 194 198 All other diseases 68 19 08 3 136 65 38 1 17 1 392 24 STATISTICAL TABLES. 15. FORT LARNED, KANSAS. TOTAL. Mean strength 160 172 137 180 318 217 181 Cases. Beaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1 Cases. Deaths. 5 4 5 4 Acute diarrhcea 55 9 ' 9 4 3 4 84 Acute dysentery 1 2 3 3 2 3 14 ' 1 Total 61 33 4 11 22 2 12 33 7 19 5 20 1 7 8 103 135 4 3 All other diseases 94 4 33 ■ 2 45 26 25 1 15 238 7 16. FORT LARNED, KANSAS. (Colored Troops.) Mean streDg;th 72 68 ,68 68 63 95 72 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera. 1 1 1 1 2 2 Acute diarrhoea 31 3 1 35 1 1 Total 32 6 1 1 4 5 1 1 1 1 6 38 23 2 2 AH other diseases Aggregate 5 1 38 2 9 2 1 7 5 1 61 4 17. FORT DODGE, KANSAS. DECEMBER. TOTAL. 231 221 301 250 314 272 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera 21 12 4 2 25 1 92 14 Cholera morbus 1 19 Acute diarrhcea Chronic diarrhcea 30 28 4 6 5 Acute dysentery 3 11 5 1 19 1 Chronic dysentery.? Total 51 14 12 32 13 2 23 14 1 4 20 17 19 1 10 19 1 137 99 15 2 All other diseases Aggregate 65 12 45 2 37 1 24 30 1 29 1 S36 17 CHOLERA. 18. COMPANY "G," TENTH CAVALRY, EN ROUTE FROM FORT BARKER TO FORT HAYS, KANSAS. (Colored Troops.) Months " 1 . . 1 DECEMBER. TOTAI,. 1 Mean strength 63 59 1 1 1 1 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. 1 Deaths. Cases. Deaths. ' Cases. Deaths. Cholera 15 8 1 15 9 Cholera morbus Acute diaiThtea Chronic diarrhoea. . , 17 4 21 Acute dysentery 1 Chronic dysentery 1 Total 1 32 2 8 4 16 1 36 18 9 All other diseases Aggregate 34 8 20 1 1 54 9 19. COMPANY "F," rniED INFANTRY, NEAR COW CREEK, KANSAS. JULY. AUGUST. SEPTEiMBEB. OCTOBER. NOVEMBER. DECEMBER. TOTAL. Mean strength 76 60 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera 7 4 1 8 4 Cholera morbus^ Acute diarrhtiea Chronic diarrhoea 12 5 17 Acute dysentery Chronic dysentery Total 1 1 20 5 4 6 4 26 9 4 All other diseases Aggregate 25 4 10 35 4 20. COMPANY "C," TENTH CAVALRY, CAMP 6EIERS0N, KANSAS. (Colored Troops.) Months JULY. AUGUST. SEPTEMBER. OCTOBER. NOVEMBER. DECEMBER. TOTAL. 81 75 78 75 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 7 4 10 4 17 8 Cholera morbus Acute diarrhoea 12 10 1 2 2 1 25 1 4 Acute dysentery 1 1 Total 20 12 4 23 6 4 3 13 1 19 47 50 8 All other diseases Aggregate 32 4 29 .4 16 20 j 97 B 10 STATISTICAL TAHLES. 21. FORT HAYS, KANSAS. JULY AUGUST OCTOBER. KOVEMIIEll. DECEMBER. TOTAL. 22 39 40 85 93 173 75 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1 1 1 16 Cholera itiorljus Acute diarrhoea 1 12 2 2 ■ 13 11 3 5 2 4 18 38 1 All other diseases Aggregate 5 1 2 11 24 5 1 8 3 11 6 56 1 22. FORT HAYS, KANSAS. ( Colored Troops. ) JULY. AUGUST. SEPTEMBER. OCTOBER. NOVEMBER. DECESIBER. TOTAL. 181 ^20 243 248 545 399 389 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1 Cases. Deaths. Cases. Deaths. 19 9 12 14 8 1 33 83 Acute diarrhcea Chronic diarrhoea 60 1 13 16 27 11 10 137 1 1 1 I Chronic dysentery 1 79 46 10 1 35 48 14 1 19 S 27 85 11 38 4 10 30 3 171 195 34 9 All other diseases Aggregate 125 11 73 15 37 53 49 4 40 3 366 33 23. DOWNER'S STATION, KANSAS. Months JULY. AUGUST. SEPTEMBER. OCTOBER. NOTEMUER. DECEMBER. TOTAL. 76 91 84 82 84 83 83 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera 3 1 3 1 Cholera morbus Acute diarrhcea 4 7 2 1 1 13 1 11 Acute dysentery Chronic dysentery 4 4 1 1 Total 8 7 13 10 1 4 5 1 10 1 10 37 46 1 All other diseases Aggregate 4 15 23 1 9 11 4 11 73 1 CHOLERA 11 24. MONUMENT STATION, KANSAS. ( Colored Troops. ) Months AUGUST. 1 115 35 40 41 63 63 58 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera 3 1 3 1 Cholera morhus Acute diarrhoea Chronic diarrhoea 10 1 11 Acute dysentery Chronic dysentery 2 1 3 Total 15 7 1 2 9 17 30 1 All other diseases Aggregate 8 2 2 2 22 1 11 8 2 2 2 47 1 25. DETACHMENT OF SEVENTH CAVALRY, NEAR FORT WALLACE, KANSitS. AUGUST. SEPTEMBER. ,. 1 Mean strength 323 117 * Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera '."'. 14 6 71 1 9 3 2 17 6 94 1 11 Cholera morbus Acute diarrhoea Chronic diarrhoea 23 Total 1 92 44 9 26 17 2 118 61 11 AH other diseases Aggregate 2 136 9 43 179 11 26. FORT WALLACE, KANSAS. JULY. AUGUST. SEI'TEMBEB. OCTOBER. NOVEMBER. DECEMBER. TOTAL. 300 425 443 385 355 320 371 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 25 6 16 11 25 6 57 11 Acute diarrhoea ■.-- 6 6 5 16 8 Acute dysentery - 2 10 2 1 ■ 2 2 17 2 Total 8 11 57 22 13 7 24 1 7 19 16 40 10 39 105 155 13 1 All other diseases Aggregate 19 79 13 31 1 26 50 49 260 14 12 STATISTICAL TABLES. 27. FOBT SMITH, ARKANSAS. -AUGUST. OCTOBER. NOVEMBER. DECEMBER. Mean strength 77 70 69 170 171 318 146 Gases. Deaths. Gases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cholera 2 2 2 2 73 2 Cholera morbus Acute diarrhoea Chronic diarrhoea 2 13 12 22 20 3 3 1 5 2 8 15 43 12 73 25 58 2 1 25 81 1 5 42 1 3 40 1 85 337 2 4 All other diseases Ag-gregate 58 85 83 3 106 1 47 1 43 1 422 6 28. FORT GIBSON, CHEEOKEE NATION. 143 130 144 140 207 189 159 Cases. Deaths. Gases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Gases. Deaths. Gases. Deaths. Cholera 1 1 1 5 20 1 4 1 1 Cholera morbus Acute diarrhoea Chronic diarrhcea. 5 10 1 7 3 1 , Acute dysentery Chronic dysentery 1 1 1 1 Total 16 15 1 8 33 1 1 1 55 1 52 4 23 1 26 31 204 2 1 All other diseases Aggregate 31 1 41 2 56 53 27 27 235 3 29. FOET GIBSON, CHEEOKEE NATION. ( Colored Troops. ) OCTOBER. 1 110 100 60 10 99 ■ 99 80 Cases. Deaths. Gases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Gases. Deaths. Cases. Deaths. Cholera 1 2 10 1 1 2 15 1 1 Cholera morbus Acute diarrhoea Chronic diarrhoea 1 3 1 1 Acute dysentery Chronic dysentery 2 2 Total All other diseases ' Aggregate 15 9 2 1 3 16 19 4 1 31 1 3 20 68 a 1 1 8 8 24 3 33 1 4 88 3 CHOLERA. 30. FORT ARBUCKLE, CHEROKEE NATION. 13 166 128 126 113 171 181 148 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 5 4 1 • 5 4 1 .Acute diarrhcea 17 5 2 1 1 2 7 10 42 1 11 Acute dysentery 4 2 2 1 Total 26 22 4 7 56 4 85 4 92 3 8 34 10 23 59 312 4 3 AH other diseases 48 4 63 89 96 3 42 33 371 7 31. FORT ARBUCKLE, CHEROKEE NATION. ( Colored Troops. ) OCTOBEIt. NOVEMBEB. DECEMBER. 64 79 88 86 189 181 115 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 3 3 Acute diarrhoea 21 3 5 5 34 Total 1 24 11 3 45 5 18 5 19 37 150 1 All other diseases 1 18 39 35 1 18 48 39 23 24 187 1 32. BATTALION SIXTH U. S. INFANTRY, EN ROUTE TO FORT ARBUCKLE, CHEROKEE NATION. JULY. AUGUST. SEPTEMBEB. OCTOBER. NOVEMBEB. DECEMBER. TOTAL. 129 - Cases. Deaths. Cases. Deaths. Cases. Deaths. 1 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 40 16 40 16 1 i Chronic diarrhoea 40 1 40 1 80 9 16 80 9 16 All other diseases 1 89 16 1 89 16 ]4 STATISTICAL TABLES. 33. FORT COLUMBUS, GOVERNOR'S ISLAND, NEW YORK HARBOR. HOVEMHEK. DECEMBEU. TOTAL. 837 875 887 777 903 892 860 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths, Cases. Deaths. 11 5 24 11 259 13 35 11 662 1 48 I 18 7 1 Acute diarrhcea 169 156 45 12 1 21 Acute dysentery 12 20 14 5 2 1 2 1 181 149 187 138 5 308 150 IS 2 48 77 2 13 100 1 1 21 118 758 732 26 3 Ali other diseases Aggregate 330 325 5 458 20 125 2 113 2 139 1,490 , 29 34. FORT WOOD, BEDLOE'S ISLAND, NEW YORK HARBOR. JULT. AUGUST. SEPTEMBER. OCTOBER. NOVEMBER. DECEMBER. TOTAI,. 409 292 337 305 382 360 347 Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. OaS(!«. Deaths. 3 8 4 10 4 Acute dJaiThcea 55 53 75 1 31 35 12 261 1 Acute dysentery 6 1 1 1 6 4 1 7 5 29 1 2 Total til 58 1 3 56 46 1 89 47 5 36 39 42 61 17 -54 301 305 7 3 All other diseases Aggregate 119 4 102 1 136 5 75 103 71 606 10 CHOLERA. 15 35. CASES OF CHOLERA DURING THE LAST SIX MONTHS OF 18C7, NOT INCLUDED IN THE FOREGOING TABLES. Months JULY ATTfiTTRT NOVEMBER. EC o p i (0 P 8 O R 6 03 i 1 03 i 2 00 WHITE TROOrS. New Orleans, La 1 4 2 1 1 6 1 1 1 25 15 13 9 3 1 1 1 4 1 2 1 CasfeofDr. McGill Platlsburg Barracks, N.Y. 1 1 1 1 Recruits en route 1 25 15 13 9 1 4 1 2 1 Recruits at Galveston Recruits at Hempstead. . . Recruits at Indianola Recruits at Onion Creek.. Total white troops 1 1 2 1 A « 64 10 71 14 COLORED TROOPS. 1 1 3 1 4 1 2 Fort Jaclsson, La - - . 1 Total white and colored. 1 1 2 1 1 5 3 67 11 76 16 36. TOTAL NUMBER OF CASES OF CHOLERA. * Months JULY. AUGUST. SEPTEMBER. OCTOBER. NOVEMBER. DECEMBER. TOTAL. 1 P o EQ P Q 1 p i DQ as O p i i 1 P CO C3 o 1 p 6 CO 1 P W^hite trooDS .... 141 135 75 58 58 24 27 22 36 3 21 11 13 3 5 4 5 2 2 64 3 10 2 314 183 138 89 Total white and colored. 276 133 82 49 39 21 24 8 9 4 67 12 497 227 * Besides the above, there are reported during the month of June 3 cases and 1 death of white, 4 oases and 2 deaths of colored troops. APPENDIX 1.— CHOLERA. B. EXTRACTS FROM OFFICIAL REPORTS. (CIRCULAR No. 3.) Wak Depaetment, Surgeon General's Office, WasUngton, D. C, April 20, 1867. In view of the possible prevalence of cholera during the approaching summer, the following instructions are promulgated : Every endeavor will be made by medical officers to prevent the introduction of cholera from infected commands, or its con- veyance from point to point, by a "quarantine of observation'' upon all detachments of recruits or troops arriving or departing from depots, posts, or recruiting stations at or near which this disease prevails ; prompt reports of its appearance in commands either en route or in garrison ; and isolation of all cases so far as practicable. In addition to the strictest hygienic police, enforcement of personal cleanliness and thorough disinfection, attention should be paid to the quality of the water used for drinking and cooking purposes. When pure rain water cannot be procured in sufficient quantities, and the spring or river water contains organic impurities, it should be purified by distillation, or the noxious matter precipitated by permanganate of potash. From half a grain to one grain of the orystalized permanganate (or its equivalent in solution) added to one galloa of water should produce a decided pinkish hue, which disappears within twenty -four hours, (if the salt has not been used in excess,) the water should then be drawn off, and is ready for use. Turbid water, such as that of the Eio Grande, lower Mississippi and its tributaries, should be filtered, or allowed to settle before using. The deposit of imparities can be hastened by the addition of powdered alum in small quantities, well diffused by stirring. It is.always, but more especially in times of threatened danger of pestilence, the duty and privilege of medical officers to submit the practical suggestions of experience and professional knowledge for the protection of the health of troops to their commanding officers ; and the history of the epidemic of cholera in 18S6 shows that only by combined and untiring vigilance, energetic action, and rigid enforcement of hygienic measures, within the reach of every commander, can we hope to avoid, keep in check, or eradicate this disease. Besides the usual reports of sick and wounded, every medical officer in charge of cholera oases will forward to the Surgeon General's Office, at the close of each month, a list of cholera patients in the following form : Special B'.port of Cholera, Patients at , MontTi of 186 - . . Name. Nativity, Kank. Eegim't. Lengthof Comp'y. servicein months. Date of attack. Date of recov'ry. Date of death. Eemarks. Surgeon, U.S. A. Successful methods of treatment and results of autopsies will also be communicated. The senior medical officer at every post at which cholera appears, will make a special report to the Surgeon General, setting forth any facts he may be able to ascertain as to the introduction of the disease, and especially those bearing upon its importation from infected points by recruits or others, or its apparently spontaneous origin at the post. J. K. BAENES, Surgeon General, V. S. A. 18 EXTRACTS FROM OFFICIAL REPORTS. NEW ORLEANS, LA. Extract from Monthly Report of Sick and Wounded, New Orleans Post Hospital, Greenville, La , November, 1867. E. A. Eoerper, Assistant Surgeon, U. S. A. A tendency to choleraic diarrhoea is showing itself. Henry Sadler, Private, Company "A," 39th U. S. Infantry, (colored,) was admitted to hospital at 11.30 o'clock a. m., In a state of collapse, and died at quarter before nine of the same day, in spite of all efforts to save him. Extract from Monthly Report of Sick and Wounded, New Orleans Post Hospital, Greenville, La., December, 1867. E.A. Koerper, Assistant Surgeon, U. S. A. Simon Green, Private, Company "A," 39th U. S. Infantry, (colored,) died eleven hours after admission. When admitted he was in a collapsed condition, from which he could only partially be made to react. Two cases of choleraic diarrhoea were suecesefully treated. Extract from Monthly Report of Sick andWounded, Greenville, La., December, 1867. Wm. Deal, Acting Assistant Surgeon, U. S.A. The three cases of epidemic cholera noted on the tabular list of diseases, contracted the disease whilst on guard duty in New Orleans. They were sent to the post hospital as soon as reported. Two recovered, and the third died within ten hours after the attack ; he was in a dying condition when the ambulance arrived with him from the city. Great care has been taken in keeping the wards clean, and disinfecting the water-closets. Daily, for over three months, a solution of sulphate of iron has been put in the privies. Many cases of incipient diarrhoea have been treated and checked without the soldiers being relieved from duty; the eight in the tabular list did not reach an average of two days in quarters. No case of cholera during the summer or fall origi- nated in camp here. Jackson Barracks, New Oeleaks, La., February 4, 1868. General : I have the honor to enclose herewith tabular lists of all the cases of cholera and choleraic diarrhoea which have occurred at this post during the month of January last; also, of those occurring in September, November, and December, 1867. No cases occurred in October, 1867. The cases of cholera number only three, and of choleraic diarrhoea four, and the cases of each disease thus recorded did not differ from each other except in the degree of severity of their symptoms, and, with the exception of the case in December, were all distinctly traceable to imprudence in eating or interaperonce in drinking. In view of the extensive prevalence of the disease in the city of New Orleans during the past four months, the small number of cases occurring in this command during the same period is noticeable, and may be considered due to the general excellent sanitary condition of the post as to cleanliness, ventilation, &c., of the quarters and hospital, the thorough daily disinfection of the sinks of the post, and the immediate disinfection of the dejections of all the sick in the hospital, which measures doubtless prevented any spread of the disease, the predisposing causes of which are apparent in the adjacent city, and inherent in the habits of the soldiers of the command, a considerable portion of whom are recruits. Very respectfully, your obedient servant, B. A. CLEMENTS, Surgeon, and Brevet Lieutenant Colonel, U. S. A. Brevet Major General J. K. Barnes, Surgeon General. Extract from Monthly Report of Side and Wounded of Co. "A," 33d U. S. Infantry, New Orleans, Louisiana, January, 1868. Heber Smith, Acting Assistant Surgeon, U. S. A. Epidemic Cholera : This report is for Co. "A," 33d Infantry, (67 men,) and the post band, (17 men.) U?idor the head of epidemic cholera, all cases of choleraic tendency are reported, although only two of them became fully developed. The others should, in my opinion, be called "choleraic diarrhoea, or cholerine." Company "A" arrived on the 10th inst. from the moun- tainous section of Georgia, and cholera made its appearance almost immediately among the men. VIDALIA — VICKSBURG. 19 VlDALrlA, I.A. Baton Rotjgb, La., November 5, 1867. Gbneeal : I have the honor to forward special report of cholera, and brief history of the same as it appeared in oainp at Vidalia, La., at the commencement of the month of October, 1867. During the months of June, July, August, and September, cholera appeared amongst the freedmen on many plantations, only several miles from our camp. This made us very vigilant. By raj advice and direction, every sanitary measure was enforced in order to prevent the disease. The camp was twice daily policed. The sinks were every day disinfected either with chloride of lime or' solution of sulphate of iron. Chloride of lime was liberally spread all over the camp, and the men were daily instructed to be careful of what they ate and drank. The first case that appeared was that of Private John Long, which terminated fatally ; though it is not without some diffidence that I so pronounce it, because I know that he had cardiac dropsy, for which he was under treatment ; furthermore, I am informed that he had no rice-water discharges, but severe cramps in his legs and constant vomiting. Having been sick myself at the time for several days, I engaged the services of a good practicing physician to attend the troops. John Long, as mentioned, the first case that occurred, was under the treatment of said physician. He took sick on the 30th September, and died October 1st, 1867. The circumstance that from this day nearly every man in the command was attacked with diarrhoea makes it, however, probable that it was a real case of epidemic cholera. Most of the diarrhoea cases were, however, easily managed, by a pill composed of equal parts of opium, sugar of lead, and camphor. The first undoubted case was Private John Enders, who was admitted October 6th, 1867. . At his admission he presented all the symptoms of true cholera asiatica : violent vomiting and purging of rice-water, cramps, cold extremities, and suppression of urine. * * * » Xhis patient rapidly recovered, but suffered a relapse by indiscretion in eating on the 14th of October. I am informed by some of the men that the preceding evening he ate apples and gingerbread in great quantities, and walked many times to the sink barefooted. On the morning of the 15th I was called to see him, and found him in a collapsed state, vomiting and purging rice-water, with cramps, cold surface, cold extremities, cold tongue, and a very weak pulse. » * * » He recovered very slowly, but at the date of this report he is strong and restored to duty. Private John Leyden wJfs the next case, admitted October 7th, 1867. I am informed that the night he took sick he ate at least a half dozen of apples and some gingerbread. He went, as I am told, about fifteen or twenty times to the sink, and was found early in the morning lying near the water-closet.- Nobody knows how long he was lying there. When I was called to see him, I found him in a complete collapse, with excessive spasms of the abdominal and other muscles, his pulse was quick and small, the skin was ice-cold, his features shrunken, the extremities cold and of a blueish color. » * » * jjjg vital powers failed rapidly; he died at 6 p. m., October 8th, 1867. The same day Charles Kopp was admitted. He had all the symptoms of cholera, but in the incipient state. He recovered. Jones, Conners, and Schrivemhold were admitted on the 8th of October, while they had the first symptoms of cholera. They all recovered. Joel L. Tuttle was the next case admitted. He had, as I am informed, diarrhoja for sijveral days, but did not call for medicines, through dread and fear that he would be obliged to go to hospital, where the former cases of cholera had been taken. October ICih I was called to see him, about 7 o'clock in the morning, and found him in collapse, with cold surface, cold tongue, cold extremities, and a quick weak pulse ; violent vomiting and rice-water discharges ; his features were shrunken ; his fingers had the appearance of what is called the " washerwoman's hands ;" there was a great similarity between this case and that of Leyden. Died October 10th, 1867. The company having been removed to a healthy camp and highest available ground, about four miles from Vidalia, La., diaiThoea prevailed among the men for some time, but the epidemic disappeared entirely. As to the probable cause of the epidemic, I have the honor to respectfiilly state that cholera was sporadic at and around Vidalia through all the summer, especially among the freedmen. Another cause may have also been that our cistern gave out, and we were obliged to use the dirty Mississippi water. This water has been boiled and purified, but, no doubt, the men have more often partaken of the water as it came from the Mississippi than otherwise. At this time a grocer at Vidalia, who had his store near the camp, received several barrels of apples, which the men of our command purchased profusely. Having been informed of this, I requested the grocer to sell no more of the apples to the troops, which he agreed to do, but the men got the apples by sending citizens and negroes to buy for them. I am, General, very respectfully, your obedient servant, E. ALEXANDER, Brevet Major General Joseph K. Baenbs, Surgeon General. Acting Assistant Surgeon, U.S.A. TICItSJBUKG, MISS. Extract from Monthly Beport of Sick and Wounded, VicMturg, Miss., June, 1867. A. A. Teomans, Assistant Surgeon, U. S. A. Maurice Kennelly, Private, Company A, 24th U. S. Infantry, was attacked with what appeared to be a severe form of cholera morbus on the morning of the 29th of June, 1867 ; he was immediately admitted to the hospital. In the course of two hours well-marked symptoms of Asiatic cholera presented themselves, Ms extremities became cold, the action of his heart weak, he had severe cramps, and rice-water purging and vomiting. Under the influence' of warm external applications, frictions and the 20 EXTRACTS FROM OFFICIAL REPORTS. internal use of stimulants, &o., he rallied for a time, but died at about a quarter past three p. m. in a state of collapse. It cannot be ascertained that KenneUy has been away from camp since the disease has been reported in Vicksburg. The sanitary condition of the camp has been pronounced excellent by several inspecting officers who have recently visited the post. Disinfectants have been freely used, and such vegetables as occasion diarrhoea in this climate have been prohibited. Notliing but cistern water is used by the command for drinking purposes. Two or three other cases have occurred, but as the disease did not go beyond the incipient stages, they do not appear on this report as cholera. Medical Dieectok's Office, Fourth Military District, Vicksburg, Mississippi, July 6, 1867. General: I have the honor to forward herewith Assistant Surgeon Yeomans' report of cholera at Vicksburg post hospital for June. The soldier reported was taken sick shortly after sunrise, on the morning of the 29th ult., and died about 3.30 p. m. the same day. A citizen in good circumstances was taken sick and died the same day, with cholera, in Vicksburg. June 30th a colored boy was attacked with cholera about 10 p. m., at the house occupied by General Ord and staff, and died in about twelve hours. All of these were undoubted cases of cholera. I have made careful inquiry in regard to the previous history of these cases. The soldier reported does not seem to have been exposed to cholera; on the 28th, the day before his attack, he ate tainted meat, and about tattoo the same day bathed in a pond of stagnant water ; otherwise his habits had been correct. Of the citizen taken sick the same day, I have no facts to report bearing on the subject— his friends say he had not been exposed. The colored boy above reported left town on the 29th to come to headquarters, which is four miles from Vicksburg ; two cases of cholera are reported to have occurred in the house he left after his leaving. Some twenty cases are reported to have occurred in town, but no new cases have appeared at the post, and I know of none, for several days, in town. The troops have been ordered to driuk no more river water, but cistern water ; their quarters and grounds are in excellent police. Very respectfully, your obedient servant, JOSEPH E. SMITH, Surgeon, and Brevet Colonel, U. S. A., Medical Director Fourth Military District. Brevet Major General J. K. Barnes, Surgeon General. MADISON, AUK. Post of Madison, Ark., September 18, 1867. Colonel : In accordance with instructions received from your office, I have the honor to submit the following report of cholera that prevailed at this post. The first case of cholera of which I had any knowledge was that of a citizen who had been engaged in rafting timber from the upper St. Francis river. He came down the river by raft to Linden, a town eight miles below this, where he was attacked, and died within twenty-four hours, from what was there understood and pronounced by his attendants to be cholera. A relative of his had the body inclosed in a box and conveyed in an open wagon from Linden through the town of Madison to a point farther up the river for burial before his actions could be prevented by the authorities. This man had inclosed his deceased relative in the box, and had accompanied it to Madison, and therertnade application, in person, at the military post, for transporta- tion to take it still further into the country. The commanding officer could not prevent the body being brought to the town, for it was already there; but he ordered it not to stop, and to be taken immediately away by the same conveyance in which it had come, and refused the request for assistance in transporting it. Of the previous history of this case I have no knowledge. I was informed that a number of deaths from cholera had occurred at Linden. According to newspaper and other reports, cholera has existed at, Memphis, Helena, and points on the St. Francis liver, for some weeks prior to its visit to Madison. We have been in weekly communication by boat with these infected places, although I have heard of no death occurring on the vessels engaged in this trade; this, however, can be accounted for by the fact that the great ma.iority of the passengers transported, probably seven-eighths, are local or way passengers, whilst those who travel the whole di.^tance are obliged to be aboard only about two days. I merely state these facts in order to show that there is a possibility, and even a strong probability, that cholera was directly imported either by the body of the Linden subject and his attendants, or by steamboat communication with the places above mentioned. About July 20tl], I was called in the night to nee the wife of a soldier — a laundress — who was suffering from vomiting, cramps, MADISON, AEK. 21 and frequent painless rice-water evacuations, accompanied by considerable prostration. I treated her case as cholera morbus, controlling discharges with astringents and opiates ; vomiting by a sinapism laid over stomach ; prostration by slow and gradual stimulation; and cramps by friction with cloths and hand; thirst, which was intense, was alleviated by pellets of ice allowed to dissolve in the mouth. Under this treatment she rapidly improved, and the extremities, which had given evidence of coldness, soon regained wonted warmth. »»» »* *»*«#» At this time diarrhoea became prevalent to an alarming extent; out of a mean strength of about 75 men, almost one-half were more or less affected, although they did not all report at regular morning "sick call." Preceding this, one or two cases of scurvy had reported for treatment, in consequence of which I had recommended a full supply of vegetables to the whole command. Thinking that probably the unusual quantity of vegetables might account for the unusual number of diarrhoea cases, I again suggested that the amount and kind of vegetable food be diminished; that only those of known healthfulness, as potatoes, onions and ripe berries, be allowed. This change of diet did not, however, produce any material reduction either in the number or obstinacy of diarrhoea cases. If an ordinary dose of castor oil was administered, it often produced a diarrhoea that was almost uncontrollable, and the same applies to other mild cathartics. The administration of Epsom salts, or anything drastic, could not be thought of in any case. Cholera morbus also prevailed ; the attacks could generally be traced to some imprudence or irregularity in diet, or to exposure : they were amenable to treatment. Among the cases of this kind that are worthy of notice is that of Private Comstock, who, in company with Private Gallagher, (\)oth of Company "E," 19th Infanwy,) had deserted their command at Fort Gibson, and after an absence of nearly a month gave themselves up to the commanding officer of this post. These men had been exposed to the deleterious night_air, from which they had no protection, and had fared rather indifferently in the matter of food. Comstock was admitted to the hospital July 20th. His symptons were violent vomiting and purging, which were succeeded by cramps of the abdomen and spasmodic contraction of the muscles of the lower extremities; rice-water discharges from the bowels were frequent and copious, accompanied by prostration; skin was cold; lips blue; discoloration and rings beneath the eyes. This case, as well as the laundress above described, recovered without any untoward event, although it might not probably have been going wide of the truth to have classed them both as gastro-intestinal cases of cholera. The first case of epidemic cholera that occurred was that of Private Jacob H. Amon, teamster. He had been sleeping in an open ambulance, and had, in consequence, been much exposed to miasm, night air, and dew. His personal cleanliness had not been exemplary. On the morning of July 26th, he reported at "sick call" with diarrhoea. A combination of blue mass, opium and acetate of lead, was administered, and he was ordered to report again after a lapse of two hours. He did not report as instructed, thought it a mere diarrhoea that would soon cease without remedy, and, from what I subsequently learned, did nothing throughout the entire day to arrest the disease. In the evening one of his comrades reported him very ill, when he was imme- diately conveyed to hospital for treatment. * * « * jje ,jied from 25 to 30 hours after first reporting sick. The next case was that of Corporal Henry C. Bennett, July 29th, two days after the death of Amon. He was in the performance of his duty as corporal of the guard; at 9 p. m. he reported sick with diarrhoea; medicine was at once given to check the disease, and some was given him to take during the night should his condition demand it. He was relieved from duty on guard, and instructed to go immediately to his quarters and to bed. At 6 a. m., July 27th, he reported no better, and was at once taken into the hospital. This case also tei-minated fatally. •»*«»*, The third fatal case was that of Terrence Gallqgher, Company " E," 19th Infantry, who was one of the deserters from Fort Gibson, elsewhere mentioned. He was admitted to the hospital with remittent fever ; had been suffering from remittent some days before attacked with cholera. Suddenly, on July 30th, vomiting and purging, accompanied with other choleraic symptoms, commenced. He sunk into collapse, and died the following day. ***»»# The fourth case was that of Private Henry Prendergast, who had been an inmate of the hospital from the beginning of the epidemic, and was convalescing from an attack of remittent fever. Owing to the fact that hospital accommodations were limited, cholera patients could not be far removed from others. He had known of the three preceding deaths, and was no doubt mentally depressed thereby. He was attacked with diarrhoea on the evening of July 31st, and died on the morning of August 2d, in less than thirty-six hours from the time of -attack. Of about six other cases that were attacked, and which had progressed so far as to have rice-water vomiting and discharges, but with only slight symptoms of cramp, their recovery seemed to be mainly due to calomel, which was administered in large doses, and repeated until either discharges were checked, or some evidence of constitutional effect of the medicine was observed. Whether these cases would have recovered as well under a different course of treatment, I have no opportunity of knowing. As to the local causes that conjoined to excite the disease, I would state that the camp was situated on an elevated ridge back of the town, and was several huudred feet higher ; that the town and surrounding country are subject to overflow from the St. Francis, Mississippi, and L'Anguille rivers, and during the freshet of last spring were completely submerged ; that the town was and is dirty, owing to the want of proper drainage, stagnant water in ponds, and decaying vegetable matter and garbage, thrown out by the inhabitants and allowed to lie festering in the sun; that low lands and swamps are in the immediate vicinity, and that miasmata must of necessity arise therefrom. The water used was from a well which had been dug by the troops, on a side-hill, protected by embankment around its mouth, to keep debris from being washed into it. Previous to the appearance of cholera the water had a tainted taste. The well was cleaned out, when, among other dirt found in its bottom, were a couple of dead rats. Whether they had anything to do with the production of the disease I cannot say. After the well w.aa cleaned, lime w^s-thrown into it as a purification. The camp and quarters for the men were as clean and comfortable as they could be made. Each tent had a floor, and bowers had been built for protection from the rays of the sun. Fatigue and other duty was suspended during that part of the day when the heat of the sun is most intense ; and-everything that good judgment and prudence on the part of the commanding officer could efliect to preserve the health of the command was enforced. The bread issued was well baked and good, and the ration generally was well prepared. I have a knowledge of ten or twelve citizens in and around the town who died of cholera. The epidemic made its first decided appearance July 26th. On the evening of August 2d we moved camp some four miles from Madison. It is on the 22 EXTRACTS FROM OFFICIAL REPORTS western slope of the' ridge formerly occupied. We have here an excellent spring of pure water. One case in which cholera symptoms were prominent has occurred since the change : it yielded to treatment, however, and the man is now well. Very respectfully, your obedient servant, J.B.DOWNEY, Acting Assistant Surgeon, U. S. A. Brevet Lieutenant Colonel C. C. Byrnb, Surgeon, U. S. Army, Surgeon-in- Chief Sub-district of Arkansas. Extract from Monthly Report of Side and Wounded, Gomipany " C," 19th V. S. Infantry, Madison, St. Francis County, Arkansas, July, 1867. J. B. Downey, Acting Assistant Surgeon, U. S. A. With reference to the cholera which made its appearance at this post July 26th, and of which there are three deaths recorded on the report, I would state that the camp at Madison I considered to be in good sanitary, condition. It was situated on an elevated ridge immediately back of the town, and was considerably higher than either the town or surrounding country. The citizens, however, consider the eastern slope of the ridge more unhealthy than the western. The two first cases that occurred were purely epidemic cholera. They died within twenty-four hours after being attacked. Two other deaths that occurred were cases of cholera supervening on the debility which follows remittent fever. The stimulant plan of treatment was a failure. Of a number of cases that were attacked, but which did not result in death, it seemed that if the secretions could be once unlocked by the influence of mercurials, the discharges were controlled. Of the cases that died, the symptoms were violent and uncontrollable; vomiting and purging ; cramps in body and limbs; shriveled, shrunken, and dark-colored skin; hands and fingers looking as if they had been soaked in water; extremities cold from the beginning; pulse weak and slow; involuntary discharges from the bowels which were frequent — rice-water, or watery with ttocculent masses floating in the liquid ; eyes sunken ; conjunctiva dry and dirty ; insatiable thirst, and cold breath and death. NEWPORT BARRACKS, KENTUCKY. Newport Barracks, Kt., July 3, 1867. Sir : I have the honor to transmit herewith my monthly report of sick and wounded at this post during the month of June 1867; also the special report upon epidemic cholera required by Circular No. 3, dated Surgeon General's Office, April 20, 1867. Although diahrroea and dysentery have been quite prevalent during the latter part of the month, but two cases of cholera have occurred. This disease was distinctly marked in its stages, but proved of mild type, terminating favorably. The treat- ment pursued was practically the same as that adopted by Surgeon J. B. Brown, at Fort Columbus, last year. In reference to the origin of cholera, whatever may be said of overcrowding as a direct agent in the production of the disease, it certainly presents the most favorable conditions for the inception and spread of the poison. Neither of the men attacked were exposed directly to the contagion so far as I have been able to learn. Cases are said to have occurred both in Cincinnati, Ohio, and Covington, Ky., a few days before these men were taken sick. Private William Anderson, a prisoner, joined from desertion, February 7, 1867, and has not been away from the post. The other recruit, Thomas Piper, general service, joined June 20, 1867, from Quinoy, Illinois. The guard-house, from whence the first case came, is occupied by seventy-one prisoners, forty-three of whom belong to regiments. These men are all confined for grave ofiences — a few under charges, the others undergoing punishment. The three rooms now occupied by the prisoners contain but eleven thousand seven hundred and ninety-one cubic feet of air space and are arranged according to the enclosed plan.* The police of the prison and the personal cleanliness of the prisoners may be con- sidered faultless. I have frequently called attention to the crowded condition of this guard-house, suggesting means of ventila- tion, and that additional rooms be given for the use of the prisoners. My suggestions have been approved and carried out to the extent of the means in the power of the commanding officer. Representations were made to the authorities sending prisoners from organized regiments to this post, setting forth the want of capacity in the guard-house to accommodate them with safety to tbe health of the troops at this depot, but the evil continues. Estimates were also made for the enlargement of the prison, but they failed to meet with approval. I deem this a subject worthy the attention of the general commanding, and would respect- fully recommend that either the forty-three prisoners, from organized regiments, confined here, be sent elsewhere, or that the prison be enlarged without delay. Enclosed I send you a copy of a communication recently addressed to the commanding officer on this subject. The second case, that of Recruit Thomas Piper, general service, occurred in the recruit barracks. There are but four rooms assignable as dormitories for enlisted men at this depot; the dimensions of these are as follows, viz : two 83 feet 6 in. X 28 feet X 12 feet each; two, 58 feet 8 in. X 28 feet X 12 feet. Three of these rooms are occupied by the permanent party, which con- sists, with the field musicians, of two hundred and thirty-five men. On the 30th ult., two hundred and seventy men nominally occupied the fourth and only room assignable for recruits. This room has a capacity of 83 feet Bin. x 28 feet X 12, thus giving 103 cubic feet to each man. * Not £iubli8hcd in this report. NEWPORT BARRACKS — JEFFERSON BARRACKS. 23 I say nominally occupied, because the men are out drilling an3 for other purposes during the day, Smd at night they can occupy four porches, the length of the building, in addition to their proper quarters. * This want of proper barracks accommodation was pointed out to one of the assistant inspectors general, and to the super- intendent of the recruiting service last summer. The most unremitting attention has been given to general police and to the personal cleanliness of the men. The drinking water, which is brought from the Ohio river, has been freed from all impurities by the addition of permanganate of potassa. As a measure of further precaution, I have recommended that camp equipage for two hundred men be provided and kept on hand, so that at any time when the health of the command appears to suffer from Overcrowding, a part may be sent into camp on one of the hills in the neighborhood.. Very respectfully, your obedient servant, G. PERIN, Surgeon, and Brevet Lieutenant Colonel, U. S. A. Brevet Major General J. K. Barnes, Surgeon General. Newport Barracks, Ky., September 3, 1867. Sir : I have the honor to enclose herewith the special report of cholera patients at this post during the month ending August 31, 1867. The recruit, Allen Burton, V. R. C, was received at this post July 30th from the rendezvous at Evansville, Indiana. The day previous to his admission to hospital he was suffering from diarrhoea and came for medicine; having taken a dose of Squibb's mixture, he was directed to return if the diarrhoea continued. He went on guard, paid no attention to the direction given him, but ate the rations of two men in company kitchen; his diarrhoea continued, and the next morning as I passed' by his post I observed him vomiting. He was immediately relieved from guard and placed in bed, but it was too late. The treatment was the same as previously reported. He died 32 hours after admission to the hospital. Very respectfully, your obedient servant, G. PERIN, Surgeon, and Brevet Lieutenant Colonel, TJ. S. A. Brevet Major General J. K. Barnes, §urgeon General. JEFFERSOIV BARRACKS, MO. jBFifERSON Barracks, Mo., July 16, 1867. General : I have the honor to report the following case, which I consider modified cholera asphyxia : At 5.45 o'clock this morning I was called to the hospital to see Private Jones, of the Engineer Battalion, who had been conveyed there sick. I found him almost pulseless; eyes sunken, nails blue, and skin cyanosed. He had been vomiting and purging some time, and now his dejections were nearly colorless. He was suffering from cramps, and two men were employed rubbing his extremities. Sinapisms had been placed to his wrists, ankles, and abdomen. I immediately applied a compress firmly to his stomach, and gave him 20 drops each of tincture of chloroform and tincture of opium. This was at once ejected, and with such force and in such quantity as to cover my clothing, standing at the time three feet from the patient. I now gave him 20 drops each of tincture of chloroform and tincture of capsicum, and followed this prescription with 10 grains each of calomel and quinine and 2 grains of opium, which was retained after considerable efforts at ejection. At the end of fifteen minutes his pulse could be counted, and was found to be 138, while his respiration was 26, hurried and difficult. At 6.30 some improvement was plainly indicated, both in his pulse and his respiration, and an hour later the former was reduced to 120 and the latter to 22; vomiting and purging had ceased, and his tongue was moist and clean. I now allowed the patient to melt small pieces of ice in his mouth to allay in some degree his parching thirst. After waiting some time for another patient to be brought to this hospital who had been reported to me as similarly affected, (not, however, arriving,) I went to see a patient at the laundry building, and, returning to the hospital at 9 o'clock, found Jones much the same as when I left him. I now ordered for him blue mass and sulphate of quinine, 10 grains each. At a subseq ent visit at midday, his pulse still 120 and respiration 21, I repeated this latter prescription, and allowed him, in addition to ice, a cold infusion of tea, his thirst being distressing. On my visit at 3 p. m. reaction was well established; pulse full, at 120, respiration 19; extremities warm and tongue furred: removed the compress from the abdomen. Private Jones is a strong and rather muscularly developed man, of temperate habits, unmarried, and aged 20 years and 10 months. Had taken for £ od the day previous, bread and coffee for breakfast and supper, and pork, cabbage, and bread for dinner. The day previous his diet had been much the same, at which time he suffered from a slight diarrhoea, which he did not think required any attention. Yesterday was fair, after a heavy rain the night previous, and the thermometer indicated 85° at 3 p. m. Last night was unusually cool; thermometer 58°, and 70° this morning at 8 o'clock, with a light breeze from the northeast. Dr. Culbertsou, Assistant Surgeon, United States Army, on duty at this post, attended an aggravated case of cholera morbus yesterday, and we have had two cases in hospital with the same disease to-day, both doing well. 24 EXTRACTS FROM OFFICIAL REPORTS If we are to consider this a case clearly of Asiatic cholera, I can only attribute its origin to emanation from last year's deposits from this disease. The police of this post is bad, and its sanitary condition not good, though improving. Very respectfully, &c., EBN. SWIFT, Surgeon, and Brevet Colonel, Xf. S. A. Brevet Brigadier General M. Mills, Medical Director, Department of Missouri. Jefferson Barracks, Mo., July 17, 1867. General : I have the honor to report, in the case of Private Jones, well-established convalescence. At 9 o'clock this morning he had a free discharge of urine, which had been suppressed 29 hours; and at 3 o'clock this p. m. his thirst is greatly diminished, feels comfortable, and has had a natural evacuation of his bowels. His respiration is good, and his pulse full, strong, and 84. Prescribed rest and a milk diet. At noon to-day I was called to see the child of a laborer employed in the soldiers' cemetery at this post. I was not at my quarters when the messenger arrived. I saw the child at 12.45 p. m. He had died about 20 minutes before. His limbs were cold and his chest warm; his features compressed, and his eyes deeply sunk. While getting the history of the case, the right shoulder was observed to raise and the arm to move. Some bystander remarked, "He is alive!" I immediately placed my hand over the region of the heart, and for a moment was myself deceived, so great was the motion observed in the chest. Three or four pulsations were imitated, and the ribs moved under my hand. Some fruitless eiforts at resuscitation soon convinced me the spark of life had fled. Would the electric fluid recall it in these cases, not uncommon, of sudden deaths? Tliis boy, John Keevans, aged 12 years and four months, was of slight frame, though well developed in body and limbs. Had generally been healthy. Yesterday he was employed at some light work, errands, etc., in a family of the garrison. He had taken bread, meat, coifee, and molasses at breakfast and supper, but had eaten no dinner at home or anywhere else, so far as I could learn. During the night, towards moraing, his mother knew of his leaving his bed and room; that he was sick and vomited. At 6 and at 7 his bowels were purged; also at 9 and 11. These latter motions, not copious, were frothy and whiteish. He now complained of excessive thirst, and had cramps in his legs. Previous to this his mother thought his sickness did not "signify anything;" he had had something like it a year ago in Illinois. This was in reply to my inquiry why she did not send for me sooner. .^ From such history of this case as I have been able to collect, its sudden fatal termination from apparently insufficient evacuations, I am constrained to look upon it as one of cholera asphyxia not unlike that of Private Jones, reported yesterday. This boy's father was attacked with cholera morbus yesterday, and Dr. Culbertson gave him calomel, rhubarb, and morphia, and to-day he is able to be about the house. Also, Pat McBride, laborer in the cemeteiy, and John O'Jfeil, ambulance driver, took the same complaint during last night. These are doing well. Very respectfully, &c., EBN. SWIFT, Surgeon, and Brevet Colonel, U. S. A. Brevet Brigadier General M. Mills, Medical Director, Department of Missouri. Jefferson Barracks, Mo., July 17, 1867. Sir: I desire respectfully to call your attention to the urgent necessity of having a large detail from your command employed in removing the rank vegetable growth of grass, weeds, etc., about the quarters occupied by the men under your charge, to permit the sunlight and heat to exercise its sanitary influence upon the surface of the ground.. They should disinfect all slop vessels, drains, privies, etc., by means of chloride of lime or zinc, sulphate of iron, or carbolic acid. Strict cleanliness should be enforced in dormitories, kitchens, etc., and the former should be fumigated with fumes of burning sulphur. Care should be observed, in the preparation of food, that meats and vegetables are thoroughly cooked. Since the spring at the quarry, from its location, may receive the sub-surface drainage of the cemetery, I must recommend that its use be at once discontinued by all. No disinterments at the cemetery should be made for the present. The unfortunate family which lost one of its members by cholera to-day should be furnished with other quarters, and those now occupied by them should be thoroughly cleansed and disinfected. Respectfully, &c., EBN. SWIFT, Surgeon, and Brevet Colonel, U, S. J. F. W. Cooper, in charge of Cemetery. JEFFERSON BARRACKS, MO. 25 Jeffersost Babkacks, Mo., July 18, 1867. General : I have the honor to report continued convalescence on the part of Private Jones. At 12 o'clock last night I was called to see Henry Hardy, employ^ of the quartermaster's department, at work getting out rook in the quarry for the cemetery. Found Wm suflfering exceedingly from cramps in the legs, thighs, and abdomen. Three men were industriously employed in rubbing him. His complaints were loud and constant, his pulse feeble and 108, and his respiration hurried. Had him immediately conveyed to a ward in the hospital, about one hundred yards distant, and gave him tincture of chloroform, twenty drops, tincture of opium and tincture of capsicum, each fifteen drops, and applied a large mus- tard plaster to his abdomen. This movement of the patient did not occupy more than ten minutes, and did not seemingly exhaust him, yet his pulse went up to one hundred and eighteen. Vomited little, but purged excessively. His evacuations were tinged with bile, and fojcal in character ; the first more so than the succeeding. Gave him of calomel and quinine each ten grains, and sulphate of morphia half a grain. Removed mustard and placed a compress firmly to his abdomen. At 1 o'clock I repeated the chloroform mixture previously given, which succeeded in arresting the cramps. At 2 o'clock I left the patient quite comfortable. I saw him at 6 this morning, and gave him blue mass and quinine, of each ten grains; which I ordered to be repeated at 10 o'clock, should there be no evacuation of the bowels. At 11 o'clock, his pulse being still feeble and 120, 1 gave him a milk punch, which seemed to establish complete reaction, and at 3 this p. m. his pulse is full, strong, and 100. I can only consider this case as exaggerated cholera morbus. The excretions were not at any time quite destitute of bile, but from the severity of the symptoms I feared the result. This case occurred in the dormitories near the rooms occupied by tlie family whose son died suddenly yesterday. Very respectfully, EBN. SWIFT, Surgeon, and Brevet Colonel,-!/. S.A. Brevet Brigadier General M. Mills, Medical Director, Department of Missouri. Extract from Monthly Report of Sicle and Wounded of Company " E," United States Engineers, Jefferson Barracks, Mo., Septem,- ber, 1867. -ff. Culbertson, Assistant Surgeon, U. S. A. As cholera has been prevailing at St. Louis, ahd so near to this post, the following sanitary measures were adopted here : The disinfection of all sewers, drains, vaults, and latrines, with a saturated solution of sulphate of iron, and also with chloride of lime, and the placing of the latter salt in the quarters of the men ; thorough ventilation and cleansing of the quarters, and policjng of the grounds; frequent airing of the bedding of the men; the proper cooking of the food, and the inter- diction of all fruits and vegetables ; the use of river water purified with alum ; the disinfection of the clothing and discharges of all patients in hospital who have diarrhcea or cholera morbus ; and the removal of the dejections at once, and the frequent disin- fection of the hospital with burning sulphur; also with chlorine. In addition, the men were enjoined to report at once for. treatment so soon as they have diarrhoea; aiyi, further, to cut off as much as possible malarial diseases, or the debilitating effects of miasmatic agencies, reveille is called at seven o'clock a. m. each day, and the men are enjoined to keep within their quarters after sunset. No cases of cholera have occurred at this post during the month. We have been employing subcutaneous injections of sulphate of morphia in acute dysentery (introduced an inch from the margin of the anus) with excellent results. This plan of treatment was accompanied with the exhibition of sulphate of magnesia, quinine, or aromatic sulphuric acid, and was used when the ordinary injections failed. It aided materially the action of the other agents mentioned. Jefferson Barracks, Mo., December l2, 1867. General : I have the honor to report for your information the following circumstances connected with the outbreak of cholera at .this post in the month of October last: On the evening of October 26th, two companies, "G" and "H," 125th Colored Infantry, arrived at Jefierson Barracks for muster out of the service of the United States. They had left Fort Bliss, Texas, a few weeks previously, marching across the plains to Fort Harker, whence they had come by railroad through St. Louis to this place. During the whole journey they had enjoyed excellent health. They numbered four ofBcers and one hundred and fourteen soldiers. Several families also accom- panied the command. They were assigned to' quarters in the south row of buildings constituting Jefferson Barracks. At sick call on the 27th of October, two soldiers of this command appeared; one of them suffered from bronchitis, and one from chronic dysentery. On the 28th three cases of cholera occurred which proved fatal within 24 hours. On the 29th, seven cases appeared ; on the 30th, two ; on the 31et, one ; and on November 1st, two. No other cases occurred among the troops. Of this number, six died, as follows : on the 29th, three ; on the 30th, two ; and November 1st, one. The command was mustered out of service and left the post Novembei' 1st. 4 26 EXTRACTS FROM OFFICIAL REPORTS. All the above-mentioned fifteen were well-marked cases of epidemic cholera, characterized by frequent and profuse rice- water evacuations, cramps principally in the extremities, and more especially in the legs, more or less complete colapse, mental clearness and unconcern, and, in nearly all the cases, vomiting. In every case but one, the patients stated that diarrhoea had existed from 24 to 48 hours before I saw them, but that they neglected to come to the doctor, because they did not want to take medicine, or be put on diet, or detained in hospital while their comrades were mustered out and going home. During this same period of time twenty-eight cases of diarrhoea occurred among the men of these two companies, all of which yielded to Squibb's mixture in drachm doses, or sulphate of morphia in half-grain doses, repeated pro re nata. Outside of the colored command no cases of cholera occurred ; nor did diarrhoea increase or prevail among the other resi- dents of the post, who consisted of a company of engineer troops about one hundred and forty strong, of a gang of workmen in the national cemetery, about eighty strong, and of a number of families of oiEcers, soldiers, and citizens. The first two cases were seen by me about 10 a. m., October 28th, and were at once diagnosed as cholera. The third case was seen about 3 p. m. All three of these cases occurred in Company "G." I proceeded at once to inspect these companies in their quarters, especially the company in which sickness existed. Both companies occupied similar quarters, which were clean and well ventilated. Company " G," however, was larger than Company " H," and hence more crowded in quarters, so that I at once caused additional rooms to be assigned to this company, into which they moved on the evening of the same day, the 28th. All the quarters occupied by these companies had been for some months vacant. I caused them to be policed, and had big fires made in the fireplaces. The food of the command consisted of soldi'ers' rations, and seemed good, and well cooked. The whole command strenuously denied having eaten anything but their ordinary food, save once in a while a man acknowledged to have eaten a single apple or a few hickory nuts. The water used was that of the Mississippi river, the same used by the other occupants of the barracks. This water was forced by a steam engine and pump from the river into large iron reservoirs in a covered building, whence it was distributed by iron pipes to hydrants throughout the post. None of the command had seen a case of cholera, or been exposed to one that they knew of In coming to this place they passed through the city of St. Louis, where cases of cholera were said to be daily occurring. No delay occurred in taking steps calculated to check the progress of the disease ; and first and foremost, I deemed it neces- sary to change the water used. For this purpose many barrels of water were drawn from the hydrants, and were disinfected by the addition of Bowers' solution of permanganate of potash in quantity sufficient to color the water perceptibly. Directions were given to use no other water but that thus disinfected, and to use that for the present sparingly, and principally in coffee. The men were also periodically questioned by their officers concerning the existence of diarrhoea, upon the first appearance of which they were directed to report to me without delay. The use of easily digestible food was directed, and temperance in that. I farther recommended that the hea' thy men should be kept occupied, and they were kept almost constantly busy at various work about the post. As the remainder of the 125th Regiment was ordered to this post for muster-out, and were hourly expected, I wrote to the headquarters Military Division of the Missouri, reporting the appearance of cholera, and recommending that no more troops be sent here until ^e disease disappeared. This recommendation was carried out. As the disease first appeared in Company " G," so did that company also suffer most during the! epidemic. Thus, of the fifteen cases reported, nine occurred in Company "G," with four deaths, while in Company "H" there were six cases, with two deaths. This I attribute to the greater crowding in quarters of the first-mentioned company, as I found no other appreciable difference in the circumstances or surroundings of the two companies. The medical treatment consisted in the use of sulphate of morphia and Squibb's mixture in the first stage of the disease, followed by whiskey and chloroform in the stage of collapse. Frictions, sinapisms, and bottles of hot water to the abdomen and extremities, and essence of beef, tea and toast, as soon as the patient could retain them. One case of cholera occurred in addition to the fifteen above mentioned; this was in the person of the wife of one of the officers of the 125th colored infantry, who was attacked on the 29th and recovered under the above-named treatment. Thus, in all, occurred twenty-eight cases of diarrhoea, and sixteen of cholera. Of the latter, six, or 37.5 per cent. died. In the six fatal cases, death occurred in one case in 16 hours ; in one case in 22 hours ; in one case in 23 hours ; in one case in 24 hours ; in one case in 26 hours ; and in one case in 31 hours. This time is reckoned from the hour that the cases first presented themselves to me. Previous to October 28th the weather had been warm. On this day it became cooler. On the night of the 28th there was a slight frost, and on the night of the 29th a heavy frost. Tliis change of temperature may have aided the measures above related in cutting short the duration of the epidemic. The abatement certainly followed promptly the disuse of unpurified water; and I am satisfied, under all the cir- cumstances, that this outbreak of cholera was caused by the change of habit of these soldiers from their out-of-door camp life in marching across the plains to life in somewhat crowded quarters, and to change in drink from the pure clear water of the moun- tains and prairie streams to the impure turbid wnter of the Mississippi. Very respectfully, your obedient servant, JOSEPH R. SMITH, Surgeon, and Brevet Colonel, U. S. A. Brevet Major General J. K. Barnes, Surgeon General. FOKT RILEY, KANSA.S. 27 FORT RIKiElf, KANSAS. FOKT EiLEY, June 22, 1867. Sir : In view of the fact that cholera in an epidemic form visited this station last smnmer, and that the warm season may bring with it a return of the disease, I respectfully suggest, for the consideration of the post commander, the necessity of instituting and maintaining, during the summer and autumn, a thorough system of hygienic police, which should be rigidly enforced throughout the garrison and its vicinity. I would suggest the propriety of having all the latrines and water-closets cleansed, whitewashed, and ventilated. Twice each week quicklime should be freely distributed in the sinks, and one quart of vinegar should be thrown into each sink in use twice a week, while there is any tendency to a return of the disease. The quarters of the enlisted men and civil employds should be kept scrupulously clean, frequently whitewashed, and all refuse garbage and eifete matter promptly removed to a distance. Slop barrels should be provided for the use of kitchens, and all persons held to a strict accountability for the cleanliness of their premises. A general police of the garrison should be made at least once a week. Very respectfully, your obedient servant, B. J. D. lEWIN, Surgeon, and Brevet Lieutenant Colonel, U. S. A. Brevet Captain C. N. Warner, ith T7. S. Artillery, Post Adjutant, Fort Biley, Kansas. [Post Order No. 7.] Headquarters, Fort Eiley, June 24, 1867. I. Upon recommendation of Brevet Lieutenant Colonel B. J. D. Irwin, U. S. A., Post Surgeon, and in view of the fact that cholera in an epidemic form visited this post last summer, a thorough system of hygienic police will at once be instituted throughout the whole garrison and its vicinity, and will be rigidly enforced during the summer and early autumn months. II. All the latrines and water-closets of the post will be cleansed, whitewashed, and provided with ventilators — the latter to extend from the vaults to about twelve inches above the roof, and to be six inches square in the clear. Twice each week — namely, on Tuesdays and Saturdays — quicklime will be freely distributed in the sinks, and one quart of vinegar will be thrown into each sink in use on such days. The quarters of the enlisted men and civil employes will be kept scrupulously clean, whitewashed, and all refuse garbage and other offensive matter will be promptly removed to a safe distance. Slop barrels will be provided for the kitchens, and all persons will be held to a strict accountability for the sanitary condition of the premises occupied by them. A general police of the post will be made on Saturday of each week. By order of Brevet Lieutenant Colonel C. C. PAESONS. C. N. WAENEE, First Lieut, ith U. S. Artillery, Brevet Captain, U. S. A., Post Adjutant, Extract from Special Report of Cholera Patients at Fort Biley, Kansas, June, 1867. Brevet Lieutenant Colonel B. J. D. Irwin, Surgeon, TJ. S. A. Thomas Cafflen, age 25, employ^ of the quartermaster's department, attacked June 22d, and died the same day. Admitted to hcspital June 18th with an attack of diarrhoea, which yielded readily to treatment consisting of 1 grain of camphor, ^ a grain of capsicum, and J of a grain of opium. At the morning visit on the 22d he showed symptoms of cholera : cold surface of body ; eyes sunken ; voice husky ; tongue cold ; has had three serous stools during the latter part of the night, and vomited twice. Sinapisms over epigastrium and to the calves of the legs ; hot water to feet ; aromatic spirits of ammonia and Hoffman's anodyne, twenty drops each, were given, with toddy every half hour. 11 o'clock, cramps severe in lower limbs ; administered chloro- form, one fluid drachm internally, which gave prompt relief. Complete collapse. Died at 1 o'clock p. m. Post mortem examination : ,Age 25 ; dark hair, blue eyes ; about five feet seven inches high, and 130 pounds weight. Eighteen hours after death, rigor mortis well marked ; upper surface of intestines blanched ; lower congested, with distinct erosion of mucus surface in small patches ; contents wheylike fluid devoid of feculent characteristics ; bladder empty and strongly con- tracted; kidney highly congested; the small quantity of urine turbid and peculiar; liver small, about 2i pounds; friable, serous covering removed with ease. 28 EXTRACTS FKOM OFFICIAL REPORTS. Extract ■from Special Report of Cholera Patients at Fort Miley, Kansas, July, 1867. Brevet Lieutenant Colonel B. J. D. Irwin, Surgeon, U. S. A, Peter Kehoe, Irish, aige 30; attacked July 11, 1867, and died the same day. This patient was an employ^ in the service of the Union Pacific Railroad Company, Eastern Division. Himself and vvfife lived on a construction train, keeping a mess for the other employfis of that train. On the 9th they visited the vicinity of Fort Barker, Kansas, where cholera was then epidemic. The train returned on the morning of the 11th. I saw him at about 4 o'clock p. m., and found him rapidly running into the collapsed stage of epidemic cholera, from which he died in about an hour afterwards. Extract from Case, Diet, and Prescription Booh, Fort Riley, Kansas. Brevet Major G. M. Sternberg, Assistant Surgeon, U: S. A. Henry Gorns, Recruit, 10th United States Cavalry, arrived at the post November 11th, from Vincennes, Indiana, via Saint Louis ; was taken sick with diarrhoja at St. Louis ; had no treatment until he was brought to the hospital on the morning of November 13th; had been purging and vomiting, and had cramps in his legs all night; no one took pains to inform the post surgeon of his condition. When first seen he was in a state of partial collapse, but still able to stand up; pulse very feeble; extremities cold ; fingers shriveled in appearance ; voice husky and weak, and tongue cold ; had but one rice-water discharge after being admitted to hospital ; vomited several times, but the vomiting was no longer severe, and but little was ejected besides the water he di-ank. Administered ten grains of calomel, and applied tin warmers to abdomen and feet ; gave brandy and water, each one fluid drachm every ten minutes. .November 13th, 3 p. m: has rallied considerably; pulse stronger; tongue and extremities warmer; brandy has been well borne and reaction is fairly established ; had several copious watery passages of a light greenish color during the day; vomited several times, ejecting nothing but a little water; had cramps in his legs. To have beef essence, a tablespoonful every half hour; daring the night sinapisms to the calves of the legs and to abdomen; brandy continued during the night, about every half hour, in drachm doses. November 14th, 9 am: pulse quite full; surface warm; had two or three passages during the day — not so copious, and containing some foecal matter. Brandy discontinued; chicken broth ad libitum, there being no beef essence. November 14th, 1 p. m: since brandy was discontinued, pulse has become weaker; resume brandy every half hour. November 15th, 9 a. m : vomiting and diarrhoea has entirely ceased; continue treatment. November 16th, 9 a. m: continues to improve; beef essence ad libitum ; to have sherry wine, an ounce and a half three times a day. November 17th, 9 a. m : still improving ; continue treatment. November 18th, 9 a. m: still improving; no passage since the evening of the 16th; continue treatment, and to have castor oil, half an ounce, and 15 drops of tincture of opium; oil operated at 6.30 a. m. Returned to duty November 25th. FOKT IIARKER, KANSAS. Extract from Monthly Report of Sich and Wounded, Companies "A," " B," and " G," With Infantry, Fort Marker, Kansas, June, 1867. Brevet Major Geo. M. Sternberg, Assistant Surgeon, U. S. A. At 3 o'clock a. m., June 28th, Acting Assistant Surgeon Perry, U. S. A., was called in haste to see George W. Keeton, a citizen employed by the beef contractor as a herder and butcher. The man was found in a state of profound collapse, with all the symptoms of epidemic cholera, (cramps, rice-water discharges from stomach and bowels, shriveled appearance of the fingers, coldness of extremities, &c., &c.) The patient died at 3.30 p. m. the same day. He had been suffering from diar- rhaja for two days. At 7 p. m. the same day. Private George Groom, Company " H," 38th Infantry, was sent to hospital by Assistant Surgeon Ely McClellan, U. S. A. (This soldier's company is temporarily at the post en route fvom Jefferson Barracks, Missouri, to New Mexico.) The patient had all the symptoms of cholera, and was in a state of collapse when admitted. He died at 11 a. m., June 29th. William Jackson, Company " G," 38th Infantry, was sent to hospital, by Assistant Surgeon McClellan, at 9 a. m., June 30th, and died at noon, July 1st; an unmistakable case of cholera. Tony Powell, Company "B," 38th Infantry, was admitted at 6 p. m., June 29th, in a state of collapse from cholera. Treated with chloroform in drachm doses. July 2d, is considered out of danger. A child of George Irwin (quartermaster's employ^) was taken sick with cholera at 2 p. m., June 29th. His wife was taken at 10 a. m. the same day, and himself at '2 p. m., June 30th. The wife and child died at 5 p. m. on the 30th ; the man is now (July 2d) in a fair way of recovery, but not yet out of danger. Wm. Edwax'ds, quartermaster's employe, taken sick at 6 p. m., June 30th ; died at noon, July 1st. G. H. Arnold, taken sick at 3 p. m., June 30frh ; July 2d, is doing well. FOET HAEKEE, KANSAS. 29 In addition to the above cases, three cases occurred this morning (July 2d) among the quartermaster's employes — one has already proved fatal — hut I have not yet had the opportunity to get the names from Acting Assistant Surgeon Chase, U. S. A., who is attending them. No cases have as yet occurred in the garrison proper. George Keeton lived in a dug-out (hole in a hank) about a mile and a half from the post, near the slaughter-pen on the banks of the Smoky Hill river. The soldiers of the 38th Infantry, reported above, are recently from Jefferson Barracks, Missouri. They are encamped three-quarters of a mile from the post, and over half a milefrom where the first case occurred. George Irwin and family lived in a dug-out in the banks of a creek one-quarter of a mile from the post. He says they sometimes drank the creek water, (stagnant nearly,) and had been eating wild gooseberries stewed. The men, Arnold and Edwards, had recently come from Fort Eiley, and were in camp on the creek bottom not far from Irwin's dug-out. The death reported to-day is at the stone quarry, over two miles northeast from the post. The wind has been blowing .steadily but gently from the south for several days. The days have been warm and oppressive ; the nights cool and comfortable ; the mornings misty. We have had for some time very poor bread at the post; it is often sour and heavy. I have recommended the issue of hard bread in the place of the bread from the post bakery. I made a thorough sanitary inspection of the post on Silnday, June 30th, and all my recommendations in regard to policing have been carried out by the post commander. The camps of the companies of the 38th Infantry have been moved to higher and better grounds. The old sinks have been filled up and new ones dug. A hospital tent has been pitched for the sick in the quarters of each company. The cases received into the post hospital have been treated in a hospital tent pitched 50 yards in the rear of the hospital. Disinfectants are freely used, and requisition has been made for more. Report on Epidemic Cholera at Fort Barker, Kansas, during the summer of 1867, iy Brevet Major G. M. Sternberg, Assistant Surgeon, U. S. A. Fort Harker, Kansas, is located on high ground, about a mile east of the Smoky Hill river, at the junction of the Smoky Hill road to Denver city and the road to Santa Fd, via Fort Zarah and the Arkansas Eiver route. It is eighty-five miles west of Fort Eiley, and since the 10th of July has been in railroad communication with the east by the completion, thus far, of the Union Pacific Eailroad, Eastern Division. The elevation above the bed of the river is from sixty to seventy feet ; the surface descends to the east, south, and west, afibrding excellent drainage. The soil is. but six or eight inches thick, and below it is a bed of fine gravel, about thirty feet thick, composed mostly of quartz and flint ; below this is a bed of clay. The bluffs to the north and east of the fort are composed of a recent red sandstone, which contains impressions of the leaves of trees of existing species, (oak, ash, willow, &c.) In places there is a large amount of iron in the sandstone. The water used at the post is obtained from a spring in the bank of a creek one-quarter of a mile west from the post. The spring issues from the bank about fifteen feet above the level of the creek, over the stratum of clay, above which is the gravel. An examination of the water from the spring, made in July, 1867, showed but a small trace of organic matter. One grain of per- maugante of potash to a gallon left a distinct pinkish tinge after 24 hours. During the past year diarrhoea has been of rare occurrence among those who have been at the post for any length of time. During the month of June, 1867, but twelve cases of diarrhoea are reported. A company of the 37th Infantry ( "E" ) came to the fort in October, 1866, from Little Eock, Arkansas. Very many of the men were suffering from diarrhoea, and nearly every one from intermittent fever. After being at the post five or six months, nearly every man in the company became healthy and robust, and diarrhoea among them' of rare occurrence. But two men of this company died of cholera. The garrison of the post, when cholera first made its appearance, consisted of Company "E," 37th Infantry, (white,) and Companies "A," " B," and "K," 38th U. S. Infantry, (colored.) The companies of the 38th Infantry had been recently organized at Jefferson Barracks, and came from there here, "A" and " B" Companies stopping a little more than a month at Fort Eiley on their way. In addition to these troops, "H" Company, 38th Infantry, and "F" Company, 10th Cavalry, (colored,) were temporarily at the post under the medical supervision of Brevet Major Ely MeClellan, Assistant Surgeon, U. S. A. The troops (with the exception of "E" Company, 37th Infantry, which was in a stockade building) were in camp at a distance of from one-eighth to half a mile from the post, on high ground. Four companies of Kansas militia were mustered into the United States service, and remained at the post about two weeks in July, during the worst of the epidemic. There were also encamped at and around the post from five hundred to eight hundred quartermaster's employes, (masons, carpenters, laborers, and teamsters.) The number of these was constantly varying, many- leaving in consequence of the epidemic, and others coming from the east. _ The police of the camps was not good when cholera first made its appearance. Some of the company sinks were in wretched condition, and there were several offensive holes about the post where slops and garbage from the kitchen had been thrown. Measures were at once taken to remedy these evils ; a strict system of policing was inaugurated ; the camps were all moved to new grounds, and disinfectants were procured and freely used. The men were in wedge tents, from two to four in a tent. On my recommendation a hospital tent was pitched for the use of the sick in the quarters of each company, (for slight cases of diarrhoea, etc.) The hospital patients were all treated in hospital tents, which were pitched about fifty yards in rear of the post hospital. Convalescent and uncertain cases were kept in separate tents from the cholera patients. The discharges from the patients were all disinfected as soon as passed. The first case of cholera in Lhis neighborhood, and, so far as I can learn, the first case this year in the State of Kansas, was that of Geo. W. Keeton, a citizen employed by the beef contractor as a herder and butcher. He had been so employed for three 30 EXTRACTS FROM OFFICIAL REPORTS. weeks, previously to which time he worked in the mess-house of the quartermaster's employes. He was first seen by Acting Assistant Surgeon Perry, U. S. A., at 3 o'clock a,, m., June 28th ; was found in a state of collapse ; had rice-water discharges from stomach and bowels; cramps and shriveled appearance of fingers ; had been suffering from diarrhoea for two days, but had not applied for treatment. The patient died at 3. 30 p. m. the same day. This man lived in a dug-out (hole in the bank) near the slaughter-pen, at a distance of a mile from the post or any camp. At 7 p. m. the same day Private George Groom, Company "H," was sent to the post hospital by Assistant Surgeon E. McClellan ; was in a state of collapse when admitted, with all the symptoms of cholera. Died at 11 a. m., June 29th. A child of Geo. Irwin, quartermaster's employ^, was taken sick with cholera at 10 o'clock a. m., June 29th ; his wife at 12 m. same day, and himself at 2 p. m., June 30th. The man recovered ; the wife and child died on the 30th. This family lived in a dug-out in the bank of the creek running near the post, (not far from the spring.) They were over half a mile from either of the other cases. They had drank the creek water. Tony Powell, Company "B," 38th Infantry, admitted to hospital at 6 p. m., June 29tb. Recovering. • The following is a record of cases and deaths occurring among the troops at the post under my supervision : Date. No. of cases. No. of deaths. Date. No. of cases.^ No. of deaths. Date. No. of cases. No. of deaths. June 28th 1 1 1 1 1 July 10th" 1 1 1 4 3 2 1 6 1 2 1 1 6 3 July 22d " 29th.. " nth " 12th " 23d 1 2 " 30th " 24th July 1st " 13th " 25th 1 " 2d " 14th - - " 26th. - " 3d . .. " 15th .... " 27th .. 2 1 1 1 2 2 3 " 4th 1 2 3 1 " 16th " 28th " 5th " 17th 1 4 11 2 " 29th " 6th " 18th " 30th " 7th " 19th " 31st " 8th " 20th " Qtli " 21st Total* 47 32 In addition to the above cases, quite a number of citizen employes of the quartermaster's department were treated at the post hospital. Many cases, that I am now satisfied were mild oases of cholera, were diagnosed at the time as choleraic diarrhoea, and do not appear in the above report, which only contains the clear and unmistakable cases. During the first few days of the epidemic. Acting Assistant Surgeon Perry, IT. S. A., rendered valuable assistance in the care of the sick. He was then ordered to Fort Zarah, Kansas, where the cholera had made its appearance. Acting Assistant Surgeon Squier, U. S. A., assisted me in a most faithful and efficient manner for about a week, and was then ordered away with the Kansas militia. He shortly after fell a victim to the disease. On the 22d of July, Brevet Colonel Swift, Surgeon, U. S. A., and Brevet Major Brewer, Assistant Surgeon, U. S. A., arrived at the post and kindly relieved me of any further care in regard to the sick, and on the 26th I left the post on leave of absence. Acting Assistant Surgeon Chase, U. S. Army, attended to the sick among the quai-termastei-'s employes during the greater part of the time, but was prevented from doing so from July 18th to 28tli by sickness. He reports 79 cases, and 26 deaths. His last case occurred on the 30th July. Many of his worst cases were treated at the post hospital, and the deaths occurring there are not included in his report. At first we tried the chloroform treatment, as recommended by Assistant Surgeon E. McClellan, in doses of from 15 minims to one fluid drachm, repeated every half hour, or at larger intervals. The chloroform seemed to have a decided effect in controlling the diarrhcea and vomiting, but I could not see that it had any effect in the way of producing reaction from a state of collapse. We afterwards adopted the calomel treatment, giving from 10 to 20 grains every hour until three or four doses had been administered, and the results of this treatment were more satisfactory than of any other tried. A number of apparently hope- less cases rallied under this treatment, but were afterwards carried off by the consecutive fever. We used Squibb's mixture very extensively in the treatment of the prevailing diarrhoea, and found it to answer admirably. This spring the Smoky Hill river overflowed its banks to an unusual extent, and the low lands near it were extensively flooded. There was an unusual amount of moisture in the atmosphere during the months of April, May, June, a:nd July, and a great deal of rain for this section of the country. Decomposition of animal and vegetable matter has taken place with unusual rapidity. The air here is usually so pure and dry, that a piece of meat, cut thin, will dry when hung in the air without becoming tainted ; but this summer the reverse was the case. There have been an unusual number of flies and mosquitoes. Houses have been infected with a large fly which differs from the common house fly. During the prevalence of the epidemic the nights were cool, and often almost cold. More deaths occurred during the coldest nights than at any other time. After a thunder storm the number of cases decreased in a marked degree. A large proportion of the cases were among those who had recently arrived at the post, or had just returned from a tour of escort duty. A number of cases could be traced to an attack of indigestion from the use of improper food, and others to the immoderate drinking of river water. The disease was most fatal among the Kansas militia, who were for several days encamped on the banks of the river near the slaughter-pen where the first case occurred. Thuy drank the river water. * The above table contains one onse more than the list of names received from Fort Harker. FOET HAEKER, KANSAS. 31 The disease has traveled from here westward on both the Santa F6 and Smoky Hill route, hat has not extended eastward, although most of the fugitives from it went in that direction. One mild case of cholera occurred on the route from Fort Eiley to this post late last year, and was brought here, where the patient recovered. I cannot find any evidence that the disease was brought here from the east by troops, or that any cases had occurred at Fort Eiley, Fort Leavenworth, or Jefferson Barracks ; nor can I find any local causes that seem sufficient to account for its appear- ance here. I can only suppose that the disease, having traveled as far westward as Fort Eiley last year, the germs have been preserved in some way until a condition of the atmosphere prevailed favorable to their extension ; and in conformity with the usual law, the disease has this summer continued its westward march. Nearly every officer at the post suffered from choleraic diarrhoea; but no case of cholera occurred among them. One of the ladies of the garrison died of cholera on the 15th of July. Fort Riley, December 8, 1867. General : I have the honor to request that the following explanatory note may be appended to my report in regard to the epidemic of cholera at Fort Barker, Kansas, during the past summer. The ratio of deaths for the number of cases is not fairly shown by my report, as the four companies of Kansas militia, "H" Company, 38th U. S. Infantry, and "F" Company, 10th Cavalry, were independent commands in camp near the post, under their own medical officers. Only the most severe cases from these commands were taken into the post hospital, and are reported by me. Many of the milder cases were treated in camp, and many of the cases sent to the hospital were in a hopeless state of collapse when admitted. Very respectfully, your obedient servant, GEO. M. STERNBERG, Assistant Surgeon, and Brevet Major, U. S. A. Brevet Major General Jos. K. Barnes, Surgeon General. Fort Leavenworth, Kansas, August 5, 1867. General : I have the honor to inform you that, on the morning of the 22d ultimo, I left this place in company with Assistant Surgeon Brewer, U. S. A., en route for Fort Harker, having been apprised of the alarming increase of the cholera epidemic at that place. At Lawrence I was joined by Dr. Swift, U. S. A., whom I had ordered up from Jefferson Barracks, and Doctors Wiggins and Eenick, physicians under contract, engaged by the Medical Purveyor at St. Louis, at my request, for service at and about Fort Harker. At 10.30 p. m. I arrived at ray place of destination, and found both medical officers at the post disabled from duty, and many sick in quarters and in hospital. Dr. Sternberg, Post Surgeon, on account of fatigue, had gone to bed. Dr. Chase, overwhelmed with grief on account of the loss of his wife, who had suddenly died at 4 o'clock that afternoon, was not in condition to do any kind of duty. In company with Doctors Swift and Brewer, I at once visited the sick in hospital, and found Ed. McEndre, Private, 3d U. S. Infantry, entered the day previous, convalescing from cholera, and now suffering from irritation of the bowels, and restive. Sulphate morphia, i grain, and mustard to the abdomen, was prescribed. Private Henry C. Irvy, 18th Kansas Cavalry, aged 23, unmarried, entered the hospital on the 19th instant with symptoms of cholera; his dejections were now small and frequent, tinged with bile; had taken 50 grains calomel. Diarrhoea mixture — calomel and sulphate of quinine, of each ten grains, morphine, J grain — and compress to the abdomen, were ordered. Visited at 2.30 o'clock and 4.30 o'clock a. m., by Dr. Swift, with other inmates of the hospital tents. At the latter hour it was discovered that the compress had been neglected, and it was immediately applied. The pulse, from being imperceptible at the wrist, could soon be distinctly counted, and found to be 116 ; bandage could not be tolerated, consequently his pulse fell rapidly ; brandy and milk punch prescribed every half hour to no purpose. Irvy died at 12 m. John Scott, a Private of the 3d U. S. Infantry, aged 21, unmarried, entered the hospital on the 18th instant with un- mistakable evidences of cholera; had taken diarrhoea mixture and 40 grains of calomel, and had mustard applied to the abdomen. Eespiration labored and pulse 105, though not then suffering from any irritation of the intestinal canal; his debility was so great that convalescence could not be considered as established. Cold tea and milk punch were prescribed. D. O. Duffy, Private, Kansas Volunteers, aged 20, unmarried, entered hospital on the 19th instant; pulse full and 108; respiration oppressed, comatose; had taken 30 grains of calomel and diarrhoea mixture ; brandy and milk punch every half hour; diarrhoea recurring at 9 a. m., camphorated tincture of opium, 2 drachms, and compress to abdomen, were prescribed. Frank Hunt, citizen, aged 19, unmarried, was brought to hospital at 10.15 a. m., pulseless, restive, and cyanosed ; had vomited his breakfast and purged twice ; complained of pain in the umbilical region, for which Dr. Brewer administered, endermically, a solution of i grain of sulphate of morphia; half a drachm of chloroform was given, followed by calomel and sulphate of quinine, of each 15 grains. At the end of 45 minutes, 20 grains of sulphate of quinine was administered; no effect was recognized, unless that produced by the morphine, and death at noon resulted. Joseph De Foy, aged 57, married, a laborer in the quartermaster's department, entered the hospital at the same time with the above-mentioned Frank Hunt; had been vomiting and purging excessively for several hours, or since half-past five, and was seized with excruciating cramps in the 9,bdomen and inferior extremities; pulseless, voice weak and husky; gave him chloroform, -J-, drachm, camphorated tincture opium, 2 drachms, which, being retained, was followed by calomel and quinine, of each 10 grains. Assistant Surgeon Brewer injected, endermically, a solution of 1 grain of sulphate of morphia ; entire relief from pain and cramp followed. A compress had also been placed upon the abdomen, though the evacuations from the bowels were entirely suppressed,. and stimulants in the shape of brandy and milk punch were freely administered ; no reaction followed; and death occurred at 5 o'clock p. m. An autopsy of the patient was prevented by his hasty intennent. 32 .EXTEACTS FEOM OFFICIAL EEPOETS. Large details have been made from the command, and from the employes of the quartermaster's department, to thoroughly police the grounds, move tents, and disinfect privies and latrines, etc. Tents are being put up for the accommodation of cholera patients on the opposite side of the garrison from the hospital now occupied. Requisitions for ice and an abundant supply of disinfectants, medical and hospital supplies, etc., have been made. The following communication has been presented to Brevet Major General Smith, commanding the District of the Upper Arkansas, for his consideration and action : FOKT Harker, July 23, 1867. General : In view of the fact that cholera prevails at this post, I feel it my duty to suggest that all labor, not absolutely necessary to the forwarding of supplies, be suspended for a time, and that the command be turned out under a commissioned officer for general police. All tents should be struck and spread in the sun, inside out, and all sinks and privies should be filled up, and new ones should be dug to the leeward of the post and camps, when practicable. All filth should be sought out, and, when found, should be burned or buried, as it is impossible to say how far the decaying, dead, and decomposing vegetable and animal matters may aiFect the health of the troops and employ6s. All rank-growing grass and weeds should be cut down and burned, and a general and thorough policing of all camps, as well as the post, ordered. Inasmuch as the mechanics are leaving the post, I beg leave to suggest the propriety of suspending, for a fortnight, the buildings going on. Very respectfully, your obedient servant, MADISON MILLS, Medical Director Department of Missouri, V. 8. A. General A. J. Smith, Co mmanding District Upper Arkansas, Fort Harker, Kansas. July 24th : McEntire, Scott, and Duffy doing well. Dr. Swift visited all the camps and trains in and about the post, advising a change of position for some, and a thorough policing of grounds for all; digging of sinks and using them; boiling all water for drinking purposes, or, when practicable, making tea to be drank cold ; cleanliness of person, etc., to be strictly observed. Tlie doctor found J. Eourke, a teamster, in one of the cook's tents in articulo mortis. He had been visited by Dr. Chase, contract physician. Dr. Chase found him in the stage of collapse; had vomited and had rice-water evacuations, cramps, etc., following a diarrhoea of four or five days' continuance, before calling for assistance. The doctor gave him J grain of sulphate ot morphia, and a mixture of chloroform, brandy, and camphorated tincture of opium every 20 minutes, to no purpose. N. N. Steele, aged 56, married, was brought to the hospital at 7 p. m., suffering from diarrhoea and a large hernial protrusion from the right inguinal region. This he had had since a boy, and had controlled it without difficulty till the present time, when he found himself unable to reduce it. He had no nausea or vomiting, but his pulse was 108 and feeble ; his skin bathed in perspiration, and his countenance expressive of anxiety ; would rather not have the hernia reduced until next day ; without the aid of chloroform, by means of local anesthesia, with firm but gentle pressure, the sack and contents gradually disappeared with distinct gargouillement; he became calm, and slept comfortably, but died suddenly and without pain the following morning. A post mortem examination revealed evidence of strangulation of the hernial sack. This case is mentioned because of a feehng prevaOing that a choleraic influence was to some degree the cause of its sudden and unexpected fatal termination. July 25th : The morning calm, clear, and bright, after a thunder storm of unusual violence ; not a breath of air to drive away the warm vapors from the low grounds. In one of these localities near the river, a wagon train still remained in camp. In this camp a case of cholera was reported about 10 o'clock. Medical officers immediately repaired to the spot, and found the assistant wagon- master, Hanse, aged 29, unmarried, with cholera, in the stage of collapse. The attack was ushered in by purging about two hours before; had vomited but twice. He was now pulseless, bathed in perspiration; breath and tongue cold; eyes sunken, skin cyanosed and shriveled, cramps and thirst excessive. He was lying on the ground, a wagon cover stretched over him to protect him from the sun, and several men were employed in rubbing his limbs. Chloroform, half a drachm, combined with 20 drops each of camphorated tincture of opium and tincture of capsicum, was given him, which seemed to control the cramping, and a bandage with a large compress arrested the involuntary rice-water discharges from the bowels. Calomel and quinine, of each 15 grains, sulphate of morphia, J grain, was given, and repeated two hours later. Pieces of ice were freely given, and cold tea as desired. Milk punch was administered with great caution, and at 2 o'clock p. m., and later, some feeble efforts at reaction were apparent, which, however, soon passed away, and he died at 4 p. m. A post mortem examination at 6 o'clock revealed nothing beyond the congestions and lesions usually found in such cases. Hanse was a man of unusual health, strength, and vigor, and up to the moment of attack was as well as usual. At the same time, and in the same locality, the medical officers were called on to see Neide, ambulance driver, aged 2'4 unmaiTied, fair complexion, slight form, and delicate organization. He had suffered from diarrhoea several days, but the day previous, and up to the moment of the attack of cholera, he felt himself to be convalescent. Symptoms, except in degree of severity, and treatment, were almost the same as in the above-mentioned case ; reaction, however, seemed to be more complete and gave promise of continuance. Dr. Swift, whom I left last night in charge at Fort Harker, makes the following provision for the command at Wilson's creek, near the terminus of the railroad track : Fort Harker, July 25, 1867. Doctor : An ambulance will be set to you in a few moments to take you to Wilson's creek, about fifteen miles from here, where it is reported two men died with cholera last night. They also report many cases of diarrhoea. You will provide yourself FORT HARKEE, KANSAS. " 33 with all necessary medical and hospital supplies, and take them with you in the ambulance. Estimate for the kind and quantity of disinfectants you will require. If, in your opinion, the water used in the camp in any way conduces to the increase of diarrhoea, you will advise the officer in command to have it boiled, or made into tea for drinking purposes. Disinfect privies and dejections promptly, and recommend a thorough police of the camp, or its immediate removal to another place on the creek. Report to me in detail the history of the cases presumed to have been cholera, and each case in full as it occurs. Very respectfully, your obedient servant, EBN. SWIFT, Surgeon, and Brevet Colonel, U. S. A. A. W. Wiggins, Acting Assistant Surgeon, U. S. A. July 26th. Neide, ambulance driver, died this morning. Dr. Renick saw the following cases at 2 o'clock this morning, (citizens' belonging to hay party and trains passing the post,) and reports as follows : Charles Ferolin, aged 18, unmarried, laboring at' haymaking one and a half miles from the post, was attacked with severe vomiting and purging at 6 o'clock on the evening of the 25th. Saw him at 2 o'clock the following morning in profound collapse ; pulse imperceptible at wrist, and heart fluttering ; had had rice-water evacuations and vomiting, which had ceased. Gave him brandy, a teaspoonful every 15 minutes. No reaction took place, and at 9 a. m. he died. Patrick Day, married, belonging to the same party, was seized in the same manner and at the same time; saw him at 2 o'clock a. m. ; symptoms and treatment as above. He was transferred to the post hospital, and died at 11 a. m. David Gillispie, Mexican, belonging to the train, aged 50, married, was attacked at 9 p. m., the 25th, with vomiting and purging. Saw him at 2 o'clock the following morning, with cramps, rice-water evacuations, pulse soft and 120. Gave him calomel, grains 10, and morphine, i grain, which, being vomited, was at once repeated and retained. Half a grain of morphine was subsequently repeated every hour. Saw him again at 11 a. m. on the 27th ; vomiting and purging had ceased ; hands shrunken, pulse imperceptible, heart fluttering ; sunk rapidly, and soon died. Jos6 Maria Villareal, Mexican, aged 30, belonging to a passing train, was attacked yesterday, about 4 p. m., with diarrhoea and vomiting. His symptoms (12 m., July 26th) are those of profound collapse — cramps in the extremities; vox choleraica; coldness of hands and feet; hands also shrunken ; tongue and breath cold. Gave' him 10 grains calomel, i grain sulphate morphia, and a teaspoonful of brandy every fifteen minutes. His pulse was imperceptible at the wrist. July 27th, 2 o'clock p. m., tongue moist, breath warm ; could detect the pulse at the wrist; has had no cramps or vomiting since yesterday evening. Had one passage this morning; ordered the brandy to be continued and the man to be transferred to hospital ; arrived at hospital at 6. 30 p. m., not much improved ; still in collapse; injected sulphate atropia, -gV grain, in ann ; his pulse rose. Dr. Brewer injected atropia in two cases, also, one of which recovered, and the other survived four days. Dr. Renick also reported, July 27th, two fatal cases. Ford and Prior, in passing trains, in the stage of collapse, and rapidly sinking when he saw them. The following communications were to-day received from Dr. Wiggins by Dr. Swift, and his requirements at once complied with : Wilso.n's Ceebk Station, July 26, 1867. Doctor: I have the honor to make the follovdng report r I arrived at this station at 4 p.m. yesterday, (25th inst.) I cannot at present give in full detail a history of the four fatal cases that occurred before my arrival, as both the officers with the company are quite unwell, and unable to give me the necessary data. Such facts as I could obtain from nurses are as follows : James Ferguson was taken sick while on guard during the night of July 23d and 24th, and drank very largely of water ; was attacked with violent pain in the stomach, cramps in limbs, frequent discharges from the bowels of "whitish water, like the white of an egg ;'' no vomiting ; died at 2 o'clock p. m. July 24th, post mortem appearance shriveled and shrunken. George Kelly was taken sick on evening of the 23d, with very nearly the same symptoms throughout as Ferguson ; died 3 p. m., July 24th. Charles Herman was taken sick at 3 p. m., July 24th ; vomited dinner, which had consisted mainly of underdone beans ; no further vomiting ; diarrhoea (rice-water) and cramps ; died at 8 a. m., July 25th. Lieutenant Amick is of opinion that in some of these cases there was a, greenish color to the evacuations, but the nurses that attended them constantly describe them as uniformly watery and whitish. I have now eleven men under treatment, none of them as yet cases of cholera, and I am sanguine of the recovery of all. Two are in a typhoid condition, resulting from diarrlicea, fatigue, improper food, &c. The cases of diarrhcea are, I believe, under control. I found the company on my arrival in process of moving from the west to the east side of creek — an improvehienfin location, perhaps, though either locality seemed very clean and healthy. The water is very much like that used at Fort Harker. I have requested that, for drinking purposes, it be boiled or made into tea. I am unable to see any adequate cause for the prevalence of this disease here ; possibly epidemic influence is at the bottom, but modified materially by bad drinking water and improper diet. The rations consist of very fat bacon, hard bread, beans, &c. Fresh meat has been had only once, and that buffalo meat. K we can bring about more variety of food, and enforce temperance in the use of water, I am convinced that the epidemic will soon be checked. Lieutenant Kennedy and Lieutenant Amick are both quite indisposed— the effect of constant labor with the sick, anxiety, and, in part, I have no doubt, from too liberal use of Squibb's cholera mixture. I will report progress as frequently as occasion requires. Very respectfully, your obedient servant, I A. W. WIGGINS, Acting Assistant Surgeon, TJ. S. A. Brevet Colonel Ebn. SwirT, Surgeon, U. S. A. 5 34 EXTRACTS FROM OFFICIAL REPORTS. Camp at Wilson's Creek, July 26, 1867. Doctor : I beg leave to request that, if possible, a small quantity of fresh beef be sent to this post for the use of the sick, in lieu of beef extract, or until the latter can be obtained. A supply of canned milk would also, under the present circumstances, be of great advantage to the sick. I would further ask if it would be feasible to have ice forwarded to the end of the railroad — say twice a week, on designated days — whence it could be conveyed to camp by company wagons. More than anything else, we need proper food for these sick men. No medicine can avail much while the sick have to subsist on fat bacon, hard bread, and beans. The company commander concurs with me in an earnest request to have supplies suitable for sick men provided as soon as possible. We cannot wait to have business forwarded "through the proper channels." There have been several new cases of diarrhoea to-day, but no deaths since those I reported to you in my communication of this morning, and which occurred before I arrived. Three men are dangerously ill, but I hope to save them, and feel convinced that, with proper food and hospital supplies, the disease can soon be brought under subjection. Lieutenant Kennedy, commanding the company, is quite ill with remittent fever; he has, in fact, taken too much medicine during the past few days, and been only partially able to attend to his duties. Second Lieutenant Amick is also unwell, having been afflicted with diarrhoea attended with choleraic symptoms. I have the honor to be. Colonel, very respectfully, your obedient servant, A. W. WIGGINS, Acting Assistant Surgeon, U, S. A. Brevet Colonel E. Swift, Surgeon, U. S. A. Dr. Reynolds, Acting Assistant Surgeon, serving with troops at the terminus of the railroad, reports, July 28th, five cases and three deaths. A report of these cases, and seven others, only one of which, a colored soldier, belonged to the command at Fort Harker, will be furnished by Assistant Surgeon Brewer, U. S. A. Captain Helm is reported to have died at Fort Zarah yesterday. The report of Dr. McGill's death is not credited. Dr. Swift, by request, visited the town of Ellsworth, four miles distant, where the epidemic raged fearfully, and with great fatality. The physicians relied mainly on chloroform, opium, camphor, capsicum, and calomel. Some gave creasote and carbolic acid, and one was found administering chloroform by inhalation; neither success nor any marked improvement rewarded their labors. At Salina, permanganate of potassa was used with no better results. At the former place the panic-stricken inhabitants have left their workshops and merchandise and have fled to distant parts for safety. A woman found by Dr. Swift in the stage of collapse, who had taken freely of cholera mixture, improved, and probably recovered, with no other treatment than blue mass and quinine, 20 grains of each, cold tea, a bandage and compress to the abdomen, and small injections of starch, laudanum, and catechu. This injection was often used with patients in hospital. Fort Harker is situated on an elevated platform, near Smoky Hill creek. The formation is coarse red sand to the depth of fifteen feet, imposed upon a thick strata of coarse ferruginous sandstone, covered with a thick coat of soil. All the water used at the post is taken from a spring located in the bank of the creek, about fifteen feet above its surface, and about the same distance below the plateau. It contains, according to analysis by Dr. Heger, five parts to 100,000 of organic matter in solution, besides what is held in suspension ; about four times as much as is contained in the water of the Mississippi river. After standing twenty, four hours it becomes disagreeable to the taste, and animalculse are perceptible to the naked eye. Though the water is clear and beautifully translucent, in a few hours it deposits a very perceptible slimy substance upon the bottom and sides of the vessels holding it. A small trace of iron is discovered in solution. This is undoubtedly surface water, and the organic matter it contains, both in solution and suspension, comes along with it from the top of the ground, where the supply is abundant, having accumulated, in the numerous camps of troops and supply trains, from men and animals. The water of the Smoky Hill Fork is still more objectionable, being really offensive at times. The bottom of this stream abounds in quicksands, into which cattle and entire herds of buffalo sink and are drowned ; its waters wash these rotten carcasses, and bear away their decomposing elements of the flesh of to-day and the decaying bones of ages. The atmosphere seemed to breathe a pestilential breath, nauseous to the unacclimated. Carrion flies (musca cadaverina, IJ/nn.) have superseded the^common house fly and swarm everywhere. The command numbers something over 200 men, and there are between four and five hundred employes of the quarter- master's department. The first case of cholera made its appearance on the river; the second was the assistant butcher, living some distance from the post. The epidemic seemed to have originated here, where causes are as abundant as among the pilgrims to Mecca and the caravans of the Great Desert. Other reports will he furnished when completed. Very respectfully, your obedient servant, EBN. SWIFT, Surgeon, and Brevet Colonel, U. S. A. By order of — Brevet Brigadier Genei'.al MILLS, Medical Director Department of Missouri. To Brevet Major Gonernl .T. K. Barnes, Surgeon Clmend. FOKT HARKER, KANSAS. 35 LABOEATOEy OP THE SUEGEON GeNEEAL'S OpFICE, Washington City, D. C, August 27, 1867. SiE r On examining two samples of water from Fort Harker, Kansas, together with two others from this city, with reference to the amount of permanganate of potash required for their purification from organic matter, I obtained the following results: Water No. 1, from Fort Harker 43 grains pure permanganate per gallon. " ^0.2 " " 25 " " " " Water from pump in yard of Surgeon General's Office 17 " " " " Aqueduct water from tank, in which much of its impurities had been deposited .23 " " " " The water No. 1 contains 29 grains of solid matter per gallon, of which 11 grains were destroyed by ignition. No. 2 contains 19.3 grains per gallon of solid matter, of which 8.2 grains were destroyed by iguitioii. Very respectfully, your obedient servant, B. F. CRAIG, Acting Assistant Surgeon, U. iS. A. Brevet Lt. Col. J. J. Woodward, Assistant Surgeon, V. 8. A: FoET Harkee, Kansas, July 31, 1867. Geneeal : I have the honor to forward the following report in reference to the prevalence of epidemic cholera at this post : "On the evening of the 22d of J^ily I arrived at Fort Harker, Kansas, accompanied by the Medical Director, Surgeon E. Swift, and Acting Assistant Surgeons W. H. Eenick and A. W. Wiggins, IT. S. A. Cases of epidemic cholera were occurring daily at that time, and the disease had existed with a certain degree of regularity since the 27th of June, the date of the occurrence of the first case at the post. I was at once assigned to duty, relieving Brevet Major G. M. Sternberg, Assistant Surgeon, U. S. A. He had recently met with a severe loss in the death of his wife, at the post, of cholera, and was unfitted for duty from physical and mental prostration. His assistant. Acting Assistant Surgeon T. B. Chase, XJ. S. A., had lost his wife but an hour previous to my arrival, from puer- peral convulsions. I immediately went on duty and visited the cholera wards, in company with the Medical Director and Dr. Swift. Measures; such as the most recent investigations warranted, assisted by the advice and experience of the senior medical officers present, were immediately gut in force. I took personal charge of the cholera wards. The most recent and approved methods of treatment were adopted, and every knovra means resorted to for the cure or alleviation of the disease. I regret to say that the result of any treatment after the disease was fully established was highly unsatisfactory. A large majority of the cases were not seen until the stage of collapse had ensued; and to this I attribute, in part, the large mortality. The following tables show the number of cases, also the number of deaths, from the commencement of the epidemic until its disappearance : Tahle showing the number of cases amd deaths from Cholera among troops, for June cmd July, 1867. * June. JULY. Total. Date 27 28 29 30 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Cases — 1 1 2 3 1 1 1 1 3 3 2 3 11 1 1 2 1 ^h 2 42 ...|... 1 1 1 1 1 6 1 2 1 6 ... 3 2 1 2 1 29 * This table is not perfectly correct j the nominal list of cases gives four cases in July, without date, which are not here included. There were also three deaths in August. Table showing the number of cases and deaths from Cholera, for June amd July, among citizens and employ^ of the Quartermaster Juke. July. Total. Date 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Cases 1 ... 3 3 4 2 3 5 2 3 4 3 3 4 4 2 4 3 2 ... 1 6 3 7 3 4 2] 2 83 Deaths . . ... 1 2 3 2 1 1 1 ... 1 1 1 1 2 3 1 1 2 1 2 2 1 29 36 " ' EXTRACTS FROM OFFICIAL REPORTS. It will bp seen that a larger relative mortality prevailed, apparently, among the troops than among the citizens or quarter- master's employes. The greater number of deaths among troops occurred among the recently enlisted Kansas volunteers. I am satiseed that some deaths occurred, which are not included in the tables, among citizens ; also, that many of the cases reported as cholera among the citizens and employes were not genuine cases of the disease. It was with great difficulty that I could collect the necessary data on which to base a report. The record was in many cases deficient; thus, none of the cases occurring during the first seven days of July were recorded. I ascertained that Acting Assistant Surgeon Ira Perry, U. S. A., who had charge of these cases, had left no record of them. He had left the post previous to my arrival.' I immediately wrote to him and obtained all the oases he had kept any record of. No detailed account of the treatment of these cases, nor of those occurring previously, could be obtained, as the hospital prescription books had not been kept up since September last. The cases which were admitted into hospita' after my arrival I treated variously. At the commencement of the attack calomel seemed to exercise a marked effect, both in allaying the irritability of the stomach and re-establishing the biliary secretion. I used opiates and alco- holic stimulants very cautiously. I saw no good effects follow their use in the early stages of the disease; but, after reaction, very small doses of brandy and beef tea, associated with diluents, I believe, contributed much towards a speedy recovery. In the stage of collapse I found no remedy so efficacious as that practised by Brevet Brigadier General J. J. B. Wright, Surgeon, U. S. A., and afterwards by Brevet Brigadier General J. B. Brown, Surgeon, U. S. A., during the prevalence of cholera last year in New York harbor, viz : the exhibition of large doses of calomel, either alone or followed by a bolus of powdered capsicum. I am satisfied that I have seen good results follow this plan of treatment. In three cases, after collapse was fully established, I tried the plan first proposed and put in practice by Professor J. T. Hodgen, of the St. Louis medical^ faculty, viz : the subcutaneous injection of atropine, followed by saline injections per rectum. Dr. Hodgen attributes the reaction which he claims is brought about by this agent to its powerful influence over the sympathetic system of nerves. In the first case no result followed its use; in the second, reaction was promptly established, but the patient died at a subsequent period from uraemia; in the third case, reaction was brought about, but was not established until the remedy had been used four times, at intervals of one hour. After the saline injections had been used some time, a marked change in the appearance ensued ; the patient lost the peculiar livid hue of collapse, and became blanched; a decided increase of bulk was manifest at the same time. The patient recovered without unpleasant symptoms. The proportions of atropine used were from 5V to -gV of * grain. I have seen no notice of this remedy other than a modest pamphlet issued by Dr. Hodgen. I believe it is deserving of further trial. Other remedies were used by the medical officers present, and a measure of success claimed for each of them. Acting Assistant Surgeon Wm. H. Eenick, used calomel and morphia, in the proportion of 10 grains of the former, and ^ grain of the latter; and in collapse, carbonate of ammonia, combined with quinine and morphia. I had assigned Dr. Renick to the duty of attending the cases which occurred among contractors' trains and citizens in the immediate vicinity of the post ; he also rendered me much valuable assist- ance in the hospital. I am unable to speak of the mode of treatment practised most successfully by Surgeon E. Swift, XJ. S. A. I had hoped to derive much valuable information from his former experience in the treatment of the disease, but he was called away to places so distant from the post that this was rendered impossible ; he remained but a short time at Fort Harker. Other auxiliary measures were adopted for the alleviation of the symptoms. Hypodermic injections of morphia were used for cramps, also to allay irritability of the stomach ; chloroform for vomiting ; frictions, sinapisms, &c. Patients were allowed to drink moderately of cold tea, and, during convalescence, of milk punch and beef tea, in small quantities; The following case I report in full, because it presented all the symptoms of a well-marked case of Asiatic cholera ; its occurrence, moreover, under the worst hygienic conditions, and in a stout, hearty man, previously in good health, is calculated to verify the fact, already, I think, so well established, viz : that bad hygienic influences are eminently concerned in developing and characterizing the disease : Foster Hanse, age 30 years, unmarried, an assistant wagonmaster in the employ of the quartermaster, was seized, on the morning of the 25th of July, at 8 o'clock, with vomiting and purging of a fluid resembling rice water, attended with cramps of the abdomen, upper and lower extremities; he had no pieraonitory diarrhoea. Patient was seen at 10 minutes past 8 o'clock by Drs. Chase and Eenick; was ordered Squibb's mixture, and sinapisms to abdomen, and friction to extremities. I saw the patient at 40 minutes past 10 o'clock, with Dr. Swift, who removed the sinapism, substituting therefor a compress and bandage. Di'. Renick also prescribed calomel, 10 grains, morphia, i grain, which was immediately rejected ; he prescribed, also, morphia, •J- gram ; followed by quinia, 10 grains ; capsicum, 2 grains. The quinia and capsicum were rejected and repeated ; the last dose was retained. Patient was allowed ice and cold tea for drink. Died at 4 p. m. I examined the abdominal viscera two hours after death, assisted by Dr. Renick : surface of body warm ; no muscular spasms; muscles of abdomen healthy in appearance, and red blood followed the track of scalpel; intestines highly injected. The region of intestine about the ilio-ccecal valve was in a state of intense inflammation. The stomach and intestines contained the characteristic rice-water fluid. The epithelium was extensively detached, and, in some situations, the mucus membrane presented a scraped appearance. Liver, spleen, and kidneys highly congested; the right kidney contained a substance resembling lymph ; bladder empty and contracted. The head and thorax were not examined. The above case presented all the symptoms of Asiatic cholera, and the autopsy verified the diagnosis. The patient had been subjected to the worst hygienic influences. The train to which he was attached was camped on a bottom, near the banks of Page creek, and received all the drainage from the fort above. I saw scattered about on the ground, in a state of decom- position, refuse articles of food, bread, meat, beans, &c. The stench arising from these sources of filth, together with that of decomposing excrement from the mules, was intolerable. There were no sinks for the use of the men. I was informed that they were accustomed to defecate on the banks of the creek, the water of which was used for bathing, and, in some instances, for drinking purposes, though the springs, situated but a shoit distance above, furnished the general water supply for the whole garrison and its attaches. I could discover no trace of disinfectants, though I believe it had' been claimed by the quartermaster that disinfection had been practised. I reported the condition of this camp at once, and it was promptly removed to a better site. As to the origin of the epidemic of Asiatic cholera at Fort Harker, nothing can be established with any great degree of POUT HAEKER, KANSAS. 37 certainty. That the disease was imported in some manner, would agree with the most generally accepted theories of the means of its propagation ; but no positive evidence of its importation can be obtained. The evidence I have succeeded in obtaining in favor of its importation is meagre, and yet not so much so, I believe, as to preclude the' possibility of its derivation from this source. The post commander at Fort Eiley, Bvt. Lieutenant Colonel C. C. Parsons, Captain, 4th U. S. Artillery, informed me that two days previous to the departure of the 38th U. S. Colored Infantry from that post for Fort Harker, a case of sudden death occurred, the patient being an employ^ of the quartermaster's department, and that the post surgeon, Surgeon B. J. D. Irwin, U. S. A., reported it to him as a case of sporadic cholera. After the 38th left Fort Eiley, and had arrived at Junction City, but three miles distant, he received information from Asst. Surgeon Gr. M. McGill, U. S. A., that he would leave a number of men at Junction City sick with diarrhoea. These men were brought back, to Port Eiley. Two days after the arrival of the 38th at Fort Harker the first case of cholera occurred, but the patient was a butcher, in the employ of the commissary department. Cases soon made their appearance, however, among the 38th, and continued to prevail among them with great fatality. Now, it is well known that cholera prevailed at Fort Riley last year, but did not extend further westward. Associated with this circumstance is the fact that, since last year, the facilities for travel westward have been greatly increased by the extension of the railroad to Fort Harker. It is also known that, as soon as the railroad reached Fort Harker, that post at once became the outfitting depot for the plains. A large number of quartermaster employes were brought thither from Fort Riley, partly on account of its being the depot and partly to construct the fort. It seems not unreasonable to suppose that the cholera germ might have been transplanted from Fort Eiley by these means ; and after having once reached Fort Harker, that the essential conditions for its development and spread were abundantly afforded, I shall presently proceed to show. Another supposed origin of the disease (but one to which little value should be attached) is based on a report brought to Fort Harker that one company of the 38th came direct from Nashville, Tennessee, to Port Harker, stopping but two days en route at Jefferson Barracks, Missouri, I have no means of establishing this fact, and, moreover, it is not even known that cholera prevailed at Nashville at the time of the company's departure. In favor of the local origin of the disease, much can be urged. That the essentials for its development and propagation (after the specific germ had been presented) existed at Fort Harker, there can be no doubt, provided the views of Professor Pettenkoffer on this subject are correct, viz : a. porous soil, the existence of subsoil water, and the presence of a certain degree of heat and moisture ; but, in addition to these, there were certain other influences at work, influences which have been long recognized as essential elements in the production of diarrhoea, dysentery, and certain diseases characterized by a low degree of vitality. Dr. Peters states, in his recent work on cholera, " that no amount of filth, imprudence, or diarrhoeal disease, without the addition of the peculiar cause, can give rise to the disease in temperate climes." Recent investigations, moreover, point to these very causes, viz : filth, imprudence, &c., operating in tropical climes, as the factors in the production of the disease. Thus, in a recent article in Banking's Abstract for January, 1867, Dr. Norman Cheevers attributes the origin of the disease at its p resumed source, the Delta of the Ganges, to drinking water contaminated by emanations from sewers, burning ghats, stable manure, night-soil, &c. That most of these causes, or their equivalent, were (with the exception of a tropical clime) in full operation at Fort Harker at the time of the breaking out of the epidemic, I think I can satisfactorily show. The water for drinking purposes at Fort Harker is derived from two springs situated about 30 feet below the general level of the ground ; the soil at their mouths is composed of coarse sand, immediately beneath which, and composing the surface soil for miles around the post, lies a porous soil of a character eminently fitted for absorbing and transmitting to the subsoil water the products of the decomposition of animal and vegetable matters. Specimens of the drinking water from each spring, with samples of the surface soU and new red sandstone from the vicinity of the post, were forwarded to the Surgeon General's OiEce. An incredible amount of filth had been allowed to collect in and around the post. Dead animals were left at no great distance from the post unburied, and subjected to the full influence of a sun almost tropical. Eefuse articles of food — beef, pork, beans, &c. — were cast out to putrify on the ground, without regard to cleanliness. Trains were accustomed to camp around the post, sometimes remaining for one night only, sometimes for several days and nights ; and no regard was paid to the construction of sinks or receptacles for the refuse food, &e. But the neglect of sanitary measures was not confined to this class. After my arrival at the post, I found, on more than one occasion, meat, bread, cabbage, &c., undergoing decomposition in the sun, and that within a few feet (in more than one instance) of the officers' quarters. Rank weeds were allowed to grow on the parade ground and about the quarters of the otticers and men. The stables of the post were situated at one end of the parade ground, on a piece of ground sloping gently to the creek. These stables, it is true, were not built until February, 1867 ; but for months previous to that time their site had been occupied by the horses of two companies of the 7th Cavalry. I think there can be no reasonable doubt that the drinking water was impregnated with organic matters derived from these several sources. One other source of contamination deserves special mention. As soon as evening closed in, a horrid stench settled down on the fort. The source of this was for a time veiled in obscurity ; it could not be accounted for by the emanations from the sinks and privies, (though these last were not in a cleanly condition,) for the same odor continued after disinfection had been practised. The Medical Director soon discovered the source of this impurity, which was a large pit, situated directly in the quarter whence came the prevailing wind, from one-quarter to half a mile from the post ; this was and had been (for how long a time it is not known) the receptacle of every conceivable kind of filth, decomposing meats, offals, &c. This hot-bed of disease swarmed with large maggots, and the stench emanating therefrom was intolerable. Swarms of large green flies filled the quarters of the officers and men, and attacked all food left exposed. There was nothing peculiar in this species of fly ; it is one which is found everywhere where filth is allowed to accumulate in large quantities. With reference to the hygienic measures adopted, as soon as I reached the post I put in operation every means available for correcting the deplorable condition of affairs. I deemed it of first importance to place the hospital, the cRolera tents, and sur- roundings in as good hygienic condition as possible. With this view, I had all sources of filth removed; weeds were uprooted and burned or buried; the grounds were thoroughly policed daily; sinks were frequently disinfected and removed; the cholera 38 EXTRACTS PROM OFFICIAL REPORTS tents were removed to new sites every second day, and the tents fumigated daily ; disinfectants were constantly kept in the cholera tents, and all vomited and other matters disinfected as soon as discharged. The drinking water was treated with permanganate of potash before use. To the free use of disinfectants in the cholera tents and sinks, I attribute the immunity from the dis- ease enjoyed by the nurses and attendants. No case of cholera occurred among them after I took charge. I desire to bear testi- mony to the energy and zeal displayed by the medical olEoers on duty with me at the post, Acting Assistant Surgeons Chase and Renick. They did their duty. Hospital Steward Darling, U. S. A., a recently enlisted steward, also deserves commendation. The nurses and attendants in the cholera wards were almost all of them negroes. I was very much surprised at their fidelity; they placed great faith in disinfectants, and after their use they seemed to have no fear of the disease. In conclusion, I desire to state that I do not claim that cholera originated, de novo, at Fort Harker ; but, in the absence of any certain proof of its importation, save the existence of the disease at Fort Riley last year, with the one isolated case mentioned this year, and the free communication with that post this spring, together with the known tendency of the disease to progress westward, I have deemed it proper to enumerate the causes which, under some circumstances, might be considered suificient to originate the disease. Very respecifully, your obedient servant, J. W. BREWER, Assistant Surrjeon, and Brevet Major, U. S. A. Major General J. K. Barnes, Swgeon General, U. S. A. Detach.mknt op tub SSxri Infantry en route from Fort Harker, Kansas, to New Mexico. Statement of the movements of Headqiiarters and the several Companies of the 38(A Infantry, in 1867. Adjutant General's Office, Washington, April 18, 1868. The regiment was organized at Jefferson Barracks, Missouri; first return on file, February, 1867. Headquarters left Jefferson Barracks, Missouri, June 22d, 1867; arrived at Fort Harker, Kansas, June 37th, 1867; left Fort Harker, Kansas, July 20th, 1867; arrived at Fort Dodge, Kansas, July 30th, 1867; left Fort Dodge, Kansas, August " 1st, 1867; arrived at Fort Union, New Mexico, August 31st, 1867 ; left Fort Union, New Mexico, September 4th, 1867, and arrived at Fort Craig, New Mexico, September 24th, 1867 ; at which post they remained during the rest of tlje year 1867. Company "A" left Jefferson Barracks, Missouri, March 20th, 1867 ; arrived at Fort Riley, Kansas, March 24th, 1867 ; left Fort RUey, Kansas, May 13th, 1867 ; arrived at Fort Harker, Kansas, May 16th, 1867 ; left Fort Harker, Kansas, July 20th, 1867 ; arrived at Fort Dodge, Kansas, July 30th, 1867 ; left Fort Dodge, Kansas, August 1st, 1867, and arrived in New Mexico August 31st, 1867, taking post at Fort Cummings, New Mexico. Company "B" left Jefferson Barracks with Company "A," and remained with that company until its arrival at Fort Harker, Kansas, at which post the company served during the remainder of 1867. Company "C" left Jefferson Barracks, Missouri, May 12th, 1867; arrived at Fort Hays, Kansas, May 25th, 1867; left Fort Hays, Kansas, September 7th, 1867 ; and arrived at Fort Craig, New Mexico, October 19th, 1867, where it remained stationed. Company " D " left Jefferson Barracks, Missouri, June 19th, 1867 ; arrived at Fort Harker, Kansas, June 25th, 1867 ; left Fort Harker, Kansas, June 28th, 1867; arrived at Fort Bayard, New Mexico, September 12th, 1867, where it remained stationed. Company "E" left Jefferson Barracks, Missouri, May 12th, 1857; arrived at Fort Hays, Kansas, May 25th, 1867, where it remained stationed. Company "F," same as Company "D." Company "G" left Jefferson Barracks, Missouri, May 12th, 1867; arrived at Fort Harker, Kansas, May 17th, 1867; left Fort Harker, Kansas, June 5th, 1867, and arrived at Fort Hays, Kansas, June 15th, 1867, where it remained stationed. Company "H" left Jefferson Barracks, Missouri, June 22d, 1867; arrived at Fort Harker, Kansas, June 27th, 1867; left Fort Harker, Kansas, October 17th, 1867, and arrived at Fort MoRae, New Mexico, December 7th, 1867, where it remained stationed. Company "1" left Jefferson Barracks, Missouri, May 12th, 1867; arrived at Fort Hays, Kansas, May 25th, 1867; left Fort Hays, Kansas, June 24th, 1867, and established a post at the Monuments, Kansas, where it remained stationed. Company " K" left Jefferson Barracks, Missouri, June 9th, 1867 ; arrived at Fort Riley, Kansas, June 12th, 1867 ; left Fort Riley, Kansas, June 19th, 1867; arrived at Fort Harker, Kansas, June 22d, 1867; left Fort Harker, Kansas, July 20th, 1867; ai-rived at Fort Dodge, Kansas, July 30th, 1867 ; left Fort Dodge, Kansas, August 1st, 1867 ; arrived at Fort Union, New Mexico, August 31st, 1867; left Fort Union, New Mexico, September 4th, 1867, and arrived at Fort Selden, New Mexico, September 27th, 1867, w)iere it remained stationed. SAML. BRECK, Assistant Adjutant General. FOKT HARKEE, KANSAS. 39 Fort Bayaed, Nkw Mexico, November 9, 1867. Sir : I have the honor to acknowledge the receipt of your letter dated Octoher 15th, and am very happy to furnish you all the information in my power upon the matter of which it treats. I will suggest, however, that Dr. Kirke, Acting Assistant Surgeon, ought to be able to give a more complete medical history of the battalion of the 38th Infantry, late under my command, than any other person, as he took charge soon (two days) after the death of Colonel McGill, with the same hospital steward and all the records. The command left Fort Harker, Kansas, on the 28th of June, apparently in good health. The following table shows the cases as they occurred, according to the records and recollection of company commanders : Date. No. of cases. No. of deaths. Place of command. Kemarks. June 29 1 1 2 1 3 2 3 2 1 1 1 2 2 4 1 2 2 1 Cow Creek Kansas.. Taken in the morning and died in the evening. Jlilv 1 Left Fort Zarah. 30 miles west of Fort Zarah.. Arrived at Fort Lamed 40 miles west of Fort Lamed. 55 miles west of Fort Lamed. 65 miles west of Fort Larned. East of Fort Dodge. West of Fort Dodge. Do. do. Do. do. Do. do. East of Pretty Encampment. Salt Bottom ' 2 ' 3 ' 6 ' 7 ' 8 ' 10 ' 11 ' 12 ' 13 ' 15 ' 16 ' 17 ' 18 " 19 ' 20 ' 21 " 23 " 25 1 Case of July 1st died. Sergeant Wort, of Co. "D," taken sick. Sergeant Wort, of Co. " D," died. 1 1 1 2 Mrs. McGill took cholera about 8 a. m., and died about 10.30 p. m. Sandy Creek. Old Fort Lyon, C. T Do. do. Do. do. New Fort Lyon. South of Arkansas. Dr. McGill took cholera while behind column at Salt Bottom. 2 1 1 1 Dr. McGill died, at 3.30 p. m., at Salt Bottom (head of), near bluff. 31 12 Ten enlisted men died, and Dr. and Mrs. McGill. The above table gives the number of deaths correctly, but the number of oases is probably larger than would have been reported as cholera by a medical ofiicer, as there was a natural tendency to name every case cholera. It will be seen that we had no new cases after leaving old Fort Lyon. The most malignant cases were at Salt Bottom. It is difficult, perhaps impossible, to determine where or how the cholera originated. There were no cases in the companies at or before reaching Fort Harker, but I was informed by Colonel McGill that there was a ease of cholera among the employes of the quartermaster's department at Fort Harker the day before we left, viz : the 27th June. My march, after the appearance of cholera, was continued and conducted strictly under the advice of Colonel McGill. He was always consulted upon the selection of camps when we were in the vicinity of posts. It is proper to add here, that he regretted the selection of the camp at Fort Larned, on account of the flow of water from our camp toward the post, which he did not notice when the ground was first examined. In view of this fact, I determined to change the camp, but was prevented by Colonel McGill, who said the troops needed rest, and that it would do my command more harm to move than it could possibly benefit the post. Colonel McGill gave it frequently as his opinion that the disease in my battalion resulted from the patients having been exposed to choleraic influence the year before ; and that the bad water of the Arkansas, and worse of the tributaries, was the exciting cause. He also gave it as his opinion that, unless the disease became more malignant in its character, persons who had not been exposed to choleraic- influence last year were almost certainly safe. He seemed to be borae out in this opinion by the fact that almost every man who had cholera had been enlisted in cities where cholera was most malignant in 1866. For instance, Co. "D" had been partly org.nnized at Jefierson Barracks, Missouri, (near St. Louis,) during the prevalence of cholera at St. Louis, and said company lost eight of the ten men who died in the battalion. Brevet Major and Assistant Surgeon Tilton, at Fort Lyon, agreed with Colonel McGill upon the question of continuing the march; both thought it better to march, care being taken not to exhaust the troops. I regret that I am not able to give you a minute report — such as a medical oificer might make — but such information as we 40 EXTRACTS PROM OFFICIAL RKPORTS. can supply shall be given. If there is anything further which, in your judgment, we may be able to give, please write again and let us have questions to answer, or in some other manner indicate the points upon which you wish information. I am, Colonel, very respectfully, your obedient servant, HENRY C. MERRIAM, Major Zdth Infantry, Brevet Colonel, TJ. S. A. Brevet Lieutenant Colonel J. C. McKee, Surgeon, U. S. A. Washington, D. C, February 8, 1868. General: Learning that the reports regarding cholera, as it appeared in the Ist Battalion, 38th JJ. S. Infantry, during its march from Fort Harker, Kansas, to Fort Bayard, N. M., has been lost in transmission, I have the honor to offer the follomng from memory, all papers, books, &c., being left with the command : While on duty with Company " C," 3d U. S. Cavalry, then encamped on the Purgatoire river, learning of the death of Dr. McGill, Assistant Surgeon, U. S. A., and that the 38th U. S. Infantry, suffering greatly from cholera, was destitute of medical assistance, my proper command being entirely free from disease of any kind, having received permission from Brevet Captain W. Cain, commanding "C" troop, I joined the detachment of 38th Infantry July 23d, 1867, they then being in camp on the Arkansas river, two miles below old Fort Lyon. The camp was, in my opinion, ill chosen, being on the bottom ; though the high bluffs, with excellent camping grounds, were within two hundred yards. The men had dug wells at some distance from the river bank, using the water that percolated through, though it was highly impregnated with the alkali that abounds in those regions. The two considerations mentioned caused me to urge upon Brevet Colonel Merriam, Major 38th Infantry, commanding detachment, the immediate necessity of moving the command to a better position, besides the effect which would be produced upon the morale of the men by the constant and varied changes inci- dent to the march. The hospital was in a Sibley tent, which, from its defective ventilation and excessive heat, was anything but calculated for hospital purposes during the summer. There were about twenty men in hospital suffering or convalescing from cholera and choleraic diarrhoea diseases. On the 24th one new case occurred, coming under observation about 11 a. m. The late Dr. McGill had confined himself to the chloroform treatment, which had met with success in his hands during the cholera , epidemic on David's island. New York harbor, so it was continued in the present case. A most inopportune rain storm, flooding the whole bottom, with over two feet of water in the hospital, it being in the lowest portion, prevented a fair test of the chloro- form treatment, as the patient was drowned, the other patients in the hospital giving him no assistance, trnd all outside commu- nication being cut off by the violence of the storm, which prostrated every tent except the Sibley. On the 25th the command crossed the Arkansas river ; after which four new oases occurred, two of them being teamsters. They were all put under the treatment thoroughly tried by myself during the epidemic of cholera which occurred in Chicago in 1853, and afterward in New York city in 1866. My belief that the extreme prostration, nervous in its character, which always accompanies a violent invasion of the disease, indicated that its force was expended almost altogether upon the spinal cord, suggested to me the use of strychnia in large doses as a powerful and certain excitant of the nervous system, combined, in the first instance, with an aqueous solution of capsicum, to stimulate the stomach and promote rapid absorption of the strychnia. The treatment, therefore, adopted was a tablespoonful of the solution, and -,^j of a grain of strychnia ; the strychnia to be repeated in 15 minutes. In all the four oases in which this treatment was adopted the improvement was so immediate and marked that, in a few minutes after the second dose, the patient fell into a calm sleep, the cramps being perfectly, and other symptoms very much relieved. Tlje treatment afterward was expectant, and all recovered. In all cases the usual symptoms of cholera, such as rice-water discharges, collapse, and apathy, were present. The last case occurred about one day's march from Iron Sprino's. There were of course many cases of diarrhoea and dysentery, about sixty men presenting themselves daily at sick call, but the vast majority of them were of such a light character that they were not put upon the sick report, or relieved from duty with the command. After crossing the Eaton range, all diseases, except those common to every column upon the march, disappeared ; and one week's quarantine on the Upper Ocate put the command in a thoroughly healthy condition. Of the cases found by me upon joining the command, three died on the march. I cannot close this report without calling the attention of the Department to Hospital Steward D. D. Peabody, U. S. A., whose devotion and care of the sick was so unremitting as to prostrate himself completely. Trusting that the circumstances under which this repjrt is written will be sufficient excuse for its meagreness, I have the honor to be, very respectfully, your obedient servant, H. M. KIRKE, Acting Assistant Surgeon, U. S. A. FoKT Lyon, C. T., July 22, 1867. Genekal: I have the honor to report that the 38th U. S. Infantry (two companies) arrived at old Fort Lyon, C. T., July 20th, with cholera among them. I visited the command by direction of the post commander, and ascertained from Brevet Colonel Merriam, commanding the detachment, that the first case occurred the day after they left Fort Harker, and that a citizen employfi of the quartermaster's department died of cholera at Fort Harker the day before the 38th U. S. Infantry left there ; that there had been twenty cases among the troops, with six deaths; that Mrs. Dr. McGill died of cholera on the 17th instant; that Dr. McGill, U. S. A., had been left 30 miles back, too sick to travel. PORT HARKKB, KANSAS. 41 I found five mild cases of cholera in the hospital tent. I advised Colonel Merriam to encamp at least six miles from the post, -where supplies could be sent him without any of his command visiting the post. I then started to visitDr. McGill ; it was 9 o'clock p. m. when I arrived at the Doctor's wagon, and found that he had died at 3 o'clock p. m., 20th inst. He was taken sick on the morning of the 19thinst. On the 21st I returned to the command, and found two additional cases, one of whom died. Colonel Merriam had gone towards the new post, leaving instructions for the command to follow. On my way back to the post I was very much surprised to find that the Colonel had pitched his camp only three miles from the post, and had gone on to the fort. When I saw him I urged him to make the distance twice as great. The post commander requested me to return and see where the troops would be encamped. They were marching into camp when I arrived. Colonel Merriam went with me to the point I selected, but declined to take his men back, saying that he thought it would do them more harm than it would benefit us by the change. He expressed regret that he had got so close, and said that just before selecting the camp he had met an ambulance driver from the post, who told him that he was about seven miles oflF. At the same time, he denied the authority of the post commander to place him in quarantine. Under the circumstances, I advised the post commander to fill their requisitions as soon as possible, and then let them march around the post, cross the ferry five miles above, and march at least five miles above the ferry before encamping. No new cases have occurred to-day. Acting Assistant Surgeon H. M. Kirke, U. S. A., who was on duty with the 3d Cavalry, Company "C," was detached and sent to the 38th this morning. Company "C," 3d U. S. Cavalry, is acting as escort to an engineering party ; it has no sickness, and there are four citizen doctors with the surveying party. Acting Assistant Surgeon E. Schiffman, U. S. A., had been sent down the Arkansas river to visit various detachments at the stage stations, and men not available. I deem it much safer for the command to continue its march than to go into a permanent camp. There is no excitement nor alarm among the men. To quarantine them would, in my opinion, greatly increase the mortality. Every day's march brings them nearer the mountains, and I have strong hopes that, by strict sanitary measures, the disease will be entirely eradicated before they cross the Eaton Mountains. The commanding officer at Fort Union has been notified. Very respectfully, your obedient servant, H. E, TILTON, Assistant Surgeon, and Brevet Major, XJ. S. A. Brevet Brigadier General Madison Mills, Medical Director Department of the Missouri. Second Detachment of the 38tii Infantry en route from Fort Hariceb, Kansas, to New Mexico. Fort Craig, New Mf.xioo, Septemier 25, 1867. Colonel : I have the honor to acknowledge the receipt of your letter of the 16th inst., enclosing a communication from the Surgeon General's Office relating to the reports of sick and wounded, for the months of June and July of this year, in the detachment of the 38th U. S. Infantry under my charge, and to report that, until the 27th of June, 1867, I performed no duty as medical officer with that command, having been ordered by Special Order No. 61, headquarters 38th U. S. Infantry, dated Jefferson Barracks, Mo., June 10th, 1867, to proceed to Fort Leavenworth, Kansas, and make requisitions for and prepare the medical supplies and ambulances for the regiment, in view of their expected march to New Mexico. I would further report that, on arriving at Fort Harker, Kansas, with the headquarters and one company of the 38th Infantry, on the 27th of June, I found that, owing to the damage to the Union Pacific Eaihvayby the severe floods, no medicines or hospital stores had arrived for the command; and that, until their arrival on July 2d, the sick of Company "H," then on duty with the headquarters of the regiment, were treated in the post hospital at Fort Harker, under the charge of Brevet Major and Assistant Surgeon Sternberg, U. S. A., in whose report of sick and wounded for June, 1867, such cases as occurred were embraced. The monthly report of sick and wounded for July, 1867, (a copy of which is herewith enclosed,) was duly forwarded, and I have made every effort to promptly furnish all required reports while the command was on the march, forwarding them from military posts or mail stations. I am now engaged in preparing, and vrill forward as soon as possible, a detailed report of the late epidemic of cholera, as it occurred under my observation. I am. Colonel, very respectfully, your obedient servant, E. McCLELLAN, Assista7}t Surgeon, and Brevet Major, U. S. J. To Brevet Lieutenant Colonel J. C. McKee, Surgeon, U. S. A., Chief Medical Officer, District of New Mexico. Fort Craig, New Mexico, November 1, 1867. General : In accordance with the requirement of Circular Order No. 3, War Department, Surgeon General's Office, dated April 20th, 1867, I have the honor to forward my special report of cases of epidemic cholera in the command with which I was on duty during the' months of June, July, and August of the current year, and to state that it was impracticable for me to make this report at an earlier date, from the fact that, during the greater portion of the months named, the comiiiand was upon the march en route for this Territory. 6 42 EXTRACTS FROM OFFICIAL REPORTS. Having been detached on special duty from the headquarters of the 38th Infantry, (which regiment I had been ordered to accompany on its march to New Mexico,) I arrived, on the 18th day of June, 1867, at Fort Riley, Kansas, to await the arrival of the command, then supposed to be upon the road from St. Louis, Mo., and was occupied until the 25th day of the same month in providing for the sick of such detachments of the regiment as preceded the arrival of headquarters. These detachments, three in number, each reported quite a large number of diarrhoea cases, painless in character, and but few requiring any considerable medical aid. On the 22d a detacliment consisting of two companies left Fort Riley, accompanied by the late Brevet Lieutenant Colonel Geo. M. McGill, U. S. A., who informed nie on my arrival at Fort Harker that quite a number of violent cases of acute diarrhoea had occurred in that command during its march to the last-named post. On the day that this detachment left Fort Riley (June 22d) an aggravated case of sporadic cholera occurred at that post in the person of a quartermaster's employ^. This case, through the kindness of Brevet Lieutenant Colonel Irwin, U. S. A., I had an opportunity of viewing a few hours prior to its fatal termination. On the 25th, the headquarters and one company of the 38th left Fort Riley; arrived at Fort Harker on the morning of the 26th, and though the men had been exposed to a violent rain storm on the preceding night, no sickness of any consequence was reported. The regimental camp was made upon a small plateau or beach formed by the iirst rise of gi'ound from a small creek, a, tributary of the Smoky Hill fork, and about half a mile to the southwest of the post, and about the same distance from the creek. This plateau, although lower than the ground upon which the post was situated, presented so many natural advantages, that it was selected, after careful consideration, in preference to more elevated posititms. The drainage was admirable ; the natural slope of the plain was to the southwest ; on the north and east large arrayos received the wash from the higher ground, while to the west the fall to the mea'dow bordering the creek was abrupt. The plain was covered with short prairie gi'ass; the soil was loose and gravelly; the gi'oundhad never been occupied for camp purposes. The troops were.well clothed, and provided with camp and garrison equipage; the tents were new, of the A pattern, and of a sufBcient number to prevent any over- crowding. Great care was taken by the commanding officer to observe all sanitary precautions. There was no epidemic of any character at the post, and the tendency to diarrhoja, which I had observed prior to my arrival at Harker, seemed to have subsided. On the 28th, a detachment of the 38th Infantry, consisting of Companies "D" and "F," under the command of Brevet Lieu- tenant Colonel H. C. Merriam, and under the medical charge of Brevet Lieutenant Colonel McGill, U. S. A., left the post en route to Fort Union, N. M. Owing to the extensive damage done to the Union Pacific Railway by the extraordinary June floods of this year, the medical supplies for this detachment, which were most liberal as to quantities and amounts, were detained at some point east of Harker, and Dr. McGill was obliged to commence the march but poorly provided with medical stores, his requisition being based upon the ability of the post hospital to fill it. A few hours prior to their departure, I had assisted Dr. McGill in his inspection of the men of this command, and no indication of latent disease was discovered, the sick report being of the simplest character. This command crossed the Smoky Hill about noon, and before any suspicion was excited as to the existence of epidemic cholera in the vicinity ; but shortly after their departure, I was requested by Acting Assistant Surgeon Ira Perry, U. S. A., to see with him a citizen employed by the beef contractor of the subsistence department, whom he feared was seized with malignant cholera. The man was living in a " dug-out," the most miserable form of human habitation, in the immediate vicinity of a filthy slaughter-pen, and about one mile and a half southwest of the camp of the 38th. On our arrival the patient was found perfectly collapsed, exhibiting all the peculiar symptoms of the disease, and the case terminated fatally within a few hours. The clothing, articles of furniture, and ground around this patient were infected by the excreta, which had been thrown out in all directions, the patient having suffered from the disease and its premonitory symptoms many hours before calling in aid. Active disinfectant measures were instantly instituted by Dr. Perry. On the evening of the same day. Private Henry Groom, of Company " H," 38th Infantry, was taken with fully marked symptoms of the same disease, and was conveyed from camp to the post hospital, where he died early the next day. These cases inaugurated the epidemic at Fort Harker; and I subsequently learned from a report which Hospital Steward D. D. Peabody, U.S. A., (who was on duty with Dr. McGill,) was kind enough to make for my information, that the first case in Colonel Merriam's command occurred at Plumb creek, their first camp, on the evening of the same day. On the 29th of June, Private Tony Powell, also of Company " H," was attacked, and was sent to the post hospital, where the disease yielded to treatment. On the 30th, Private W. Jackson, of the same company, was seized with the disease ; he was also sent to hospital, whore he died the next day. The removal of these men to hospital was necessitated by the non-arrival of my medical supplies, from the same cause as was stated in Dr. McGill's case. In the camp of the 38tli Infantry the most rigid precautionary measures were at once adopted. The men were, as far as possible, debarred from communication with the post. The supj)ly of water was obtained from a spring near the site of the abandoned Fort Ellswortli, distant nearly two mil1 s M e I^ g B » !2; c> u K fa( M 9 > •^ h-l R *>J g O 4) § $> FH « m »■ n pq CM e 1 w H h e H P< <1 H > *» N ^ O :^ 'd w 'r^ w 1^ A r> t 00 CCJ V <1 «« O ■S P^H H o • >^ M g ;^ p O! •SaTJBAOOai II-B JO'OiJ "^ ^ § ?? ?; o •Sq?-B9p IIB JO -Oil « CO « CO H g' sasBD uu JO 'OK CO Ol -S^ «s r-t t~ Ct ~l i o '6 •l«*ox '. 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IS ■paia W CO rH CD •pajaAooaa (N « OT rH r- •5[0|9 uaai^x rH CO to CO j CO i-H i ►^ 1 i < i § to 1 i 1 E-c [= o r^ s be s A CC p o s 05 a ^ s ,^ t: bo S< a 5 § PI 43 M P O af ►J CO O W en (—1 M 1^ H 02 (> O M P P O M CO 1 -d c^ 3 « •> r-< = ^ -< S -s Pi fe rH O) ■001 10 Gi jad sqieap jo oi?i3|i S ^ * ■9q^B9p It^ JO 'OJI rH ^ J ^ ■esijd S g p -A009I 1[B JO 'OiJ b: •ponioipB .tCi I-" £ SaSBO I[B JO -oji " •Il!»ox rH a in CO ?5 •SOIBOlO^il «3 in -H ■saiBH 3 " ^ •moi CO rH . S > uo to rH •saiBuiaj P^ M CJ ■soiiiH CO rH s* CO rH ■mox S S ■S 00 CO •uMonitu^ ■S8IBUI0J ? ^ s Q S a tr ■SOIEM 4 s H H 1 •c GALVESTON — VICTORIA. 91 U. S. A. Post Hospital, Galveston, Tjsxas, Apnl 17, 1868. General : In response to your communication of the 11th instant, inquiring as to the number of citizens who died of yellow fever in this city in the epidemic of 1867, I have the honor to enclose the city sexton's report of interments from July 27th to November 11th, inclusive, a period including most of the epidemic. The summary of the records I enclose estimates the 1,134 interments to have been of yellow fever. For the period reported, it is impossible to obtain an entirely accurate estimate. Yellow fever is known to have been in the city since the preceding month of June. The sexton furnishes me with a list of 14 interments of yellow fever, and one of jaundice, for July, not including enlisted men of the army. This increases the number for the period reported to 1,149; to this, I judge, may be added in July and in the latter portion of the epidemic — say 50 to 70 deaths from yellow fever, incorrectly reported as due to congestion of the brain, inflammation of bowels, and miasmatic and typho-malarial fevers. Not only was cerebral congestion one of the prominent characteristics of the epidemic, but also the tendency to other local determinations is well known to be, in this disease, influenced by the peculiar health and habits of the system of the person attacked. And, again, in the presence of a sweeping epidemic, almost all sickness more or less partakes of the type of the prevalent disease. If we estimate 15 deaths from yellow fever for the close of the epidemic not given in report, we obtain a total of 1,234, which, less 5 ofBcers and 49 soldiers, leaves 1,180 deaths of civilians. I yesterday mailed to Colonel Webster my report of the epidemic, in which I had collected considerable material of interest relating to the rise and course of the fever in the city. I am. General, very respectfully, your obedient servant, C. BACON, Jr., Assistant Surgeon, and Brevet Major, U. S. A. Brevet Brigadier General T. A. MoParun, U. S. A., Medical Director 5th Military District, New Orleans, La. VICTORIA, TEXAS. Victoria, Texas, September 24, 1867. General : I have the honor to report, in compliance with circular order, the first ease of yellow fever at this post of which, personally, I have any knowledge. The patient was T, H. Leeds, quartermaster's agent at this place. He is now under treat- ment by me, progressing favorably. Health of troops, under existing circumstances, most favorable. Every precaution has been adopted to enforce a strict sanitary police. No communication allowed between the troops and the citizens of the town. I am hopeful in believing that I will not have any yellow fever cases in-military hospital. I have the honor to be, with great respect, your obedient servant, JOHN EIDGELY, Acting Assistant Surgeon, U. S. A, Brevet Major General Joseph K. Barnes, Surgeon General, * Extract from Montldy Report of Sick and Wounded, Victoria, Texas, September, 1867. Acting Assistant Surgeon J. Midgely, Companies " B," " D," and " E," S5th Infantry. Yellow fever is now epidemic, combined with a favorable endemic condition. Two-thirds of the citizens are down, or have been sick with the disease. The mortality with them, so far as I can learn, is very heavy. With the troops, no deaths as yet. New Orleans, Louisiana, November 26, 1867. Major : I have the honor herewith to transmit special reports of yellow fever at Victoria, Texas, for September and October, 1867. The names and military history of the men I am unable to give. Having only a detachment hospital, no record is kept except the morning report and prescription book. I have applied to headquarters, of the regiment at San Antonio, Texas, for the information ; but as so much time has elapsed since the report was overdue, I send withoufit. I would respectfully state that I reported for duty at Victoria August 27th, at which time most conflicting reports were prevailing as to the existence of yellow fever in the town. Necessarily much occupied with my official duties, having a large 92 EXTEACTS FKOM OFFICIAL REPORTS sick call of endemic diseases, I had neither time to make a diligent inquiry, nor did I wish to suhject myself to the personal discourtesy which, as a federal officer, I would have received, even when laboring in such a service. Finding that my views of the advent of that deadly scourge, yellow fever, conflicted widely with the opinions of those higli in rank' and power, and not having either health or mental ability now to urge them, I would respectfully say, in conclusion, that I know of no specific treatment for yellow fever. On the other hand, I would be understood to say that, to my own knowledge, too much medication has been resorted to, and that quinine has been used to such an extent as to become a poisonous agent. In no other way can I account for the mortality in Victoria. There, I am told, persons ranged before the counter of the apothecary ranks deep, the prescription being the same — 30 grains quinine, 10 pills. * " I placed the sick man in a hot bath enveloped in blankets ; had him supported therein till he became faint, and then removed to bed ; gave him 30 to 60 grains of quinia, with 10 grains of bismuth ; in two hours a mercurial purge ; allaying irritability of the stomach by mustard sinapisms, (mustard that would act,) with 8-grain dosos of bismuth, lime-water and milk together, and, strange to say, beef essence, which I found to be the most effective agent. I have used the bisulphite of soda with marked success. Mrs. Lathrop was treated with it by me. In conclusion, I would, with all due deference, say thatthere are cases in which all human interference avails nothing. Such was the case of the late Brevet Major S. H. Lathrop. With every consideration, I have the honor to be your obedient servant, JOHN EIDGELY, Acting Assistant Surgeon, U. S. A. Brevet Major C. Bacon, Jr., Chief Medical Officer District of Texas. Sedgwick Hospital, Gkebnville, La., January 10, 1868. General : I have the honor to present the following statement, in lieu of the report forwarded to the chief medical oftlcer District of Texas. When I reported for duty at the temporary post of Victoria, Texas, (August 23d, 1857,) I found a great state of excitement, consequent upon a report which the physicians of the town had made, that yellow fever was prevailing as an epidemic. Conflicting statements prevailed, both as to the truth of the report and the origin of the disease. As for myself, knowing none of the physicians of the place, and not wishing to subject myself to discourtesy by asking questions of strangers, I have no definite knowledge as to the prevailing opinion of its origin in Victoria, but believe that the disease was introduced from Indianola, Texas. Being occupied in consolidating the men, getting them out of the weather, (as it was raining continually,) and establishing a detachment hospital, and not having any assistance, no soldier in the command being qualified to act as hospital steward, every moment of my time was taken up from the time I reported until I was taken sick ; therefore, I know nothing but from hearsay testimony, and that of a conflicting character, as to the history of the first cases of yellow fever in the town of Victoria. As to my own men who were taken sick with the disease, the first, second, and fourth on the list had been treated by me for remittent fever for a considerable time; they were convalescent from that disease when attacked with yellow fever, but still inmates of the hospital. Meyers was on detail duty at the commanding officer's quarters, sleeping over a stable in a log-house in the rear of the quarters — a most unhealthy locality. I had broken up this place, but, as the discipline was lax, several of the men would resort there. Crighton was detached as baker, employed in the town, and was taken sick there. Paradise, being a Hebrew, had permission to attend the Jewish New Year festival, and was taken sick while absent. Nelson was detached as clerk at Major Lathrop's quarters, and was taken sick in town. Moore and Colter were hospital attendants. Colter was taken sick in Tny quarters while acting as nurse to me. Good had just returned from Halletsville. Downing had been sleeping, contrary to my order, in the aforementioned log-house. The two last cases were of a highly malignant character. It appeared to me that the epidemical influences were greater with the citizens of Victoria than with the troops, and that, among the latter, the influences were endemic. Beyond a doubt, yellow fever prevailed in the town of Victoria as an epidemic, and so affected the citizens ; but with the troops the disease was modified or changed by endemic influences, those soldiers who had been treated for remittent and intermittent fevers escaping, or having the disease of a mild type ; whereas two of the fatal cases had never been to sick call until taken with yellow fever. I would respectfully state that I know of no specific treatment for yellow fever. On the other hand, I would be understood to say that, to my knowledge, too much medication has been resorted to, and that quinia has been used to such an extent as to become a poisonous agent. In no other way can I account for the great mortality among the citizens of Victoria. Unless one takes into consideration the different characters the disease assumes in different localities, and even in each separate case, and does not allow himself to he misled by resorting to medication for every vagrant symptom that may present itself, he had better leave the sick man to nature and the disease, for by so doing the struggle will be more equable. In most of my cases abortive treatment was used ; whether the result was from that treatment or otherwise, I cannot say. I have the honor to be, with great respect, your obedient servant, JOHN RIDGELY, Acting Assistant Surgeon, TJ. S. A. Brevet Brigac'ier General T. A. McPakhn, Medical Director Fifth Mitit/iri/ District, New (Means, La. GOLIAD — HOUSTON. 93 OOI.IAD, TEXAS. Lake Trinidad, Texas, ApM 28, 1868. Sir : I have the honor to acknowledge the receipt of your communication of March 24th, 1868, relative to the yellow fever at Goliad, Texas. The presence of the fever at Goliad was, in niy opinion, consequent upon intercourse with the neighboring town of Victoria, 28 miles distant, where the disease prevailed some time previous to any cases occurring in Goliad. Heretofore, when the disease has existed on the coast, and in some of the interior towns, Goliad has been exempt. No local cause, I think, produced the yellow fever in Goliad. It is a place noted for health, and situated on high gTound, with no. swamps or stagnant water for several miles around. Communication between Goliad and Victoria was uninterrupted during the prevalence of the epidemic at the latter place, and many refugees resorted to Goliad to escape the disease. The disease existed in Goliad about three weeks before the troops were attacked. In consequence of the fever making its appearance in the town, a quarantine was established, allowing no soldiers to leave camp or citizens to visit there. The camp was situated about a quarter of a mile from the town. About one-ninth of the entire population were attacked, and there were about twenty-five deaths among the citizens. The comparatively few cases among the troops was, I think, in consequence of the rigid quarantine enforced. Very respectfully, your obedient servant, COLUMBUS J. WHITE, Acting Assistant Surgeon, XJ. S. A. Brevet Major General J. K. Barnes, Surgeon General. HOUSTON, TEXAS. Houston, Texas, November 30, 1867. The following statement in regard to the first appearance and subsequent progress of yellow fever, as it occurred at this post during the months of September, October, and November, 1867, is respectfully submitted : The first oases of yellow fever in the city of Houston were brought from Galveston in the second week of August, where the disease was at that time prevailing epidemically. The number of new cases gradually increased from this time forth till about the 20th of August, when the fever was declared epidemic. The first case of yellow fever among the troops at this post occurred on September 7th, terminating fatally on the 11th by the supervention of a Yiol^nt congestive chill. This was the case of Private Matthew Hale, Company "D," 17th U. S. Infantry, who had for some weeks been employed as teamster, and was consequently compelled to visit the city daily for drinking water and other purposes. Brevet Colonel J. D. O'Connell, U. S. A., Major 17th U. S. Infantry, commanding this post, who was at that time residing with his family at the Hutchins House, in this city, was attacked by the fever September 12th, and died September 16th. Mrs. O'Connell took the fever on September 13th, and died on the morning of the 19th. * » » Captain Lyman H. "Warren, U. S. A., commanding Company "C," 17th U. S. Infantry, was taken with the fever on September 15th, s « » » ^nd died at an early hour on the morning of the 18th, having ejected during the night large' quantities of black vomit. During the month of September the fever made but slow progress among the troops, 15 cases (jccurring in all, of which number 5 died. On the 30th of September there remained under treatment 4 cases, all of whom died during the first week of October. In October, however, the fever made rapid progress, 54 cases occurring, 20 of whom died. On the 31st of Octobei: there remained under treatment 7 cases ; 2 new cases occurred on November 1st and 3d, respectively, all of whom recovered. There occurred in all 71 cases, 25 of whom died. The extreme virulence of the prevailing epidemic influence — the fact that all our men were entirely unacclimated — the impos- sibility of effectually establishing complete non-intercourse of the men with the inhabitants of the city — the prevalence of the violent north winds during the greater part of September and October, to which our camp, otherwise very favorably situated, was exposed — and the unfortunate circumstance that so many of our convalescents, in spite of all our endeavors to prevent it, clandestinely managed to procure for -themselves improper articles of diet, in which they imprudently and voraciously indulged, thereby causing relapse, which proved to be much more severe and fatal than the original attacks — all these causes combined go far to account for the heavy mortality among this command during the past epidemic. *■»»»*» The general sanitary condition of the troops composing this command before yellow fever became epidemic in the city was very satisfactory, no death having occurred during the year ; and, with the exception of the months of July and August, when an increase of intermittent and bilious remittent fever cases was observed, there was but very little sickness at any time in the command. As soon as yellow fever was known to exist in Galveston, we had every reason to infer that it would also soon make its appearance here; and as our old camp was at that time on the north side of the Buffalo bayou, exposed to the generally prevailing south winds, sweeping over the entire extent of the city, and as it had been proved by the experience of previous epidemics that the mortality had invariably been much heavier in the northern portion of the city than elsewhere, I advised Colonel O'Connell, commanding the post, to move the camp, for obvious hygienic reasons, to the extreme eastern portion of the city limits. Colonel O'Connell coinciding with me, our camp was accordingly moved during the latter part of July, particular attention being paid in selecting favorably situated grounds, where we also had the advantage of being able to obtain readily a suitable building for the purpose of establishing a hospital therein, in case it should be'necessary to do so. 94: EXTRACTS FKOM OFFICIAL EEPOKTS. Having stated that the generally prevailing winds were from south to north, I would here observe, that during September and October, contrary to the general rule, the prevailing winds were from the reverse direction. In order to attain the highest possible hygienic standard in the command, all due attention was paid to the rigid enforcement of every sanitary measure known and attainable. The entire extent of our camp ground was thoroughly policed daily ; large fires of pine wood and tar were made nightly at various points around and inside of the camp ; the different disinfectants were freely used about the sinks, kitchens, &c., and doses of quinine and whiskey dealt out to every man in the command regularly every morning and evening as a prophylactic against general miasmatic infection. Colonel O'Connell, anticipating the outbreak of the epidemic, sought and got permission from Headquarters District of Texas to employ, in that event, more medical help ; and as no medical oiEcerB could be ohtained from the department in order to render such temporary aid at this post, he authorized me to make arrangements with an acclimated citizen physician, well acquainted with the pathology and treatment of yellow fever, to act as my assistant during the prevalence of the epidemic among our troops, vfith the understanding that he should consent to be in constant attendance with our sick in camp, day and night, until the epidemic had entirely subsided. Such an agreement I accordingly made with Dr. J. W. Daniel, of Houston, who entered on the discharge of his duties September 19th, and continued to attend our sick, in conjunction with me, and under my special supervision, until November 20th, when, nearly all our men being able to return to duty, his. services were no longer needed. The yellow fever, as it prevailed among the troops stationed here, was essentially the same as I observed it among the citizen population of Houston, in its prevailing tendency to assume the intermittent and congestive type, complicated frequently during its course by hsemorrhages from the nose, stomach, and anus. Among the citizens of Houston the same well-marked peculiarity in the manifestation of the past epidemic was observed that was noticed in Galveston and New Orleans, distinguishing the epidemic of this year most essentially from previous ones by its most sweeping and universal character, no class of the popula- tion being able to claim the least immunity from its ravages. Heretofore the majority of the most experienced members of the medical profession practising in yellow fever districts firmly believed that the fever rarely, if ever, would a second time attack the person that undoubtedly had it before ; that people residing for a long time in yellow fever districts were much less liable to its attacks than newcomers from places where it was never known to have occurred; and that small children, born and raised in fever districts, as well as colored people, were nearly exempt from its ravages, or, in case they did take it, experienced generally but very light attacks. The experience of the last epidemic has most incontrovertibly proved the utter fallacy of these tenets, as a great many instances are known of persons having the fever this year a second time; and of others, claiming to be perfectly acclimated, taking it quite severely and dying of it; and of numbers of children and colored people suffering severe attacks of it with fatal results. Considering the great virulence of the prevailing epidemic this year, it is no matter of surprise that all of our soldiers, being entirely unacclimated, should have taken it, with the exception of eleven. During the first five months of this year very little sickness prevailed in Houston and vicinity ; in June and July, however, a great number of bilious remittent and.intermittent fever cases occurred, with a well-marked tendency to assume a pernicious and congestive character. That the first cases of yellow fever observed in Houston occurred in persons that contracted the disease in Galveston is proved beyond doubt; but it is quite as certain that on account of the excessively muddy and filthy condition of the city and all its streets, caused by the long-continued rainy season during May and June, and the utter negligence on the part of the city authorities to attend to proper drainage and the removal of the accumulated filth from the streets, gutters, and yards, together with the unusually high range of the thermometer during July, August, and September, there was cause enough for the epidemic influence, once brought here, to take root and spread. As soon as the fever became epidemic in the city, the post quartermaster of this station. Lieutenant Wm. M. Van Home; upon my recommendation, rented a building close to our camp, which I immediately fitted up as a hospital for yellow fever patients, and had my three hospital tents pitched in the rear of it for the accommodation of the convalescents. Having, by necessity, to meet the approach of the grim visitor, every precautionary measure that hygienic knowledge and experience could suggest was, if possible, more rigidly than ever enforced throughout the command, in order to be thoroughly prepared to battle with the insidious enemy ; for, situated as we were, and unable to maintain complete non-intercourse of our men with the citizen population, we could hardly expect to escape more or less speedy attacks. All of our men being unacclimated and liable to contract the fever at the slightest exposure, it became necessary, as soon as the disease was among us, to employ acclimated citizen nurses conversant with the nursing and general management of yellow fever cases. As regards treatment, according to the difference in type and character of the fever in individual cases, different indications arose and various methods of treatment were resorted to; generally speaking, however, the principal aim was to interfere as little as possible with nature's own resources and recuperative endeavors whenever powerful and energetic enough to bring about a cure. #»»»«»»»»»»»*#»,«*),, In those cases exhibiting the mild form of the fever very little medicine was given, those cases doing well generally without any active treatment. All that was done generally consisted in giving a thorough purge at once, such as compound cathartic pills, castor oil, or solution of citrate of magnesia, inducing free perspiration by the application of hot mustard foot- baths and keeping the patient well covered up. He was not permitted to partake of any kind of nourishment for three or four days, and was allowed to swallow from time to time a mouthful of either ice water or cold orange leaf tea, in order to quench his thirst. If his fever rose considerably, the pulse remaining for tliirty-six hours over 115 per minute, a teaspoonful of the follow- ing sedative mixture was administered every hour or two till the fever abated and the pulse fell below 90, when the medicine was omitted, and ri^commenced in ease the pulse rose again : tincture of aconite root, thirty-five drops ; tincture of veratrum viride, fifty drops ; tincture of digitalis, one fluid drachm ; orange flower water, two fluid ounces — mix. In case the secretion of urine became scanty, some diuretic was repeatedly given till the kidneys acted freely. Whenever HOUSTON — HEMPSTEAD. 95 the surface of the body became either hot and dry, or cold and clammy, the application of hot bricks, enveloped in woolen rags saturated with vinegar, to the soles of the feet and linees, almost always sufficed to bring about very speedily the desired moist state of the skin. In order to counteract the septic influence of the fever poison on the composition of the blood and mucus membranes of the stomach and bowels, a tablespoonful of solution of two drachms of either the sulphate of magnesia or hyposulphite of soda, in six ounces of water, or a teaspoonful of chlorine mixture, (prepared by mixing together two ounces of hydrochloric acid, two ounces of water, and two drachms of chlorate of potassa, and taking from this mixture one fluid drachm , to be added to eight ounces of mint water,) was, in some cases, ordered to be given every three or four hours. If, on the fourth day, the fever had nearly abated and no untoward symptoms of any kind were observable, the patients were generally allowed small quantities of some bland, mucilaginous, and slightly nourishing drink, such as barley slime, oat or cornmeal gruel, &c.; the day after, perhaps a little weak beef tea and brandy toddy were added ; and on every succeeding day the quantities and variety of nutriment were very carefully and gradually increased till full convalescence was established. In those cases where excessive dryness of the skin was, from the beginning, a noticeable feature, and where the repeated applications of hot mustard pediluvia, hot moist bricks, and rubbing the body and extremities with either dry mustard powder or hot stimulating lotions seemed to be of little or no avail, nothing has succeeded better in my hands, in order to bring about reaction and establish free diaphoresis, than resort to the cold wet-pack ; that is, enveloping the patient in a cold wet linen sheet, and rolling him up very closely in three or four woolen blankets. If, in such conditions, the resort to this wet-pack is not too long deferred, it generally acts like a charm in soon producing very profuse perspiration and abating the excessive heat and often insupportable cephalalgia. Care must be taken not to let the patient remain too long in the pack — two or three hours are generally sufficient; when he should be quickly taken out and the surface of his body thoroughly rubbed oS with rough towels and well covered up afterwards. Another admirable method of treating such cases consists in applying several smaller wet sheets, under a good cover, over the entire surface of the body, and changing them as often as the sheets become hot and steaming. In cases early showing an irritable state of the stomach, with a sensation of heat and oppression about the precordia, the frequent administra- tion of a half tablespoonful dose of the chlorine mixture above mentioned had the happiest effect in allaying these untoward symptoms. In others, however, where this remedy seemed to do no good, and where nausea and vomiting supervened, I often succeeded in effecting a change for the better by giving, every two or three hours, a tablespoonful of a mixture of subnitrate of bismuth in creasote water, and chloroform, in conj unction with applying a blister to the region of the stomach. In cases where patients were of very robust, plethoric habits, and seemed to be threatened, soon after taking the fever, with symptoms of general congestion, I promptly bled them from the arm to the amount of from twelve to twenty-four ounces, following it up in some instances by free cupping, after a lapse of eight or ten hours, and I am satisfied that by doing so I saved their lives. In others I applied counter-irritation in the form of small blisters to the extremities, and. feel convinced that it did good service as a derivative in a good many instances. In cases where the patients were taken with a severe chill, during the the first intermission of the fever a powerful dose of quinine was ordered, and sometimes with the best effect, as chills hardly ever recurred again, and the subsequent fever was very light and easily subdued. Before closing this report, I will take this occasion to attest to Dr. J. W. Daniel's very faithful performance of his arduous duties ; to the untiring labor and energy displayed by him on all occasions; for to his intelligent arid valuable services are due the saving of many lives and the alleviation of the suffering of all our patients. Much praise is likewise due to Lieutenant Wm. M. Tan Home, commander of this post since the death of Colonel O'Connell and Captain Warren, for the prompt and efficient manner in which he supplied me with everything needful for the comfort of our sick during the trying time of the late epidemic. Our supply of various articles of diet, stimulants, bedsteads, mattresses, sheets, &c., becoming exhausted, and not being able to obtain these articles in time from the medical purveyor at New Orleans, I was obliged, several times, to make _ requisition on him as post quartermaster in order to supply our immediate wants. All of which is respectfully submitted. F. HASIJNBURG, M. D., Acting Assistant Surgeon, TJ. S. A. Brevet Major General J. K. Barnes, Surgeon General. HEMPSTEAD, TEXAS. Hempstead, Texas, April 6, 1868. Slli : In compliance with your request, I have the honor to inform you that yellow fever was introduced here from Galveston' It first apppeared amongst the citizens, one Vorhees, from Galveston, who died hei-e in August, 1867, being the first well authenticated case, so far as I can learn. Several citizens were attacked soon afterwards, and on the 6th of September one of the officei's of this post was taken with it. None of the privates were attacked until near the middle of the month. Very respectfully, your obedient servant, F. A. WILMANS, Acting Assistant Surgeon, U. S. A.' Brevet Lieutenant Colonel Warren Webster, Surgeon-in- Chief. 96 EXTRACTS FROM OFFICIAL REPORTS. BRENHAm, TEXAS. Brenham, Texas, December 2, 1867. Sin : In accordance with your instructions, I liave tlie honor to submit the following report relative to the pi'evalence of yellow fever in this town, and the remarkable fact that the troops stationed here have escaped entirely : On the 8th of August, James A. Devine, late Captain, U. S. Volunteers, and at that time on duty in the Bureau of Refugees, Freedmen, and Abandoned Lands, came to this post en route for the interior. He left Galveston the day before, tlie yellow fever prevailing there at tlie time. The next evening, at 4 o'clock p. m., while in camp, he complained of feeling unwell, and went to his hotel ; in a short time he sent for me. I saw at once symptoms of yellow fever, but he insisted that lie had had the disease, and I was not certain as to his case until the day following, when yellow fever was plainly developed. On the 13th instant he died with black vomit. This was the first case that occurred in Brenham. No apprehensions were then felt that the disease would assume an epidemic form, as there had never been but two cases of the fever in Brenham, and those were persons who had come from an infected district a few hours before they were attacked by tbe disease. I think there were one or two cases reported by resident physicians during the two weeks subsequent to Devine's death, when the disease became epidemic, and its ravages were most fearful ; whole families were swept away, every family suffered, and the inhabitants became terror and panic stricken. About this time I chanced to bear that mustard seed (sinapis alba) had been used successfully as a prophylactic against yellow fever, and remembering to have seen it used on the Isthmus of Panama as a preventive against intermittent fever, I thought that if I adopted the use of something of this kind, and could lead the men of this command to believe that they were safe from the disease, it might, perhaps, have a good moral eifect upon them. Through your kind assi-stance I procured a large supply of mustard seed, and gave a tahlespoonful, with an ounce of whiskey, to all in the command, including servants and laundresses; this was given daily, at 11 o'clock a. m., up to this date. "We have had a heavy frost, and I now believe the fever to have left us entirely. Our camp is located in the town, about one-fourth of a mile from the centre. During the epidemic there has been more than one hundred and fifty fatal cases among the whites, and half that number among the blacks. Almost the entire population who remained in town have had the fever ; every house in the vicinity of our camp, and at every point of the compass around it, has had fatal cases of the disease — one house, in close proximity, lost six members of the family. Our men were exposed to the disease as much as any others living in town, they being compelled to go through town for wood and to the depot for supplies. Two of these men nursed a case of the fever. What conclusion, if any, can we draw from these facts? Here is a camp in which are sixty souls, located in a town where yellow fever is epidemic, and of a most malignant type — where, in every occupied house, from one to ten cases of the disease may be found — where, at one time, scarcely people enough could be found to bury the dead — these sixty souls breathing the same atmosphere, and exposed, in everyway, as much as any of the inhabitants — not scattered, hut living together — escaping without one case. Troops ordinarily suffer as much from any prevailing disease, perhaps more, than any other class. At Hempstead, but twenty-two miles from this place, the troops have, as you know, suffered terribly. I might remark here that our camp has been a very clean one. As early as June Ist I gave my careful personal attention to disinfectants ; the camp was disinfected twice daily with sulphate of iron, and all wood-work frequently whitewashed ; the tents were raised eighteen inches from the ground and lime thrown under them ; the ends of the tents fronting north and south were made of lattice- work, giving a free circulation of air. I am not prepared to say that white mustard seed will prevent an attack of yellow fever ; but this body of people have entirely escaped, and I can safely say that they are the only ones in the town who have escaped, and they have been exposed equally with all. Not one of these men was acclimated. A clerk from Galveston en route to Austin was taken with the fever in one of the tents of the command ; he had slept with one of the men the night previous. Not a person who has taken the mustard and whiskey has taken the fever. "We know that the mustard promotes the action of the kidneys, stimulates the digestive organs, and creates a moisture upon the surface of the skin. "While the troops have, in this State, suffered terribly, we have escaped ; whether it be mustard seed, or whatever the preventive may have been that has kept us preserved from the disease, we can but feel thankful that we have escaped. "7ery respectfully, your obedient servant, CHAS. E. "WARREN, Actinff Assistant Saryeon, U. S. A. Brevet Major C. Bacon, Assistant Surgeon, U. S. A. Brenham, Texas, April 6, 1868. Sir : First Lieutenant L. J. Lambert came to this post from Houston ; he had been on duty at that place for a considerable length of time, during which time, and at the period of his leaving, yellow fever was an epidemic at Houston. He was taken with the fever about thirty-six hours after his arrival at this post, and did not use mustard seed. During his sickness I was ordered to Fort Stockton, and relieved by Dr. Jackson. Dr. Jackson put Private J. Thompson oii duty as a nurse, he being then a patient in the hospital. He had been under my treatment for some time previous for gastritis. A day or two after Private Thompson was put on duty as a nurse with Lieutenant Lambert, Dr. Jackson was taken sick with remittent fever, and I took charge. I found Thompson lying beside Lieutenant Lambert's bed exhausted. I removed him to the hospital, where he died from exhaustion. Dr. Jackson did not see him for some days before his death, but was on duty at the end of the month, and made the report for the month of September to which the letter from the Surgeon General's Office refers. Dr. Jackson recovered. Private J. Thompson had not the; yellow fever, nor a single symptom of the same. "Very respectfully, your obedient servant, CHAS. E. WARREN, ■D 4T- * 4.11 1 i,T ,„ Acting Assistant Surqeon, U. S. A. Brevet Lieutenant Colonel Warren Web.ster, j i • Surgeon-in-Chief JJistrict of Texas, Austin, Texas. AUSTIN, TEXAS — SUB-DISTEICT OP THE EIO GRANDE. 97 AUSTIIV, TEXAS. Extract from fecial Eeport on Yellow Fever, Austin, Texas, September, 1867. Acting Assistant Surgeon B. M. Kirk, U. S. A. Higgins, a prisoner, supposed to be a member of the 4th U. S. Cavalry, was attacked September 9th, and died same day. He arrived, some days previous to the attack, from New Orleans, La.; was unconscious when received in hospital, and remained so till death. Mxiractfrom Special Eeport on Yellow Fever, Austin, Texas, November, 1867. Acting Assistant Surgeon B. M. KirTc, U. S. A. Private J. B. Shearer, attacked November 6th; recovered November 12th. Was clerk at District Headquarters. Arrived at the post, from Galveston, October 23d. SUB-DISTRICT OF THE KIO GRANDE— BKOWWSVIL,L,E AND RIIVOOOED BAR- RACKS, TEXAS. Headqtjaetebs Sub-Disteict of the Eio Grande, Office of Chief Medical Officer, Brownsville, Texas, January 28, 1868. General : In compliance with the instructions of Circular No. 3, S. G. O., April 20th, 1867, I have the honor to forward the accompanying special reports of yellow fever patients for the months of October, November, and December, 1867, in the sub-distiict of the Eio Grande, at the posts of Einggold Barracks and Brownsville, at which posts alone cases of the disease have occurred. The special and full instructions relative to the sanitary condition of troops issued from the Office of the Surgeon General U. S. A., and by the medical director of the Fifth Military District, and the chief medical officer of the District of Texas, during the earlier part of the past season, were carefully followed and strictly enforced by commanding officers at all posts in the command. The health of the troops continued remarkably good during the whole season, with the exception of the few cases of yellow fever reported. On the 28tji of June last application was made to the chief medical officer of the District of Texas for instructions relative to the establishment of a quarantine station at Brazos Santiago, and, in accordance with the orders received, a rigid quarantine was established July 8th at that port, and so effectually enforced that none of the cases of yellow fever that have occurred during the season in the vicinity of the Eio Grande can be traced to that port as the source of infection. There were three deaths in quarantine during the season, but none were reported by the health officer of the port as yellow fever ; and only one case was regarded as suspicious — on board a schooner from Peusacola, Florida — which resulted in death early in September. Much apprehension was felt during the months of August and September regarding the port of Bagdad, Mexico, at the mouth of the Eio Grande, where, notwithstanding the satisfactory assurances of the Mexican authorities at Matamoras and the port of Bagdad, and the great vigilance and very commendable efficiency of Acting Assistant Surgeon Wm. E. Savage, U. S. A., the health officer at the port of Brazos Santiago, Texas, there was some laxity in the enforcement of quarantine regulations in regard to some vessels from Mexican ports, and to the steamer Pisano, from New Orleans, some passengers from which arrived in Mata- moras about September 16th. None of these people were allowed to come to Brownsville, although their passage from New Orleans had been a long one, and there was no sickness among them. In regard to the port of Bagdad, however, it is considered certain that no elements of infection or contagion were admitted there from which the epidemic that appeared a month later could have been developed. As soon as it was announced that yellow fever was epidemic at Corpus Christi early in August, quarantine stations were established, on the 12th of the month, at the crossings of the Arroyo Colorado and the Corpus Christi roads, between that place and Brownsville, and, it is believed, with the most satisfactory results. Almost all travel on this route was prevented or turned in other directions by these obstructions, but few people arrived at Brownsville from Corpus Christi during the months of August and September, and no cases of the fever occurred among them or can be traced to them. At about the same date, August 12th, directions were given from this office, to Acting Assistant Surgeon C. C. Furley, U. S. A., post Surgeon at Einggold Barracks, to exercise all possible vigilance in quarantining the road to that point on the Eio Grande from Corpus Christi. Soon after very stringent orders were issued by Brevet Brigadier General McKenzie, commanding that post, prohibiting all travel upon that much frequented route. That these orders were most vigilantly enforced is indicated by the accompanying special report of Dr. Furley. It is believed that a number of deaths from yellow fever occurred on that route among persons attached to wagon trains, and others at points outside of the quarantine stations, during the months of August and September, while the disease was prevailing at Corpus Christi. In the latter part of July and in August the usual summer freshet of the Eio Grande occurred, and the river continued very high during all the month of September. From the 19th of August, for ten days, it rained almost incessantly, and during this period the whole country along the lower Eio Grande, from Eio Grande City down, was almost literally flooded, rendering all the roads quite impassable. Upon the cessation of the rains and the subsidence of the waters, about September 1st, malarial fevers of a congestive type began to prevail among the Mexican people in the vicinity of Eio Grande City, Texas, and Camargo, Mexico. The same thing occurred in the vicinity of Brownsville, but the sickness was confined to the ranches near the river, 13 98 EXTRACTS FKOM OFFICIAL EEPOETS. above and below, and did not appear in Brownsville. It is believed to be beyond doubt that there was nothing like yellow fever in .these cases. With the exception of these cases, the sanitary condition of the post of Einggold Barracks and vicinity continued quite good until some time in September. About the 1st of September began a series of interesting events, of which an account is given in the accompanying report of Acting Assistant Surgeon C. C. Furley, U. S. A. In forwarding this report, however, it becomes my duty to correct some of the statements made therein, and to present the results of my own investigations relative to the disease which has recently prevailed at Eio Grande City and vicinity. This report was received at this oiBoe from Dr. Furley about the 6th of November. I afterwards received from Dr. Cunynghame, post Surgeon at Einggold Barracks, the accompanying letter, dated October 30th.* Further inquiry was rendered necessary by that letter and by other contradictory statements received; also by the fact that Dr. Furley was entirely inexperienced in regard to yellow fever, and had not seen any of the cases that occurred outside of the post subsequent to the date of September 20th, from which time till November 1st (when his contract was annulled for official misconduct) he was in arrest, and, excepting to see the case of Dr. Keilly, did not leave the post of Einggold Barracks. In the latter part of November, copies of all official papers relating to the subject of Dr. Furley's report were obtained from Einggold Barracks, and are enclosed with the report ; also copies of letters received from medical and other officers at that post.t There are three or four doctors in practice at Eio Grande City, Texas, and Camargo, Mexico, (which places are about four miles apart,) but of these it is understood that the only physician by education is Dr. Headley, of Camargo, who is repeatedly refen-ed to in the accompanying report and letters, and his opinion regarding the recent epidemic in that vicinity is the only professional one to be obtained. * * » Since December 1st I have had several conversations with Dr. Headley, and substantially the same account is given by him as by Dr. Furley in the accompanying report of the events which occurred early in September. An ambulance arrived at Eio Grande City from Corpus Christi, on the evening of September 2d, in which was a man sick with yeilow fever, who was immediately sent out of town, and who died the next morning. Very energetic action was at once taken by the military commander at Einggold Barracks to prevent the further development of the disease. These cases were all seen by Dr. Headley of Camargo, and those of the persons who crossed the Eio Grande and died of the fever at a house three miles from Camargo were under his care. .The Doctor believes that these cases (of the ambulance party) were yellow fever, but that subsequently to these there have been no cases of the disease in the vicinity of Camargo or Eio Grande City. His grounds for this belief are, that the vigorous and thorough action taken with regard to the ambulance and its contents, (all ol which were burned and entirely destroyed, including all blankets, silks, &c., &c., and even the pistols of the sick man, so great was the fear of contagion among the Mexican people,) and the similar course pursued with regard to those of the ambulance party who crossed into Mexico, rendered propagation of the disease by contagion improbable, if not impossible; that the disease which became more prevalent in September was entirely malarial, of a decidedly intermittent character and congestive type, and was such as usually prevailed in the region at that season ; that all the cases properly treated recovered, the plan of treat- ment being a mercurial cathartic followed by large doses of quinine and stimulants ; and that few deaths occurred among the better class of the people who had medical attendance, but many among the poor Mexicans, who could not employ physicians, but treated themselves with herb teas, sweating, &c., &c. This Mexican plan of treatment. Dr. Headley argues, should have cured a fair proportion of the patients if their disease had been yellow fever; and, on the other hand, that the actual results were what might have been expected from such treatment (without quinine) for malarial fevers of a congestive type, viz : a mortality in two months of about one hundred and fifty or two hundred persons in a population estimated at from 500 to 750 people. Eeturning now to Dr. Furley's report, it is evident from his letters, dated September 11th, 18lh, 24th, and 25th, that matters went on very quietly at Einggold Barracks and vicinity subsequent to the ambulance burning, September 3d, and that the existence of yellow fever was not suspected, or, at least, that the idea of its existence was not entertained, until the 24th of the month, when a citizen named Forbes was admitted to the post hospital at Einggold Barracks. During all this period, however, there had been some sickness and a few deaths in Eio Grande City, particularly among children, and at various ranches above and below that place along the river. It is stated as an interesting fact, that during the whole time of the prevalence of the epidemic there was no sickness beyond a ranch about twelve miles above Eio Grande City, and that at the larger town of Koma, only three miles further up than the point where the epidemic appeared to stop, or fifteen miles from Eio Grande City, there were no cases of the prevailing disease, and but a few deaths in.fieptember and October. At the Garcia ranch, where the ambulance was burned, half a mile from Eio Grande City, there are several houses or huts in which Mexican families are living. It is stated by credible persons that, immediately subsequent to September 3d, there was no more sickness at this ranch than at many other neighboring ones at the same time, and that it was not of a peculiar character. Had there been any evidences of yellow fever at this suspicious locality they should have been recognized earlier than September 24th by the military and civil authorities who were looking for the appearance of the disease. The three cases (it should be stated as two) mentioned in Dr. Furley's report as having been pronounced yellow fever by Dr. Eeilly, who had never before seen cases of the disease, were two women, seen but once by him, and that after dark, in a' Mexican hut, and the only examination made was by the light of a coal of fire held over their faces. The women died shortly after, and were buried before morning by direction of the doctor, who afterwards repeatedly declared that they were not cases of yellow fevei'. The first declared case of yellow fever, after those of the ambulance party, was that of Mr. Forbes, before mentioned as having died at the post hospital at Einggold Barracks, September 24th. Dr. Furley had previously been placed in arrest, but • In this letter the writer reviews the alleged cases of yellow fever reported by Acting A sslstant Surgeon Furley, and denies that thoy were really such, or that true yellow fever had existed up to that date in Kio Grande City or its vicinity. tThese letters are not here published for want of space ; their substance is embraced in this document, SUB-DISTEICT OF THE EIO GEANDE. 99 on this day was allowed to visit Dr. Eeilly, whose case will be noticed hereafter, and who had been taken sick in town on the 22d, two days before. Upon Dp. Farley's return to the post hospital he found Forbes there sick. * » * Forbes was a notorious drunkard, and for more than two weeks before his death had been drinking excessively. A few days before Lis death he started to go to San Antonio, but was taken sick and lay by the roadside (it is stated) nearly 24 hours before he was taken back to Eio Grande City, and from thence to the post hospital. That he vomited black matter, as stated, before his defith, may be admitted, but there is most reasonable ground for doubt as to the character of the disease. It is quite certain that no one at the post of Einggold Barracks contracted yellow fever from him by contagion. At about this date— September 24th— communication between the post and Eio Grande City was stopped ; and as Dr. Furley did not again leave the post till about November 1st, none of his statements regarding the events of this period in Eio Grande City are made from personal knowledge. The second case reported as yellow fever in Eio Grande City was that of Dr. B. S. Eeilly, late Acting Assistant Surgeon, U. S. A., who was taken sick Sunday, September 22d, and died Saturday, September 28th. This case has at all times been declared by Dr. Jleadly to be one of congestion of the brain. The history of this case, as nearly as can be ascertained, is as follows, viz : Dr. Eeilly was taken sick on Sunday evening with a slight chill, followed by a moderate fever, which continued without increase or abatement till "Wednesday. He had pains in the head and back, and flushed face, when attacked, but no redness of the eyes was noticed. He did not appear to be very ill, but believed from the beginning that he would die, and on Wednesday sent for a priest. On this day increased feverishness was noticed in the morning, which abated at night, and he begun to have irritabiUty of the' stomach. The Doctor had been taking cathartic medicines, but they did not operate well, and believing now that his disease was intermittent fever, he began to take quinine. He was very thirsty, and during the day — Wednesday— drank freely of a very acid solution of citric acid in water. On Thursday morning another and more severe exacerbation of the fever occurred, with increased irritability of the stomach, and occasional vomiting of a clear liquid; Dr. Eeilly became much excited, and at times irrational, and feared that he had yellow fever. More quinine was taken, but, as with everything else taken during the day, was vomited as soon as swallowed. On Friday morning the fever was again greatly increased; he became delirious, was quite violent during the night, and continued delirious until death on the following day. The irritability of the stomach continued, and an increasing amount of dark -colored sediment was observed in the matter vomited during the succeeding 24 hours. Dr. Headley, of Comargo; first saw the case on the evening of this day— Friday — and said it was one of congestion of the brain ; had Dr. Eeilly's hair cut short, cooling lotions applied to his head, and gave medi- cines which were rejected. Dr. Eeilly grew worse rapidly, and on Saturday morning was placed in a hot bath containing u, pound of Colman's mustard, (so says Dr. Headley,) and after being taken from the bath, was given black coffee to drink. Dr. Eeilly became quiet and slept (comatose ?) shortly after the bath, and remained so until death at 3 o'clock p. m. He vomited very black matter two or three times during the last three hours, which made stains on the bed linen that could not be washed out with soap and cold water ; experienced nurses then present declared this case to be one of yellow fever, which Dr. Headley does not believe. In Dr. Furley's report it is made to appear that Dr. Headley contracted the fever by contagion from Dr. Eeilly, and that Mrs. Headley was sick afterwards with the same disease. The fact is, that Mrs. Headley was ill early in September with a disease which Dr. Headley thinks was more like yellow fever than any other case he saw, and that Dr. Headley was not sick with yellow fever, which he had already had long before, but with some other disease. Colonel Gautierez, who is reported to have died October 5th with yellow fever, did not see his friend. Dr. Eeilly, during his illness, as stated, and was treated by Dr.- Headley for congestive intermittent fever. Colonel Gautierez survived two severe paroxysms of the fever, and was in a fair way for recovery, when. Dr. Headley being taken ill, the case came under the treatment of a doctor by whom castor oil was given to the patient, producing severe catharsis and vomiting, followed by a third paroxysm resulting in death. Mr. Dallas, whose case is mentioned in Dr. Furley's report, was a very intimate friend of Dr. Eeilly; was with him night and day during his illness, and ■vyas greatly fatigued, as well as much depressed, by the death of his friend. Mr. Dallas was taken ill on the day of Dr. Eeilly's burial — Sunday, September 29th — with a very high fever, but was on the street again in three days. He has since suffered much from intermittent fever. In regard to Dr. Furley's own case, it must be said that there is much ground for doubting the correctness of his statements. On the afternoon of the 30th of September I was at Einggold Barracks for two hours while the steamer from Brownsville, by which I visited the post, was stopping there. Dr. Furley was evidently very nervous and apprehensive; said that he was not^feeling well ; that he had been twice exposed to yellow fever, in the cases of Dr. Eeilly and Mr. Forbes, during the preceding week, and that he expected he would be sick. He was much jaundiced, with decided yellowness of the eyes, and had been talking much to other officers of his having the fever. Dr. Furley was taken sick on the evening of this day — Monday, September 30th — and became greatly alarmed. Dr.- Headley, of Camargo, was sent for, and visited and prescribed for him during the night, or on the .following morning, a fact not mentioned in Dr. Furley's report. Dr. Furley was given some blue mass and quinine, and on the following day was considered out of. danger. Dr. Headley declares that Dr. Furley did not have yellow _ fever, and his nurse now says the same thing. It is altogether probable that his disease was simply bilious fever, as stated by his physician. It is quite certain that no cases of yellow fever followed Dr. Furley's iUness at the post. Lieutenant Colonel Shafter, who is reported as the third case on the tabular report of Dr. Furley, arrived at the post on the afternoon of September 30th from Brownsville; was taken sick only 48 hours afterwards; his illness was not severe, and, undoubtedly, was not yellow fever. The fourth case on Dr. Furley's tabular report is of so doubtful a character as hardly to require notice. In addition to the papers already referred to, relating to the recent epidenlic at Eio Grande City and vicinity, it seems not improper to forward an official report of the cas'e of Acting Assistant Surgeon William E. Savage, U. S. A. Dr. Savage left Brownsville, where yellow fever was prevailing, on the 8th of Novetnber, arrived at Einggold Barracks on the 10th, was taken 100 EXTEACTS FROM OFFICIAL REPORTS. ill on the ISth, and died on the 21st of the same month.* There is so much in this case that is like yellow fever that it is still a matter of doubt in my mind whether it was not one of that disease. The prevalence of yellow fever at Indianola, Galveston, Corpus Christi, and afterwards at New Orleans, Louisiana; from all which places there is direct communication to the valley of the Rio Grande, was a sufficient warning during the months of June,. July, August, and September, that the epidemic might be expected to appear in this sub-district. With the comparatively few avenues of approach, viz : via th§ ports of Brazos Santiago, Texas, and Bagdad, Mexico, and the roads from Corpus Christi to Brownsville and to Rio Grande City, it was hoped that either the advent of the disease could be prevented by rigid quarantines, or that, by vigilant observation, the first cases of the disease could be noticed, and important and interesting facts ascertained as to the manner of its introduction from infected localities. To this end, very explicit instructions were given to the medical officer at Ringgold Barracks, from whom, as a result, the accompanying report has been received. It is to be regretted that the report is entitled to so little confidence, that such contradictory opinions regarding the epidemic in that vicinity are entertained by professional men, and that the statements of the'only physician (Dr. Headley, of Camargo) personally cognizant of all the facts, are not quite credible. Under these circumstances, it is thought best to forward the accompanying papers t as an appendix to Dr. Furley's report, to review them at length as I have done, and to give the results of a careful investigation of information received from all credible sources. The history of the recent epidemic in the vicinity of Ringgold Barracks may be summed up briefly in the following state- ments, which, I beUeve, contain all that can be relied upon as facts, and that can be accepted as quite well established by the evidence furnished : 1st. The prevalence of yellow fever, during the month of August, at Corpus Christi, the nearest infected locality, and the existence of rigid quarantine by land and sea, rendered it most likely that the disease, if introduced at all in the valley of the Rio Grande, would be so by the route from Corpus Christi to Rio Grande City, a distance of about 150 miles ; the roads between those places being the most travelled and most difficult to be efiectually guarded, as they are quite widely separated and pass through an open country. 2d. The quarantines established upon these roads, and other measures adopted, were so far efiectual as to delay the intro- duction of the disease for at least a month after it might have been expected to make its appearance, if it did so, by importation from Corpus Christi, had the roads from that place been unobstructed. 3d. Fevers of a malarial character were somewhat prevalent in all of the lower regions of the Rio Grande during the month of August, and became more general in September and October. ■• 4th. Yellow fever was introduced by importation to the vicinity of Rio Grande City as early as the beginning of September ; but while development of the disease by contagion cannot be traced and proven by such evidence as is furnished, still, at the same time, it cannot be denied that the disease may have been so developed. It also appears that it was not until the latter part of September that the diseases prevalent in the vicinity of Eio Grande City began generally to assume the type of yellow fever. 5th. Many of the cases commonly believed to have been yellow fever were not of that disease, but were purely pernicious or malarial fever ; many more were of a mixed ■character, complicating both types of the disease ; and not a few were well- marked, uncomplicated cases of yellow fever. 6th. The mortality from these diseases during the months of September, October, and November, among a population of about seven hundred people residing at Rio Grande City and the adjacent ranches within ten miles of that place, in the Rio Grande valley, was over one hundred deaths of persons whose burials were registered, and nearly or quite that number of those not registered, and who were buried at different places. Respectfully submitting the above-mentioned reports, together with my accompanying report for the post of Brownsville, I have the honor to be, very respectfully, your most obedient servant, EDWARD COWLES, Assistant Surgeon, and Brevet Captain, TJ. S. A. Brevet Major General J. K. Baknes, Surgeon General. Fort Bkown, Brownsville, Texas, January 20, 1868. GeKbral : I have the honor to forward herewith special reports of yellow fever patients at this post during the months of October, November, and December, 1867. It will appear from these reports that in the military force at the post there have been but four cases of yellow fever, all officers, and that all happily resulted in recovery. During the months named the fever prevailed quite generally in Brownsville, and the history of the epidemic presents some points of considerable interest. Soon after the appearance of yellow fever at Indianola, quarantine stations were established — on the 8th Of July — at the ports of Brazos Santiago and Brownsville, Texas ; and at Bagdad, Mexico, by the co-operation of the Mexican authorities. The regions of the lower valley of the Rio Grande being, comparatively, so much isolated, by wide tracts of nearly unin- ha,bited country, from all localities where yellow fever could be expected to prevail, and communication with such localities being held by sea via, the above-named ports, and by land via the long roads from Corpus Christi to Brownsville and Rio Grande City, the distance in either case being about 160 miles, it was hoped that strict quarantine upon these routes of travel would prevent the introduction of the disease. At the same time all sanitary measures possible were adopted to improve the hygienic condition of the city of Brownsville, and in compliance with instructions from the Headquarters of the District of Texas, a health officer was appointed for the city, and frequent and thorough inspections were made by him and myself. * Dr. CunyDghame's letter of NovemTDer 23(1, forwarded with this report, denies that Dr. Savage had yellow fever. • t These papers are not published for want of space ; their substance is emliraced in this report. * SUB-DISTI{ICT OF THE RIO GRANDE. 101 The recommendations made were ordered to be carried out and enforced by the military commander of the post of Browns- ville with very beneficial results, as far as the cleanliness and appearance of the city was concerned. The sanitary regulations in force in the garrison were continued with unabated care and vigilance by all the commanding officers of the troops and the camps at the post. As soon as it was known that yellow fever had appeared at Corpus Christi, quarantine guards were, on the 12th of August, placed upon the Corpus Christi roads where they cross, by several ferries, the Arroyo Colorado, which is a salt-water inlet extending many miles inland. These crossings are distant from Brownsville about 30 miles. At about the same date quarantine guards were also stationed upon the roads from Corpus Christi to Eio Grande City. All these quarantine stations were con- tinued, and their regulations rigidly enforced, until after yellow fever had declared Its presence in Brownsville in October. In regard to the quarantine at the ports of Brazos Santiago and Bagdad, they were so effectual, through the most commend- able efBciency and vigilance of the health officer at Brazos Santiago, Acting Assistant Surgeon Wm. E. Savage, U. S. A., now deceased, that it is believed that no elements of infectious or contagious diseases were introduced through those ports. In regard to the land quarantine, it did not so effectually obstruct travel by the land routes. During the months of August and September three or four persons arrived in Bi'ownsvUle from Corpus Christi, but such was the apprehension of the people here, and the vigilance of the health officers and other city authorities, that every such person is believed to have been reported and kept under observation. These persons were residents of the country, who, finding themselves unable to return here by sea, and having already had yellow fever an d not being afraid of it, did not fear to return by almost the only available route — by way of Galveston, Indianola, and Corpus Christi — by land. They were, in every case, a long time on the way, and it is believed that all were kept under observation at the quarantine stations until the period of incubation was over. No suspicion has been attached to these persons as carriers of the contagion from which the recent epidemic was propagated; nor has it been possible to trace to them, as sources of contagion, any of the first oases of fever that occurred in Brownsville in September and October last. During the month of August everything seemed promising for the continued good health of this community; the weather was pleasant and agreeable during the first eighteen or twenty days of the month, and the healthful southeast breezes prevailed. In this month occurred the usual summer freshet of the Kio Grande, and the river continued very high till the latter part of September. In the month of August there was also a great deal of rain, which fell continuously from the 19th for ten days, or till the 29th. All the lower Valley of the Eio Grande and adjacent country was almost literally flooded, and all the roads leading to Brownsville and Matamoras were, for many weeks, so bad that the amount of travel upon them was trifling, and they were at times quite impassable. The August rains ceasing about the 29th of the month, the water began to subside from the flooded country, but it was again very rainy for many .days from the 10th of Septemjjpr. ■• Nearly all commercial intercourse between Brownsville and places up the river was stopped during the months of August and September, in consequence of the importation of merchandise being obstructed by the quarantine. The only communication by steamer during these months, with the towns above, was one trip to Eio Grande City about August 16th, and one about Sep' tember 16th, and one to Einggold Barracks , which is below Eio Grande City, September 30th. After a careful investigation of the circumstances relating to this apparently possible means of importation of contagion, it must be admitted that no suspicion can be entertained of the introduction of any elements of disease by the river steamer from any infected locality. When the steamer was at Eio Grande City in August there was then, certainly, no yellow fever there. Again, in the middle of September it was not believed by any one at Eio Grande City that there had been any cases of the fever in that vicinity, except of some persons who came by ambulance from Corpus Christi and Were disposed of on the 3d or 4th of September, of whom an account is given in the accompanying report from Einggold Barracks. Furthermore, it is found impossible to trace any connection between these circumstances and the appearance of yellow fever in Brownsville. Upon the last-mentioned trip of the steamer it became known, just as she was leaving Brownsville on the 27th of September, that there had been some cases of the fever reported at Eio Grande City. The steamer touched only at Ringgold Barracks, and there remained about two hours on the afternoon of September 30th. Being present at the time, I am personally cognisant of 'all the circumstances, and can state as my firm belief, that the only possible means by which yellow fever could have been contracted by contagion by any one, was by personal contact with Acting Assist- ant Surgeon C. C. Furley, U. S. A., the post Surgeon, who was taken sick on the evening of the same day, after the steamer's departure. But it is my opinion, for which reasons are given in an accompanying report on. this subject, that Dr. Furley did not have yellow fever at all. I also believe that there was no disease, nor were there any elements of contagion, existing at Eing- gold Barracks on the afternoon of September 30th, to be communicated in any way to persons on board the steamer. Nothing can be found in subsequent events to indicate that yellow fever was conveyed to Brownsville by this steamer. In regard to the communication between Eio Grande City and Brownsville by land, a distance of about 130 miles, it was unobstructed during the month of September, no reason being known for placing any restriction thereon, except by the very bad and almost impassable condition of the roads, on account of which there was but little travel between the two places. But upon the recognition of the existence of yellow fever in Eio Grande City, an efficient quarantine guard was placed on the roads at a point 12 miles from Brownsville, and all communication between the two towns was prohibited on the 2d of October. At the town of Edinburgh, on the Eio Grande, about 75 miles from Brownsville, on the road to Eio Grande City^ there began to be some sickness from malarial disorders in the latter part of September, upon the subsidence of the waters after the August and September rains. The first death at this period occurred about October 12th; and subsequently there was much sickness and a few deaths, the number of inhabitants being small, and most of the sickness being among children. There is no physi- cian in that vicinity, and it is reported to me that it was not thought by the people, who are, with the exception of two families, all Mexicans, that there were any cases of yellow fever among them during the past season. Similar facts have been elicited with regard to the sickness at other points along the Eio Grande, between Brownsville and Edingburgh, and it appears that malarial disorders wojp very general among the people during the months of September, October, November, and December, but with little mortality. 102 EXTRACTS FROM OFFICIAL KEPOETS. Taking into consideration all the circumstances detailed above, and those connected with the first cases of yellow fever in Browsville, as far as they can he known, the results of all investigations made by well-infoi-med medical men in this vicinity, and hy myself, do not discover any facts, or even well-grounded suspicions, to indicate that the disease was imported to Browns- ville from any infected locality. During the month of August there was some sickness at the ranches along the river above and below Brownsville, and it seemed to increase somewhat in the latter part of September, upon the subsidence of the waters after the August and September rains. During this period the appearance of yellow fever was several times rumored, as was to be expected from the appre- hension that prevailed among the people of this vicinity; but in all cases, upon investigation, the sickness was found to be of a malarial character and with little or no mortality. In the city of Brownsville, however, and also in Matamoras, Mexico, a remarkable state of health existed during the months of July, August, and September. In Matamoras, with a population estimated at 12,000, it is reported that there were only five interments in the city cemetery in the month of August, and the mortality in September was also very small. On the 15th of September, the health officer of Brownsville reported that, from the 1st of July to that date, there had been only 23 deaths in a population of 5,000. Of these deaths, 13 were children, and in none of the cases was the disease of a suspicious character. There was an equally small rate of mortality from September 15th to October 7th, and none from yellow fever ; and at the latter date it was officially reported and generally believed that there had been no cases of yellow fever in Brownsville. On the 7th of October the lower valley of the Eio Grande was visited by a terrible and destructive hurricane. The storm came from the Gulf of Mexico and moved in a direction from about southeast to the northwest. Its path was about 80 miles in width ; its vortex passed over the cities of Brownsville and Matamoras, and it^ was about 20 hours in passing those places. On the mornmg of the 7th the wind began blowing from the northeast, and gradually increased in violence until midnight. There was then a calm for nearly an hour, when the wind began blowing from the southwest with appalling fary, and continued until morning, when it gradually ceased. The cities of BrownsvUle and Matamoras appeared almost entirely destroyed, and in fact there were very few houses left standing without being seriously damaged. There was no little loss of life, and many persons received severe injuries. All were more or less exposed, and in many cases the exposures of the night induced serioas illness. The rapid increase of sick- ness after the night of October 7th was attributed to the effects of the exposure during the storm, but on the 12th of the month it was announced that a German had died in Brownsville of yellow fever, and vrith the black vomit, and that there were several persons sick with the disease in different carts of the city. The number of cases increased, and in a few days the fever became decidedly prevalent. From the 9th to the 18th of October there were 20 deaths from yellow fever, and by the 20th the deaths were from 3 to 6 daily for several days. The mortality continued at about the same rate and became somewhat increased in the latter part of November. About the Ist of December there were in one day seventeen interments of persons who had died of the fever. It is estimated that at the end of 60 days after the appearance of the fever, or on the 9th of December, there had been at least 240 deaths; and on the 9th of January there had been at least 300 deaths. On the latter date frost appeared, and the dis- ease was suddenly checked, there being five interments on the 9th, four on the 10th, and none for many days after the 10th of January. Of those who had yellow fever, many were Germans, with whom it was especially fatal ; and a large proportion of the sick were unacclimated persons. The disease prevailed quite extensively among the Mexicans, who compose a large part of the popu- lation of the city of Brownsville, and who suffered much from exposure, insufficient shelter, and want of the necessaries of life, consequent upon their losses in the storm of the 7th of October. A marked peculiarity of the epidemic was the exemption of females fi-om the disease. Of 67 recorded deaths, that occurred in the practice of one physician, before the 20th December, 5 were females, and 10 were children ; and among females there was an equally small proportion of sickness. During the last 30 days of the epidemic, before the 9th of January, a very large proportion of the sickness and the deaths was among children. The epidemic is considered as having been mild in its character, and with all persons in a good physical and hygienic con- dition the rate of mortality was very small. Persons addicted to the use of alcoholic stimulants were, other things being equal, apparently most Uable to the disease, and were earliest attacked, and it was most fatal to them. In all fatal cases there was a decided tendency to gastric irritability, and in an unusually large number of these cases there was black vpmit. The plan of treatment quite generally followed during the epidemic was, to give the patient, upon the onset of the disease, a mercurial cathartic, to be followed in a few hours by a full dose of castor oil. Immediately upon being attacked the patient was well covered in bed after having a hot mustard foot-bath. Cooling applications were made to the head, when agreeable to the patient, and indicated by a tendency to cerebral congestion, and orange leaf tea was administered freely during the con- tinuance of the fever, Spongmg the body under the bed clothes was employed to allay the heat and dryness of the skin. Little nourishment was allowed, except rice water or barley water at the approach of the second stage, and afterwards fresh milk, chicken broth, or beef tea, as convalescence advanced. Nourishing enemata were administered in cases of gastric irritability. Small pieces of ice, lime water, with or without milk, and sometimes oreasote, &c., were employed to allay irritability of the stomach, together with sinapisms externally. In pursuance of this plan of eliminating the disease by the perspiration, urine, &c., nitrate of potash was also given for its action upon the kidneys, and to meet the perplexing symptom of suppression of the urine. Quinine was not given unless there were marked periodic exacerbations of the fever. Opiates in any form were avoided as dangerous, and no stimulants were allowed until convalescence was well advanced. The most absolute rest was enjoined during the progress of the fever, and little physical exertion was permitted until recovery was well assured. This plan of treatment was varied somewhat in many cases to conform to the theory of elimination of the disease by the lungs, and, to my mind, the results 4()peared to be quite as satisfactory as by the other method of treatment. Mercurial carthartics were not given, unless especially indicated by oonstipa- SUB-DISTEICT OF THE EIO GEANDE. 103 tion or irregularity of the bowels, and castor oil was also avoided as generally inducing nausea ; but instead of these a saline draught was given, (as sulphate of magnesia, half an ounce, and carbonate of magnesia, 15 grains — in solution.) The patient was well, but not heavily, covered to the neck in bed with a sheet and single light blanket, the object.being to promote gentle diaphoresis, and to keep the body as cool as possible without danger of chilliness after perspiration. An abundance of fresh air was provided by placing the bed in the centre of the room, with doors and windows open to allow sufficient but not too much draught; and the patient was also fanned if there was too little movement of air. Diuretics were regarded as of little avail in restoring the arrested renal functions, and were not given. This constituted nearly the whole treatment, and, in other respects, nearly the plan detailed above was pursued. On the 13th of October orders were issued stopping all communication between the garrison and the city, except by permis- sion to certain officers and orderlies to visit the headquarters of the post then in the city. This order was very strictly enforced until the epidemic had decidedly abated in the city; and no cases of the fever occurred among the troops, except those of the four officers reported, who all resided in Brownsville, excepting myself. On account of the total destruction, by the hurricane, of the post hospital under my charge, and the increased sickness among the trooops, consequent upon their exposure in the storm, extraordinary demands were made upon my time and strength, and I was greatly fatigued during all of the week after the 7th of October. I saw the sick man in the city on the 12th, who died the same evening with yellow fever and black vomit, and two or three cases of the fever among the quartermaster's employes came under my care on the 13th and 14th. I was attacked on the 15th instant, and did not resume my duties until nearly the middle of November. Brevet Colonel A. M. Eandol, Of the 1st U. S. Artillery, who was taken sick on the 27th of October, and Lieutenant John Gotshall, of the 26th U. S. Infantry, who was taken sick on the same day, were under the care of a physician at Brownsville. Brevet Lieutenant Colonel S. K. Schwenk, of the 41st U. S. Infantry, who was taken sick on the 20th of November, was under my own care, and though he was somewhat enfeebled by previous attacks of interinittent fever, and was in a v^y critical condition in the second stage of the fevei-, he fortunately recovered. These cases were all well marked, and in each there was like previous exposure. In each of them equally valid arguments can be adduced to support the theory of contagion or of infection in regard to the manner in which the disease was contracted. In other words, in each of these four cases, the disease may be believed to have been contracted by receiving contagion from persons sick with yellow fever, or, equally well, by visiting or residing in infected localities. • In returning now to the consideration of the circumstances connected vvith the origin of the disease, I am obliged to depend greatly for information upon the statements of physicians practicing in Brownsville, who have given me the results of their observations, viz : Dr. A. F. Watson, of Brownsville, and Dr. C. Macmanus, of Matamoras. These gentlemen have resided in this country for more than twenty years, and both served, at different tinies, as post Surgeons at Fort Brown. ^ The first suspicious cases of illness in Brownsville were two Mexicans, (male^) and occurred between the 10th and 15th of September, terminating in recovery. These two persons were natives of the place, and had not been away from Brownsville for two years. These cases are now stated by Dr. Watson to have been quite well marked, and I am unable to obtain any evidence to indicate that the disease was contracted by contagion. There was some sickness of a malarial character among Mexicans and others during the remainder of September, but the first case of fever, of a suspicious character, that came to notice after the two before mentioned, was a young man, an American, named Fisher. This man had but a short time before been discharged from Battery "L," 1st U. S. Artillery, and was employed as a clerk in the quartermaster's department at the time of his illness. Mr. Fisher was taken sick on the 23d of September and recovered on the 11th of October, and was also under the care of Dr. Watson, who regarded the case as undoubtedly one of yellow fever. The man had not been away from Brownsville for a long time before his illness, and it cannot be ascertained that he was in any way exposed to the disease, either by contact with persons sick with the disease, or by visiting infected places. These three cases, occurring in September, were not reported, and it was not until some time after the epidemic became pronounced that the, case of Mr. Fisher was spoken of publicly by his attending physician as being one very much like yellow fever. It is now asserted by him that the case was an undoubted one. Until recently I have entertained the belief that there had been no cases of yellow fever previous to the hurricane of October 7th, hut it is plainly evident from the statements above, that its existence in Brownsville previous to that event cannot be positively denied. At the same time, the assertion that there may have been a few unrecognized cases among poor Mexican people, who did not employ physicians, also cannot be denied. In whatever state or form the elements of the disease may have existed previous to the hurricane, it is certain that this untoward atmospheric tumult exercised a profound influence in developing the epidemic, and, as it were, expressed the disease from some epidemic infecting elements already in action. Yellow fever declared itself immediately after the storm, and, as before stated, its epidemic character was very rapidly developed. The first case recognized and reported as yellow fever resulted in death, on the 12tli of October, as has been before stated ; but the first death from the fever is now believed to have occurred on the 9th, at a place known as Mechanics' Boarding-house. This is a low wooden building, in which a few small, close, badly ventilated rooms, used as dormitories, were crowded with boarders, most of whom were Germans or Austrians. There were many of these Austrians about Brownsville at that time, who formerly belonged to the Mexican Imperial army, and who were especially obnoxious to the diseases of this climate, mth whom and the German residents yellow fever was very fata,l. There was some sickness at the boarding-house during the two weeks before the 7th of October, of a trifling character, and which came Under my immediate notice in attending several quartermaster's employds boarding there. The man that died on the 9th of October was an Austrian, who was ill a day or two before the hurricane, and is declared to have died of yellow fever by his medical attendant, a German doctor, who professes ,to have seen much of the disease at Vera Cruz and elsewhere. The second death from yellow fever occurred on the 10th, also of an Austrian, who died at the same boarding-house, and was under the care of the same doctor; his illness supervened upon exposure during the storm. A third death, with black vomit, also of an Austrian, occurred at the same house on the 12th, and is the one before mentioned as that first recognized and reported as yellow fever, and was unmistakable in its character. From this time this boarding-house was evidently an infected locality, and many deaths occurred there during the ensuing ninety days. 104 EXTRACTS FROM OFFICIAL REPORTS. The first recognized. case of yellow fever occurring elsewhere in Brownsville, and in a distant part of the city, after the hurricane, was that.of a young man (an American) employed by the U. S. revenue collector, who had an ordinary attack of inter- mittent fever on the 6th of October. He was greatly exposed to the rain and cold during the night of the storm. He became intoxicated on the following morning, and on the same day was attacked with a chill, followed by a fever, which terminated in death from black vomit on the 13th of October. .One other case (of a German) occurred, beginning before the hurricane with intermittent fever, from which the patient was apparently convalescent; but it assumed the type of yellow fever after, exposure in the storm, and resulted in recovery. There was another death from black vomit on the 13th, that of a house carpenter, (German,) who had not been away from Brownsville for two months, and who was perfectly well before his exposure diiring the stoi-m. The cases of yellow fever previous to the date of the 13th were of persons living in different parts of the city, and the disease did not appear to affect any particular locality, excepting, perhaps, the mechanics' boarding-house mentioned above. It is impossible to state with accuracy the number of persons attacked with yellow fever during the first seven days after the hurricane. It can only be said that before that event the amount of sickness in Brownsville was trifling, with only the few suspicious cases before mentioned, but immediately afterwards the sickness was suddenly and largely increased ; and that there were at least five recognized cases of yellow fever on the 13th, eight on the 14th, and as many on the 15th. In fact, the arrangements made for securing thoroughness of investigation and accuracy and completeness of reports of cases of yellow fever were overthrown in the confusion consequent upon the hurricane, and little reliance can be placed upon the imperfect city re:!ords of sickness and mortality during the period of the epidemic. In the neighboring city of Matamoras, two miles distant from Brownsville, yellow fever prevailed to feome extent, but there was much less sickness there than on this side of the Rio Grande. The disease did not make its appearance in Matamoras until after it had declared itself in Brownsville. It is stated, on good authority, that very many of the oases of yellow fever occurring there were of persons who had left Brownsville to escape the disease, and that in the houses in which they were sick or died no second cases occurred. It cannot be shown, however, that yellow fever was developed in Matamoras from elements of the disease conveyed there from Brownsville ; and similar phenomena were observed in Matamoras'to those in the neighboring city in regard to the non-existence of the disease before the hurricane, and its subsequent apparently spontaneous origin there. In considering the events of the past season, in regard to their bearing upon the question of the introduction of yellow fever U) this vicinity by importation from some infected locality, or of its apparently spontaneous origin here, I have to refer to the foregoing statements and details in this report as all the facts relating to the subject that I am able to obtain. I cannot find any evidence that the disease was imported here and developed by contagion. It can be said that the disease may have been thus introduced in some unknown manner ; but, granting this, no satisfactory evidence can be adduced from the facts observed to account for its development from such imported contagion. It is, probably, hardly to be doubted that several cases of disease manife3ting the type of yellow fever occurred before October 7th, but I cannot believe that the sudden and wide-spread develop- ment of the disease after the hurricane can be accounted for on the theory of contagion. The facts as observed rather indicate that there may have existed an atmospheric epidemic influence, affecting especially the crowded and unhealthy localities in the city. This infecting element may have made its advent with the hurricane, or, if existing before, was then greatly augmented in virulence ; while,, at the same time, the people were made more susceptible by being generally subjected to great physical exhaustion and the reaction from fear and mental excitement. I have the honor to be. General, very respectfully, your obedient servant, EDWARD COWLES, Assistant Surgeon, and Brevet Captain, U. S. A. Brevet Major General J. K. Baknbs, Surgeon General. Ringgold Barracks, Texas, October 20, 1867. General : In my letter of September 4th, you will recollect I reported that upon my arrival here in the early part of Aug-ust, I recommended the commanding ofiicer at this post to stop all communication with Corpus Christi and other infected neighbor- hoods by putting guards upon the most frequented roads between those places and Rio Grande City. In accordance with these suggestions, this was done in time to prevent the entrance of an infected merchandise train, from which two persons subsequently died of yellow fever, near our quarantine station. The mail rider, who arrived from Corpus Christi about the same time, and was ordered back without his mail being opened, died of that disorder during his trip. I have the honor, also, to recall to your memory the fact, then mentioned, of the arrival of an ambulance containing three pas- sengers from Corpus Christi, which, by making a detour of fifteen miles north, had avoided our quarantine guards. Two of these passengers, all of whom were ill of yellow fever, were left at a point above, and crossed into Mexico, where one of them is known to have died. The third, and owner of the carriage, passing down to his residence at Rio Grande City, was seen and sunt half a mile from town, where he died during the succeeding night from that disease. The citizen (Merrick) who warned him off, and, no doubt, came in contact with him, an old resident, habituated to yellow fever, and thoroughly acclimated, was, on the eighth day afterward, taken ill, and this was probably the first case of yellow fever in town, though, from fear of isolation by the military quarantine, and in part from the pecuniary interests of the few American inhabitants of the place, it was kept strictly secret. The family of the deceased person who had been with him during his illness, consisting of four adults and two children, after taking some blankets from the carriage and remaining a part of the night with some friends (named Garcia) at a ranch near the spot, fearing a rigid quarantine for themselves, crossed the Rio Grande into Mexico, having first sold the blankets which had been used by the deceased during his illness to the friends with whom they stopped during the remainder of the night. All this family, with the exception of one child, died of yellow fever. One other person, who, though not a clergyman, officiated as confessor to the SUB-DISTRICT OF THE RIO GRA.NDE. 105 dying man, fearing isolation, went to a ranch about four miles down the river, on the American side, where, some days afterwards, he was taken ill and died, it is supposed from the effects of the same disease. This one, and those of the Garcia family, six or seven persons, mentioned above, were the first deaths from yellow fever, but not known to be that disorder, because the connec- tion between the Corpus Christi cases which occurred in the ambulance was not established, and, being poor Mexicans, no physi- cian was consulted. These'parties, vnXh the exception of the two left up the river, were all Mexicans, and ihe evidence, thus far, of direct infection, is reliable. The ambulance, a private conveyance which had conveyed the disease to this locality, was burned during the day, after the death of its owner, on my recommendation, by order of Brigadier General Mackenzie ; and it was supposed that the entire contents of the carriage were at the same time destroyed, and it was not for some time subsequently that the sale of the two blankets mentioned above was ascertained from the surviving member of the Garcia family. About the third week of September the mortality in Rio Grande City, which is about the third of a mile from these barracks, and said, according to good authority, to contain about seven hundred and fifty inhabitants of all ages, began to assume an alarming increase, but was entirely confined to the Mexican portion of the population. About the same period Dr. B. S. Reilly, late an Acting Assistant Surgeon, stationed at this post, informed me that he had seen and treated three cases of yellow fever in one jacal, (hut,) but on an inquiry being made of him a short time afterward by the commanding officer, he denied its being yellow fever. Inquiry made of citizens at the same period brought out the statement that it was not yellow fever, but a bilious remittent fever, usual every fall. No more attention was paid to the subject until September 23d, when a citizen was sent to the post hospital by Brevet Brigadier General Mackenzie, commanding the post, without my knowledge. The patient, F. H. Forbes, a former employe of the quartermaster's department, being sick in town, was sent into the hospital as stated. On hearing of his admission about four or five hours afterwards, I visited him, arid, suspicious of his appearance, cautioned the hospital steward ; and when the disease developed itself, I had the greater poKtion of the bedding removed from the ward. A short time afterward, the unmis- takable black vomit appearing, the hospital was at once vacated, and the patients put into tents. The patient died during the night, and was buried two hours afterward. The hospital was then closed and thoroughly fumigated with sulphurous acid, and no person permitted to enter the building. Some of the clothing of the three soldiers (blacks) acting as his attendants, together with all the bedding contaThed on the patient's bed and the two adjacent ones, was burued, and it was expected that these promjit steps would prevent its further development at these barracks. The second case known as yellow fever, occurring in the neighborhood, was that of Dr. Reilly, at Rio Grande City, who was taken ill on Sunday or Monday, September 21st or 22d, and died September 27th. Dr. Headley, of Camargo, Mexico, who attended him throughout the night of September 26th, and until he died, pronounced this a case of yellow fever, as did a number of citizens who had before seen and nursed the disease. The following Saturday, October 4th, Dr. Headley was taken ill at his home in Camargo, and on the 9th day succeeding his attack, October 13th, his wife, Mrs. Headley, who attended him through the first night of his illness, was taken sick with the prevalent disease. Another case may be mentioned of an American named Garner, who was the sleeping companion of Forbes for about ten days previous to his illness. This person was taken during the middle of the week and died on Saturday, September 27th, the same day as Dr. Reilly. Mr. Dallas, on Tuesday, September 23d, brought my patient Forbes to the hospital in a- buggy and was taken ill on the following Monday night. On the same day, September 29th, I was taken ill, it being the seventh day after the admission of i'orbes to the hospital. There being no physicians of easy access, I had recourse to a merchant who had spent the summer in Corpus Christi, where, "having recovered from the disease, he acted as a volunteer nurse and saw a large number of cases. His idea of my appearance was that the disorder which manifested itself was yellow fever. The skin, though not presenting a marked appearance, was, I have been told since by officers, very slightly tinged; and the eyes, according to my nurse, the merchant spoken of, presented a peculiar appearance. Pain over the inner canthus of the eye, which seemed to reach to the back of my head, where it was most intense, was the most noticeable symptom to me. Tenderness over the stomach and liver were reserved until the third or fourth day, and not very marked. The icteroid hue of the skin became very plain, and the ey^s somewhat more highly colored about the same period. I have followed the origin of this disorder here more closely, and have taken pains to ascertain the facts more particularly, because many seemed at first to question if this was yellow fever. Some of the citizens insisted that it was not ; but a remit- tent fever, with a jaundiced condition of the skin and eyes, and, in fatal cases, a vomiting of blackish matter, but not the real black vomit of yellow fever. Others, quite as intelligent, as strenuously asserted that it was yellow fever, of which they were com- petent judges, having seen and nursed jt through repeated epidemics. The first case recognized as yellow fever in this vicinity was that of the citizen Forbes, which occurred in this hospital, and whatever the citizens in town may determine their epidemic to have been, it is none the less certain that it was an infectious disorder presenting many of the characteristics of yellow fever. Never since the last epidemic of yellow fever in 1858 has the mortality at this place been one-tenth as severe as during this fall. The little graveyard of Rio Grande City, for the thirty days ending the middle of October, showed over eighty new-made mounds, speaking louder of the mortality for that month than any statistics that could be arrived at in such a community. The first nights of October we're ushered in with quite chilling weather, and, either from want of more material, which some assert, or the effects of a few nights at a temperature about forty -five degrees, the disease seems to have abated, and we hear of scarcely any new cases, though I am told six or seven deaths have occurred during the past week. The commanding officer of the post, as soon as the first case was discovered, was recommended to prohibit communication between the garrison and the citizens, and isolation of all suspected cases ; a cordon of sentinels completely around the garrison accomplished this object, making ingress and egress impossible. My own case being the only one that subsequently occurred, I received the full benefit of my own suggestion, by having sentinels placed a short distance off entirely around the building which I occupied during my illness. Two other cases were reported during my illness : the first was that of Colonel Shafter, who was taken ill on the second day after his arrival at the post, but, according to my mind, with none of the symptoms of the yellow fever. The other was tliat of 14 106 EXTRACTS FROM OFFICIAL REPORTS Private Alexander, (a negi-o,) a nurse, who liad been exposed, and may, perhaps, have had a slight attack; but I think his case was called yellow fever on too slight grounds. I have the honor to be, very respectfully, your obedient servant, CHARLES C. FURLEY, Actinfj Assistant Surgeon^ U. S. A. Brevet Major General J. K. Baknes, Surgeon General. JEFFERSON, TEXAS. Jefpbkson, Texas, November 30, 1867. Genekal : I have the honor, respectfully, to report as follows upon the appearance of yellow fever at this post : Sergeant Joseph Hogan, Company " D," 20th U. S. Infantry, arrived here on the evening of the 22d ultimo direct from Baton Rouge, La., by steamboat direct from New Orleans, (where he had gone about one month previous as witness at a court martial,) with no apparent symptoms of disease but those of the character to which unacclimated persons are so subject in this climate, and similar to attacks he had had during the season. Several days previous to his departure he was seized with a violent attack of vomiting and retching, which recurred, while en route, several times during the day, but less violently. It is my opinion that what he had here was a relapse, the disease having been contracted at Baton Rouge, La., and that he had gone through the first and a portion of the second stage before arriving here — in a very mild form, however ; three prominent resident physicians whom I had in consultation fully concur with me in this. It is my opinion, further, that his was a sporadic case, as he was not directly exposed to any contagious influence, it not having been epidemic at Baton Rouge, La., nor was there even a case there so far as I can learn ; neither were there a case on board the boat which brought him here. Though the season was far advanced and our camp distant four miles from the city, upon a high and open site, yet every precaution was taken to prevent its spreading, by isolating those who had been directly exposed upon sites to leeward of the camp, keeping large fires burning continually to windward of it, and administering quinine and whiskey as a prophylactic to the well portion of the command three times per day for the period of two weeks. Out of five who were directly exposed, but one took it; this case was of a very mild form, recovery was rapid and without one untoward symptom, having used no other treatment than that known here as the domestic. I am. General, very respectfully, your obedient servant, A. L. BUFFINGTON, Acting Assistant Surgeon, V. S. A. Brevet Major General J. K. Barnes, Surgeon General. lVE\r IBERIA, l,Oi;iSIANA.* [Extract.] New Iberia, La., Octoler 1, 1867. Generai>: r have the honor to acknowledge the receipt of Circular No. 5 on epidemic cholera, it being the fourth circular that has reached me since I have been here. Having been sent here by the Surgeon-in-Chief of Bureau R., F. and A. L. to assist in the relief of the sick and destitute freedmen during the terrible epidemic of yellow fever, there being no acting Surgeon besides, I have taken them from the post ofBce. The command at present is removed, for safety, some fifteen miles from this place, their acting Surgeon having died lately. Most respectfully, WM. M. MILLER, Acting Assistant Surgeon, U. S: A Brevet Major General J. K. Barnes, Swrgeon General. * With regard to the origin of the epidemicat Now Iberia, see also the New Orleans report of Brevet Major H. E. Brown, Assistant Surgeon, U. S. A. NEW ORLEANS, LOUISIANA. 107 NEW ORLEANS, LiOlJIISIANA. Hbadquabtbks Fifth Military Distkict, New Obleans, La., May 29, 1867. General: I have learned from a reliable source that yellow fever is prevailing in the harbor of Havana, island of Cuba, and call your attention to this fact, so that you may put the troops of your command in the best sanitary condition, as the epidemic may reach here at any time, owing to neglect of the proper authorities to establish quarantine regulations. I am, General, very respectfully, your obedient servant, P. H. SHEEIDAN, Major General, U. S, Army. Brevet Major General J. A. Mower, Commanding District of Louisiana,, New Orleans, La. Circular Letter addressed to the Medical Officers serving in the Fifth Military District. Headquarters Fifth Mii.itaey District, Medical Director's Office, New Orleans, La., June 17, 1867. Sir : Your attention is invited to Circular No. 3, Surgeon General's Office, April 20th, 1867, with the suggestion that the attention of the post commander be drawn to the propriety of selecting, in advance, proper sites for " quarantine of observation' alluded to therein ; and for a temporary separate encampment of his own command in addition, should the outbreak of cholera or yellow fever necessitate its removal. Care should be taken to insure these places being kept in a fit state for occupation by troops, and with a sufficient supply of wholesome water available on each. Camp equipage should be at hand if no buildings are available. • Where it is possible to choose, the highest places should be selected, and the dryest and hardest ground, such as the ridge of a watershed, and never excavated or moist ground, for encampment of troops or site for hospitals. The recession of surface water, and the consequent drying of impregnated porous soil that has been thoroughly soaked for some time, appear to be of the greatest weight in determining the time of outbreak of a cholera epidemic. In river channels, in valleys, and at the feet of steep declivities, the above three factors are often in combined action, since these conditions of surface promote the formation, collection, stagnation and variation of surface water.* Against peculiarities of soil, surface water, and poisonous impregnation, scarcely anything can be attempted at short notice ; when the intrbduction of cholera geims coincides with the presence of these three factors in an unfavorable sense, there is nothing to be done — save disinfection — but to avoid or desert the locality. A judicious preference of high levels with compact subspil is the more important when it is impossible to insure perfect disinfection of all excreta. The use of lime, chloride of lime, and alkalies for disinfection of excrementitious lluid or other such matter should be discontinued, and copperas, carbolic acid, or other agents, used instead to produce an acid reaction. As it is probable that the alkaline condition is essential to development of the germ or poison of cholera, the retardation of this reaction, or its complete neutralization, if the alkaline condition has been already produced, is to be secured by systematic daily use of sulphate of iron and carbolic acid, articles which are cheap and easily procured. The most complete possible removal of .all exposed organic remains and foul substances from the vicinity of human dwellings, and the destruction of all worthless and suspicious refuse, should be strictly enforced, but always with a preceding thorough disinfection. The excreta, urine, and vomited matters should be received in vessels already disinfected ; all buckets, uteiTsils, water- closets, cesspools, sewers, pipes, &c., that may have at any time contained them, as well as soiled hnen, clotljing, or wooden floors on which excreta have been spilt, should be thoroughly disinfected and purified. The intestinal contents of cholera corpses and everything soiled by them must be similarly disinfected. Copperas and chloride of manganese (containing iron) would injure clothing and floors by rust stains. Solutions of carbolic acid in water or the salts of zinc have not this disadvantage. Carbolic acid leaves a very persistent odor, so that for linen and such matters watery solutions of sulphurous acid or of sulphate or chloride of zinc may be preferred. Whatever articles of bedding or clothing have received infected matters from patients, and cannot be readily disinfected, should be destroyed by fire. Places where cholera or yellow fever prevail should generally be avoided by troops on the march, and they should encamp in the neighboring open country rather than go into quarters in an infected town. If quartered in the healthy section of a larg^ city, all traffic with the infected districts therein should be prohibited. Cases of diarrhoea should, if circumstances allow, be treated in an isolated premonitory ward, the dejections being disin- fected. A special hospital at some little distance, or, still better, tents or huts, should receive cases of suspected epidemic disease, especially of cholera or yellow fever. Prompt isolation and disinfection may prove to be protective of the command and no dispersion become necessary. The greatest care and attention should be given, therefore, to these objects, as the inconveniences and difficulties inseparable from a removal are great, although the contingency may have been anticipated, and under the best circumstances. * Note. See rules for the guidance of sanitary authorities, practitioners, and the public during the prevalence of epidemic cholera, hy the Pro- fessors Dr. W. Griesinger, Dr. Max Von Pettenkofer, and Dr. C. A. Wunderlich— Appendix to Half-yearly Abstract Medical Sciences, Vol. XLIV, July— Dec, 1866, quoted here and elsewhere in this paper. 108 EXTRACTS FROM OFFICIAL EEPOETS. If a decided outbreak, however, occur in tlie barracks, especially of cholera or yellow fever, (indicating an epidemic tendency in an unmistakable manner,) it will be proper to evacuate Ihe premises, and then no delay should attend the movement; the sick with ordinary diseases being also taken away, to share the benefit of removal from the infected atmosphere. The command should not return until the epidemic has ceased. The barracks should not be reoccupied until they have been thoroughly fumigated, disinfected, ventilated and purified. ^ Should cholera or yellow fever follow the troops, they should be moved short distances every second or third day without fatigue to the men, at right angles, if possible, to the prevalent wind and track of the disease. Wood fires, if necessary, can be maintained to the windward of camp. A camp once left should not be returned to again if another can be selected. Separate the sick and place the hospital tents to leeward. The excreta should be buried deeply and covered with earth by a special party with a non-commissioned officer in charge. Take care in moving to cover effectually everything liable to make the place a focus of disease for others. During the removal the men should not sleep on the ground or in damp places; cots should be carried, if possible. The prevision of the commandei- for this contingency mil diminish the amount of exposure and consequent sickness among the men. The daily use of disinfectants should be continued throughout the season, and will assuredly tend to lessen the tendency to grave types of disease and promote the general health and efficiency. At all times let the best water be secured, and see that the supply is daily as pure as possible. When cholera approaches every person should carefully avoid all influences which his experience tells him are likely to produce diarrhoea, and if attacked should immediately seek medical aid. I'requent daily visitations of the healthy, so as to detect all illness at its commencement, has, in all epidemics, been of the greatest benefit to the people. Tainted provisions should be avoided, diet should be moderate, clothing should afford sufficient protection from cold without checking transpiration. Being chilled will often drive the circulation from the surface of the body and occasion congestion of internal organs, or catarrh of the mucus membrane. The abdomen should be warmly clothed, which can be suitably done by a flannel bandage. Good beds and .clean linen are important aids to uninterrupted transpiration. Long continuance in a confined air (as in a dwelling) which withdraws too little water and carbonic acid increases the disposition io cholera. The absence of fresh air, bad ventilation (as in ships) in crowded barracks, prisons, or rooms too small for the number of inhabitants, have been shown by much experience to be a frequent cause of violent choleraic outbreaks. The perils frequently, but erroneously, ascribed to too great a current of air ("draught," as it is termed) may be obviated much better by clothing, bedding, heating, &c., than by shutting up the doors and windows. Ventilation improves foul air and dilutes all foreign matter it contains. The use of chloride of lime in rooms containing tainted air has long been customary, but there is no proof of the smallest benefit from it. The evaporation of vinegar or acetic acid may be supposed to exert some little power as a disinfectant, and at the same time diffuses, an odor agreeable to the sick. When the introduction of cholera is feared, we ought not to wait with our disinfectants until the epidemic character of the outbreak has been shown in several houses and cases. The acid reaction produced in the excreta should be maintained until they can be moved away from the vicinity of human dwellings : they should be deeply buried. The concealment or neglect of the first case of cholera is one of the greatest errors, and usually occasions more injury than can be retrieved by the greatest efforts and sacrifices. The vigilant enforcement of sanitary measures is particularly necessary in a southern climate, and if yellow fever, like cholera, maybe considered to be a foecal disease, we may presume that successful efforts directed to the prevenfion of one disease are prophylactic with regard to the other. I am, sir. Very respectfully, your obedient servant, T. A. McPARLIN, Surgeon, and Brevet Brigadier General, U. S. A., Medical Director Fifth Military District. Report of the Epidemic of Yellow Fever in New Orleams, La.., during 1867, by Brevet Brigadier General T. A. McParlen, Surgeon, U. S. A., Medical Director Fifth Military District. Medical Director's Office, Fifth Military District, New Orleans, La., May 15, 1868. General : I have forwarded to your ofBce, at different times, all reports received from the medical officers upon the diseases prevalent at their stations. The reappearance of yellow fever and cholera in this district in 1867 gives the subject unusual interest, especially in regard to yellow fever, which commenced early, spread widely, and proved fatal to many thousands. In 1866, Asiatic cholera, newly imported, rapidly spread after June, and was tlie prominent and most fatal disease. Yellow fever did not appear until late in August, 1866, and though the individual oases were severe, its greatest mortality did not exceed seven per day. The lateness of the season, the advent of cold weather, (which was earlier in 1866 than in 1867,) and the presence of cholera, may have contributed to prevent it becoming epidemic in 1866. Cholera reappeared here June, 1867. It assumed, in July, an alarming character in one precinct, and called for very energetic action on the part of the civil authorities. It then declined and almost passed out of consideration until autumn, when, as yellow fever declined, cholera again increased to sixteen deaths per day. Five hundred and eighty-one citizens died of the disease in 1867 compared with 1,180 in 1866. Five soldiers died in 1867, (average mean strength of the command 1,140,) as compared with 173 in 1866 among United States troops in this vicinity. NEW ORLEANS, LOUISIANA. 109 , In anticipation of an epidemic, disinfectants were distributed to the stations in the spring, and recommendations made in April to establish quarantine stations in Texan ports, and maintain quarantines of observation after May 1st, 1867. In Louisiana, civil quarantine stations, regulations, and oflSoers were already in existence under State laws. The public press had reported yellow fever at the Isthmus of Panama in March, and also in May at Nassau, St. Thomas, Jamaica, Guayaquil, Buena Ventura, Havana and Vera Cruz. There were 68 cases and 18 deaths reported on the steamer Resaca en route from Panama to San Francisco in July. * At Havana, and especially in Vera Cruz, which had been some time a besieged city, the disease prevailed severely. From both places there were arrivals at this port as well as from Indianola, where yellow fever had been introduced by arrivals on the schooner Santa Margarita, which left Vera Criiz the 11th of May and arrived May 21st. There was no quarantine attempted anywhere in Texas until July, and in Louisiana, although it may have been enforced generally by quarantine physicians with especial vigor, it is true that passengers from several infected localities passed up to this city, without being detained as saspected, until July. The fever broke out in Indianola in May, 1867, and though many were dying in June of the disease, the fact was not known elsewhere until late in June, perhaps July, when passengers from Indianola had sickened and died at Galveston, South West Pass, mouth of the Mississippi river, and New Orleans. The fever appeared at the Mississippi river, the principal quarantine station, July 1st, viz : 4 cases on the brig Virginius from Havana. It did not, however. Visit the colored troops and white officers at the forts a few miles below quarantine, viz : Fort Jackson and Fort St. Philip. Neither did it appear at Fort Pike at the Rigolettes. If the disease be propagated by an atmospheric wave, it might be expected to have affected some one of these localities. The only stations in the State of Louisiana where the troops were affected to any extent were those at and adjoining New Orleans. The troops here; when yellow fever appeared, were quartered as follows : Commercial Hotel building, corner Tchoupitoulas and Girod streets, 1st district. Companies " C," " G," and " H," Ist U. S. Infantry ; Sailors' Home building, comer Tohoupitoulas and Erato streets, 1st district. Companies "A," and "B," 1st U. S. Infantry ; Cotton Press building, comer Cotton Press and Love streets, 3d district, Company "Q," 6th U. S. Cavalry; Jackson Barracks, six miles from the centra] portion of the city but adjoining the city limits, Companies "E." "P," and "K," 1st TJ. S. Infantry, and Battery "K," 1st XJ. S. Artillery. Three Companies ("C," "G," and "H") 1st Infantry were moved from Commercial Hotel to Jackson Barracks August 28th, 1867. Companies "A"' and "B," 1st XJ. S. Infantry, quartered in the Sailors' Home since March 29th, 1867, and the post band, were moved, August 17th and 18th, 1867, to Greenville Barracks, being the late General Hospital pavilions connected with the post hospital at Greenville, distant six miles from the central portion of the city. Greenville Barracks, headquarters band, and "H" and "I" Companies of the 39th U. S. Infantry, colored regiment, numbering 25J5 men, occupied the pavilions not in use as hospital wards. At Greenville, 79 colored recruits of the 9th U. S. Cavalry, and 16 recruits of .the 41st U. S. Infantry, were encamped several hundred yards from the hospital. In consideration of the previous use of the building, and the unhealthfulness of the locality, the troopsin the Sailors' Home were observed closely in the expectation that disease might appear there early, and as soon as there was reason to believe a local cause might be operating, the building was vacated. Dr. Brown, in his report, states that the Sailofs' Home was occupied in 1865 and 1866 as a yellow fever hospital for the naval vessels stationed at New Orleans. Dr. Heber Smith details the history of the occupation and use of the building. His letter is enclosed. It would appear that it was during the summer and fall of 1864 that there was so much fever in the squadron, and that yellow fever patients were received from the ships until late in the winter. Fatal cases occurred there as late as February, 1865. He thinks there were no cases of yellow fever admitted in the summer of 1865, and that no new patients were received for several weeks before it was finally broken up, patients being transferred to Pensacola at different times, as they were able to travel, before the hospital was broken up, October 1st, 1865, and the appurtenauces removed. It was feared that yellow fever would again prevail in 1865 if this course was not pursued. The Sailors' Home was vacant in 1866, I believe. It was first occupied by U. S. troops March 29th, 1867 ; July 20th, August 3d, 4th, 7th, 8th, and 9th, single cases of fever occurred at the Home. On the lOlh, two cases; on the.l2th, four cases; after which it was determined to evacuate the building. The troops were transferred thence to Greenville, a few miles above the city. The troops at the Commercial Hotel were moved, not because there was necessity for vacating the building, but as the disease was extending in the city, and likely to invade these quarters, they were moved while still considered a healthy command to the barracks, in order to be out of the city, and at the same time to be near to hospital accommodations for prompt treat- ment. After August 30th the troops, except Company "G," 6th Cavalry, which, being in the 3d district, was not far from Jackson Barracks, were out of -the city, and convenient to the principal hospitals. The necessary duty to be done in the city, however, brought the men back and forth to the city, and in the hot sun. The admissions to post hospital Greenville of cases of yellow fever early in the season were of soldiers serving in New Orleans, and did not originate at Greenville. The period of extreme severity among the troops, when the number of daily admissions of new cases and deaths were largest, continued from the 15th to 30th of September. As the epidemic advanced additional medical attendance became necessary. Assistant Surgeon Cronkliite, and Acting Assistant Surgeons Mauran and Tonner, were sent to Galveston; Assistant Surgeon C. B. White, September 5th, and Acting Assistant Surgeons J. d: Johnson, September 14th, Z. P. Doehnler, September 20th, J. T. Payne, September 26th, and Charles Lodge, October 2d, were sent to Jackson Barracks for duty. The following Acting Assistant Surgeons were sent to Greenville for duty in and near the New Orleans post hospital : Dr. J. J. Auerbach, August 12th ; J. T. Scott, September 16th ; Heber Smith and Charles Pelaez, September 23d ; F. A. Wilmans, September 26th ; and J. O. Taylor, October 22d. The o-reatest virulence of the disease seems to have been manifested in the following commands : Indianola, where, out of 29 cases 14 died ; Henipstoad, 55 cases, 29 died ; Galveston, 207 oases, 82 died ; Houston, 71 cases, 25 died ; New Orleans and 110 EXTRACTS PROM OFFICIAL REP.OETS vicinity, 822 cases, 218 died ; Victoria, Texas, 18 cases, 4 died. It is proper to remark that only 18 cases and 9 deaths occurred in the whole of the commands serving in the District of Louisiana outside of New Orleans. The number of citizens who died in Galveston of yellow fever was 1,170, and in New Orleans, 3,107. The disproportion in the popidation between the two cities evidences the excessive fatality of the disease at the former place. I am of opinion, however, that many died in New Orleans of the prevailing disease who were erroneously reported as dying of other diseases. The mortality by fevers in New Orleans during the year was 4,076, and from all causes, 10,096. The aggregate number of yellow fever cases belonging to the army, serving in the States of Louisiana and Texas, and in Ship Island, Mississippi, dm-ing the season, was 1,237, and the deaths 384. During the year the total mortality from all causes in the army serving in the Fifth Military District was 592. John Cowarts, the first fatal case reported in New Orleans, died June 10th, with black vomit, in the Charity hospital, a day after admission ; he came from No., 261 Circus street. Three weeks before his death he had shipped a% sailor on the Italian hark Bessie, loading with Staves in the 4th district for Barcelona. The vessel came from Havana March 25th, 1867, loaded with sugar; arrived in New Orleans April 22d, and went into dry-dock at Algiers for repairs before loading with staves, having been damaged while coming up the river. Second case, John Eoddis, Dr. Brickell reports as taken sick on St. Charles street, near Julia street, on the 13th of June ; he recovered. Third case, H. A. Gelston, reported, by Dr. Folwell, sick on Julia street, between Camp and St. Charles streets ; he died June 23d. Fourth case, John Bonanan, arrived from Galveston on steamer Hewes ; sick in Galveston on the 19th with chill; arrived at New Orleans stock-landing 21st of June, and went to the Texas Hotel, at the head of Napoleon avenue; he died June 26th with black vomit. Fifth, John Dougherty, died at Charity hospital 29th of June — brought from No. 61 Girod street ; he was employed near the shipping on coal barges at Algiers. Lieutenant Orville Dewey, U. S. A., died of yellow fever, June 30th, at the St. Charles Hotel ; he had arrived from Indianola on a steamer a few days previous. June 30th, Mrs. Hooper, wife of the captain of the bark Florence Peters, died of yellow fever; arrived at Algiers from Havana and quarantine about June 22d. The bark left Havana June 3d loaded with sugar. Mrs. Hooper was- sick on arrival at Algiers, opposite New Orleans. Dr. Barnes, who visited Mrs. Hooper, reports the following cases of the disease connected with the bark Peters : Mrs. Hooper's sister, taken sick June 25th, recovered ; Mrs. Hooper's babe, taken sick June 26th, recovered ; Mrs. Hooper's son, taken sick during the same week, recovered ; 1st mate of the Peters, taken sick about June 30th, recovered ; 2d mate of the Peters, sent to Charity hospital, and died July 9th ; Captain Hooper, of the Peters, taken sick July 7th, died July 13th ; Seth Yorke, who had visited the Peters frequently, died at Charity hospital of yellow fever July 25th. The remainder of the crew, si.'c sailors, disappeared, and no trace has been found of them. Captain J. D. Bell, Texan stock-trader, who came passenger on the same steamer with Lieutenant O. Dewey, was visited by Dr. Wood, June 30th, at the Stock-landing Hotel, being then in the third day of his attack of yellow fever. In the same house, Bonanan, Dr. Greenleaf's patient, died the day previous to Captain Bell being taken sick. Captain Bell recovered. Captain Pennington died July 19tli of yellow fever; I believe he was Captain of the bark Frank Marion, which arrived in New Orleans from Cardiff about the 22d of June. He was a patient of Dr. Wood. July 1st, four cases of yellow fever were brought to the quarantine station, arriving on the brig Virginius, from Havana, after eight days' passage. During their detention two other cases occurred. Private Benjamin Miller, 1st Artillery, taken sick at Jackson Barracks July 1st, died July 8th, of yellow fever. Private Charles H. Wurtz, taken sick July 11th with yellow fever at Jackson Barracks, recovered. Private John O'Neil, Company "G," 6th TJ. S. Cavalry, was taken sick July 5th, in New Orleans, and died July 13th of yellow fever, at post hospital, Greenville. Private Francis Zimmer, Company " H," 1st U. S. Infantry, reported July 22d, and died July 25th of yellow fever, at Greenville. Thomas Kelly, age 30, born in Newfoundland, longshoreman, last at sailor's boarding-house. No. 373 Victory street, near Pontchartrain railroad depot, came from New York, had been twelvemonths in the city, was admitted to Charity hospital July 32d, and died the same day of yellow fever. Peter Ferrell, age 21, came sick from Galveston, Texas, July 24th, died July 27th; he came to New Orleans on steamer Fire Queen, from Dublin, Ireland, May 24th, 1867, and came from Galveston on steamer Hewes ; he was born in the city of Dublin, had been attended by Dr. Bell, and died with yellow fever at his brother's residence. No. 621 Moreau street, near Mon- tague. Ludwig Antonell, age 32, from Denmark, arrived about February, 1867 ; he was taken sick July 30th, 1867, and died August 4th, 1867 ; he was a glazier, and died at his boarding-house. No. 365 Victory street. The wife of Antonell, age 31, from Denmark, came with her husband, was taken sick July 30th, and died August 2d, of black vomit, at No. 365 Victory street. Mrs. Lawson, age 44, from Copenhagen, Denmark, came from Mobile, July 5th, 1867, was taken sick August 9th, and died August 12th, of black vomit, at No. 365 Victory street. James Hannigan arrived from Galveston, Texas, on the steamer Harlan ; took board at No. 339 Old Levee street, July 22d ; died on the 25th with yellow fever. The preceding cases suffice to show the origin of such as are known to me. The archives of the board of health may give more, and in regular succession. I question whether there is any source from which a complete record could be prepared, on account of the neglect of practitioners to report all their cases. The very diverse estimates made of the number of cases and rate of mortality evidences the difficulty of obtaining reliable data. Whatever may be deduci'd from some of the cases, importation is shown from Havana, Indianola, Galveston, and New Iberia. The disease was introduced into Indianola from Vera Cruz, as before stated, in May. The fever was epidemic in Indianola June 15th ; at Galveston late in July. It very soon appeared in the adjacent interior towns, viz : at Houston, Lavacca, and Corpus Christi, Texas. Quarantine was enforced in New Orleans in July against Texan ports, and passengers from Texas made their way into the adjoining counties of Louisiana. Very soon yellow fever broke out with violence in New Iberia, in western Louisiana, and became epidemic the first week in August. The Howard Association of New Orleans sent assistance, nurses, and physicians there August 10th. On that day Dr. Shields, Acting Assistant Surgeon, U.S. A., recently arrived from New Iberia, upon sununons as a witness, died in this city, of balck vomit. Other places in the interior of Louisiana and Texas then became affected. The yellow fever of 1867 may be stated to have become epidemic generally wherever it appeared within its usual limits, and it would seem that the type of the disease was such as tended naturally to extend rapidly over populations. In New Orleans sanitary efforts were liiade for prevention and vnitigation of its spread. Although they were employed at a late period, to a limited extent, and not employed generally with confidence by the health autliorilies, it is fair to say, that such as were properly employed were beneficial. The trial of disinfection has not yet been complete, fair, and conclusive as to NEW ORLEAKS, LOUISIANA. Ill ita value in yellow fever, etc. The report of Dr. Lewis (copy appended)- deserves the attentive consideration of practitioners in this section. It may be claimed by the health authorities, that the disease was held in check, and restrained from becoming epidemic as soon as it otherwise would have done, by the vigorous measures taken to combat it in the localities where it appeared. In this connection it is proper to remark, that the earlier and important cases were sick in widely distant sections of the city, viz: Bull's Head, Circus street, St. Charles street near Julia street. Charity hospital, Julia street near Camp sti-eet, Girod street, Texas Hotel, the St. Charles Hotel, at Algiers, at Jackson Barracks, "G" Co., Cavalry quarters, 3d district, and at Greenville. It is diiiioult for a health officer to ascertain promptly when sanitary measures and disinfectants are needed, as the report of any case of suspicious or infectious disease to the Board of Health is liable to be neglected. The fever was epidemic in New Orleans about September 1st. It was reported there, also, as of milder type and less fatal than elsewhere. Why did it thus differ, and why was it slow in attaining, in New Orleans, the epidemic character, (the maximum mortality was reached on the 25th of September,) are questions of interest. In certain localities in the 2d and 3d districts the cases were grouped together, in July and August, chiefly in or around sailor boarding-houses and fever nests which received passengers from Texas, Mexico and the West Indies. The levee, market, and restaurants in this section were favorable resorts for newly arrived passengers. There was an arrival there during the season of several hundred discharged soldiers of the Imperial Maximilian Legion, from Mexico, and in the same district was the field of cholera, where so many died in July, details of which will appear in the accompanying papers.* ."^ The municipal andhealth officers of the 2d and 3d districts put in force vigorous sanitary measures as soon as they believed that genuine yellow fever cases were under treatment and a tendency to outbreak was noticed,' and, as I believe, accomplished very beneficial results in their districts. I regret that similar efforts were not made sooner by the authorities in the_ 1st and 4th districts. The fever finally spread gradually in every direction, advancing upward to Lafayette, (4th district,) Jefferson City, and Carrollton, and backward in the direction of the swamp and Lake Pontchartrain. On the 3d day of September, quarantine was raised by the local authorities as being, in their opinion, useless and no longer necessary. The pestilence increased day by day, and extended to many who, as Creoles or long residents in the south, had deemed themselves and their families secure, and not a few who had the disease in former years were again attacked. The experience of this season established the fact, that the number of persons liable to be exempt, as a rule, is limited to the class who have unquestionably had the disease during an epidemic season. Here, as well as at other places, it was noticed that many young children, born in the city, were attacked, and a number of them died. It is reported that cases already in hospital at the time when patients with yellow fever were admitted and brought beside them, contracted the disease in some instances. This was observed at the City hospital, Galveston, by Dr. Dowell, and at Charity hospital. New Orleans, by Dr. Heber Smith. The propriety of isolating the first cases of the disease is clear ; and when it cannot be perfectly accomplished, the cases should be spread out far apart in hospital, and the companies in barracks and tents dispersed or removed from the locality and isolated from infected precincts. It is probable that here upon the border of the yellow fever zone two kinds of yellow fever may be confounded by observers, and laws deduced from observation of one type in any season erroneously applied to the other. The febris icterodes remittens (malarious yellow fever) may occur sporadically in New Orleans every season. The febris icterodes, true specific yellow fever of continuous type, and communicable as stated by Aitken, would seem to be more virulent and essentially epidemic in its tendency. While the necessity of excluding such a disease by quarantine (and it is generally imported) is imperative, the difficulty of dojng so is great, for the virus conveyed by fomites may pass the ordeal of quarantine undestroyed. I know of no special advance in the etiology of the disease this season. Some tolerance has been gained for efforts towards prevention, and to stay or extinguish it. An honest endeavor to do something in that direction is laudable, and preferable to indifference and inaction. An exhausted treasury, the depression of the times, and the disturbed political situation, will prevent this city from speedily improving its sanitary condition. A step has been gained recently in the purchase and control of the water-works by the city, with the possibility of improved drainage and cleanliness. Cases of the fever conveyed to some localities, (e. g., to Austin, Texas, l though fatal, did not spread to others and infect the community. In concluding this paper, I desire to acknowledge the valued services rendered by medical officers of the army serving in this district, specially exposed for two years past to the incursion of epidemic diseases. Their intelligence, zeal, and vigilance have greatly contributed to preserve the general health of the command. Doctors George Taylor, Samuel Adams, and Charles H. Eowe, of the medical staff, died in the performance of their duty, all within 30 days, at one station. Doctors Bacon and Cronkhite promptly repaired to the post of danger, at Galveston, where the latter soon after became ill with the fever. Surgeon B. A. Clements and Assistant Surgeon C. B. White, at Jackson BarracksJ Assistant Surgeons H. E. Brown, in New Orleans, E. A. Kcerper, at Greenville, La., and E. Cowles, on the Eio Grande, were themselves stricken down while administering to others. As one fell, charge was taken by another. Acting Assistant Surgeons Orsamus Smith, Heber Smith, and Mathew Stovell, took charge in this way of their respective hospitals. Acting Assistant Surgeons Wm. Deal, F. A. Wilmans, J. J. Auerbach, and Henry Smith, also contracted the disease while on duty with troops. The commands with which Assistant Surgeon W. D. Wolverton, and Acting Assistant Surgeons Charles E. Warren, C. W. Koechling, and J. F. M. Forwood, were serving, were shielded from the shock of the epidemic. As they were liable. to receive it, the gratifying result is creditable to these gentlemen and the commanding officers. In the period of greatest need, many physicians of the army being prostrated by illness, a very generous tender of profes- sional assistance was made to me by the President of the Board of Health, Dr. S. A. Smith, and the Professor of Practice of * The greater part of tliese papers are omitted in this report for want of space. — JEd. 112 EXTKACTS FROM OFFICIAL REPORTS. Medicine in the University of Louisiana, Prof. S. M. Bemiss. This contemplated, unavoidably, very great sacrifice on their part, their time being occupied by pressmg and important professional engagements. The timely permission accorded to employ experienced nurses prevented many embarrassments in administration and suffering to the sick. Assistant Surgeon H. E. Brown gave me his assistance in procuring them by contract at times when increase of duties at the height of the epidemic, and the necessity of visiting the hospitals, prevented my being present in my office. I am, General, with much respect, your obedient servant, T. A. McPAELIN, Surgeon, and Brevet Brigadier (ieneral, V. S. A., Medical Director. Brevet Major General J. K. Barnks, Surgeon General. New OkleaNs, Louisiana, December 2, 1867. SiK : Your note of November 1st, requesting a general report of the work accomplished at my ofBce from May to November, was not received until the 25th, otherwise the report would have been made out earlier. During the month of May, and until about the latter part of June, mydistrict was exempt from epidemic diseases, and consequently neither fumigants nor disinfectants were employed. From that time until August, true cholera appeared in the district ; the first case, originating at the corner of Mandeville and Prosper streets, terminated fatally at the Charity hospital. This place was not immediately disinfected, and soon the whole neighborhood, from Elysian Fields to Mandeville, on Prosper, Josephine, Solidette, Morales, and Urquehart streets, was thoroughly infected with cholera, about twenty-five cases occurring in a week. Requisitions for disinfectants were made and forwarded to the street commissioner, and about the tenth of July over thirty houses in the locality mentioned were thoroughly fumigated and disinfected. From that time not more than two or three oases originated in that part of that district. Other cases were afterwards reported in various portions of the district — on Greatmen, Congress, Casacalvo, and Front Levee streets — but the infected houses were promptly attended to, and the cholera was effectually checked. I have no hesitation in stating that it was checked, for I observed that wherever the work of purifying infected houses was delayed, whether from want of promptness on the part of physicians in reporting these cases, or from other cases occurring in tlie same places, that the adjoining houses suffered, which did not prove the case when nothing interfered with or obstructed me in my duty. Though 1 cannot assert so positively the beneficial effects of disinfectants during the prevalence of yellow fever, I firmly believe that yellow fever can be checked ; but for that purpose, a removal of the sick would be necessary, especially the first cases, and a better knowledge of the disease on the part of practitioners of medicine, so that the early cases would not escape notice. The number of houses disinfected of yellow fcver from the middle of August to November 1st was about three hundred. The first case died at the hospital, but was taken there from Antonio Baptistella's, on Victory street near Elysian Fields street. Four days after there were upwards of forty cases on Victory street, from Frenchmen to Elysian Fields streets. Every house is a boarding-house, and many were filled to overflowing with strangers. These houses were not only fumigated with sulphur and disinfected with sulphate of iron in solution, but were pumped from top to bottom with carbolic acid, which impregnated the atinosphere for some distance off. This was repeated as often as new eases occurred. From the 1st of September to the present time, there has not been a more healthy neighborhood ; and notwithstanding new sets of boarders, also equally unacclimated, have taken the places of those who have gone away, but very few, to my knowledge, have been sick with yellow fever. For the removal of various nuisances since the first of May, four hundred and sixty-seven written orders have been issued by me. This is independent of the orders given by police officers, acting under me, in their inspections of privies. From November 24th to the present day, 23 places, infected with cholera, have been fumigated and disinfected: No. 32 Elmira street, corner of Moreau and Frenchmen; 432 Casacalvo; brig Harvest Eome ; shipZimi; barkEstin; house corner of Spain and Casacalvo streets; 160 Clonett street; Congress between Moreau and Casacalvo; No. 8 Port street; Piets near Cove; 115 Frenchmen street; 36 Annette street; Casacalvo near Frenchmen; Levee between Mazant and Liseps; shipZimi, a second time fumigated; ship City of Limerick; corner of Enghien and Morales streets; Independence street; 595 Casacalvo; corner of Port and Good Children; corner of Elmira and Greatmen. Respectfully, E. S. LEWIS, Health Officer, Third District. Dr. S. A. Smith, President of llie Board of Health. New Orleans, Okficu of the Health Ofkicer, Second District, December 3, 1867. Sir : In compliance with your letter, I make the following report of the operations of this oflice during the months of July, August, September, October, and N» ■ >. >i >» 1 ..^ i 1 1 1 1 1 •§ . « O W O O ?:( 1 II 1 III 1 1 ■d H Si a H- f^ '^' « ■« W .H^feHHHW'W&i^HHHW^^^^^^ "^ «■ ^ - - P P ^ ^ =^ ^ '^ ^ ^ ^ "^ ^ ^ ^' ^ § '^ ^ «^ ^ § § § § § § » ^^ i =^ 1^ >. • k. >. >. >. ^ n p a ■ ^ § 1 ! 1 i 3 ; 1 1 5 ;i§ll33SB««3633 n i P £ 6 i ^ ^ H & ^ ^ : ^ W S H ^ ^ H f4 W H H W W H S ^ H H H H H W H h ^ Q !2 5 !2 '^ m xj 3 CO » 3 ;z ft ft 1 p OD fT o (M rt Tt ir V. 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S NEW OBLBANS, LOUISIANA. 12£ Jackson Barracks, New Orleans, La., December 12, 1867. General : In compliance with instructions, I have the honor to forward, herewith, tahular statements, on the prescribed form, of all cases of yellow fever which have occurred at this post during the recent epidemic. Appended are several tahles showing the number of cases, ratio of mortality, duration of the disease, &o. ; also, a record of temperature, weather, &o., extracted from a public journal. I have the honor to submit, as required, the following special report of the epidemic, endeavor- ing to present only the more salient facts as they manifested themselves to my observation. The first case of yellow fever at this post occurred on July 1st, the second on July 11th ; thereafter, no other case occurred until August 2d, when they gradually became more frequent, and, by August 31st, the disease might be considered to have become epidemic. The last case was seized on the 22d of November, but none had occurred before since the 4th of November, and the epidemic, which reached its height about September 28th, may be considered to have lost its epidemic character about the 10th of October, when there was little material left for it. During the extremes of this period 374 cases occurred, of which 111 died, including 4 officers. For the five months com- mencing with July, the mean of the average strength of the command was 380 officers and enlisted men ; but it will be observed (table 1) that in September the strength was 477. Perhaps less than 50 men of the whole command, consisting, in September, of six companies of the 1st Infantry, and Battery "K," 1st Artillery, escaped the disease while here. It will be seen that the ratio of deaths to cases was 29. 67 per cent., a result which, compared with the average mortality, (quoted from La Eoche as 43. 18 per cent.,) is favorable. In Jime, when I assumed the duties of post Surgeon, the post was in a very thorough state of police. Later in the summer, some of the drains in the vicinity of the hospital building were not kept in the best condition, though the fact was represented ; but on the whole the post was exceedingly clean; the discipline seemed excellent; though grog-shops abounded in the vicinity, but little drunkenness was usually witnessed, and the duties of the command were not arduous. A very thorough disinfection of the sinks and privies of the garrison was in daily operation, according to the plan recommended by the best authorities ; this was kept up constantly, and the drains were repeatedly sprinkled with carbolated lime. In the hospital, an invariable rule was rigorously observed, to cause every stool of any patient to be disinfected, and I believe it was scarcely ever, even at the height of the epidemic, disregarded. It was recognized thai these measures would tend to limit the liability to the disease and to moderate its severity; but during the whole epidemic I observed no fact which lent support to the suggestion that, like cholera, it might be considered a fcecal disease; but it will be observed that the measures adopted and just referred to would present a sufficient testing of this point. Though scarcely any one escaped the disease, it can hardly be doubted that these measures were of great value. When, towards the end of August, it was seen that an epidemic was imminent, hospital accommodations were prepared for 100 men, a number nearly equal to one-third of the command at that time, and which it was hoped would be ample. But on August 30th three companies of the First United States Infantry, stationed in the city of New Orleans, were, unexpectedly to me, transferred to this post, and, for a few days subsequent, they furnished the greater number of new cases. On the 12th of September ten new cases were taken, and the number daily increased, until, from the 13th to the 16th, inclusive, (four days,) eighty-two new cases of the disease occurred, and from the 17th to the 28th September, inclusive, (12 days,) one hundred and sixty-five new cases occurred. The epidemic reached its height on September 28th, there being on that day 283 men on sick report, and but 4 officers and 112 men for duty. So sudden and great an invasion of the disease was not expected. It was necessary to provide further accommodation for the sick. Brevet Major C. B. White, Assistant Surgeon, U. S. A., who, on the 15th September, assumed the duty of post Surgeon, (I being prostrated with the disease the previous night, ) applied himself with great energy to this work. For two or three days there was some embarrassment, but the wise liberality and prompt action of the Medical Director in affording Dr. White every means which the resources of the department afforded, enabled him, by the 17th of September, to have sufficient hospital accommodations, though for a short time the wards were much crowded. Brevet Major White, after six days of incessant duty, during which time his services were of great value, was himself seized with the disease on the 20th, and Acting Assistant Surgeon M. Stovell, U. S. A., perfoi-med the duties of post Sugeon until October 3d, when I resumed charge. During this period the condition of affairs was depr,essing ; the permanent commander of the post, seized with the disease, left his command and went to a civil hospital in New Orleans. This example was fortunately followed by but few officers, most of them remaining with their men, evincing a soldierly desire to share equally with them the perils of the epidemic. Something of a panic prevailed for a while ; many men indulged in intoxication, to which cause the deaths of several have been clearly traced. They were unwilling to act as nurses, and there were barely enough well men to do indispensable guard duty, to nurse the sick, and bury the dead. On September 25th there were ten deaths, and in one day thirteen bodies were carried to the cemetery of Chalmette. Among the deaths were Lieutenants Arnold, Hubbell, and Ingxaham, young officers, whose sudden deaths added to the gloom which pervaded the command. Before the epidemic assumed such large proportions, many men attacked with the disease delayed to report themselves sick, either supposing the insidious symptoms to be trivial, or actuated by the soldierly motive of not avoiding duty; but it was urged upon the company officers not to permit this course. Some officers visited their companies very frequently during the day and night, and ordered to the hospital any man found complaining, and they may justly have the satisfaction of knowing that their timely care, in all probability, saved the lives of several of their men ; and it was noticed by the medical officers that the men of those companies whose officers showed this interest in their welfare were more contented, andj in so far, less hable to death. During the whole epidemic the Medical Director of the Fifth Military District afforded myself, and the officers in charge during my illness, in his almost daily visits, the benefit of his advice and opinion in all matters of administration and treatment of cases. "With a wise liberality, which was indeed a just economy, he authorized the purchase and issue of any articles which, in the opinion of the medical officers, were actually required for the proper care and treatment of the sick. The medical pur- veyor filled, with marked promptness, every requisition made upon him. The expenditures for proper diet and ice were neces- 126 EXTRACTS FEOM OFFICIAL REPORTS. Barily large, and in excess of the savings of ihe hospital ration. A considerable number of citizen nurses were employed, male and female, and it was found that the latter were by far the most efficient, and, indeed, indispensable. In concluding this brief and general account of the principal circmnstan-ces attending the epidemic at this post, omitting many particulars which might add weight to the statements made, it may be proper to suggest for consideration that some practical lessons may be drawn from them : 1. When an epidemic is imminent, hospital accommodations for at least one-half the whole command should be at once provided, if at all practicable. 2. It may be regarded as certain that in an epidemic of this pestilence the hospital fund will never suffice to furnish proper diet for those ill of the disease. 3. The usual allowance of nurses is wholly insufficient ; there should be at least one nurse to five average cases, to allow for day and night service, and half, when practicable, as it is in this place, should be women. Brevet Major White, U. S. A., in his report to the Medical Director of his service here, (a copy of which he has kindly furnished me,) refers to the want of screens in the wards, a want which was very marked, and which could be easily supplied at small cost. 4. There should be an allowance of one medical officer to every forty patients, if possible. Epidemics of yellow fever are temporary ; the disease requires more careful watching than any with which I am acc[uainted,»and no preparation that can be made to meet the emergencies it entails should be omitted. It is economy in the end, even in point of expenditure, human life is saved thereby, and the profession is enabled to prove its character of usefulness. I might adduce much evidence of an unrecorded kind in support of these suggestions, but will let them pass without it. In regard to the medical aspects of the disease as presented during this epidemic, I wish to express myself with reserve. Previously unacquainted practically with the disease, and, I think, unbiased by preconceived ideas of it, I have endeavored to form no opinion that is not founded on observed facts and tlie valuable unwritten experience of the epidemic. The epidemic began insidiously. In July and August a number of cases of disease occurred which gave rise to much doubt as to its real character. The patients would generally have a not strongly pronounced chill, of short duration, followed speedily by great heat of surface, especially of the head, suffusion of the eyes, flushed face, and rapid pulse, with great pain in the head and in the limbs — in fact, with the usual phenomena of a febrile paroxysm ; but generally the pains in the limbs were complained of as excessive, lasting thus from twenty-four hours to three days, but rarely more than sixty hours, when there was a marked remission and, in some cases, a pronounced intermission, followed in most instances by speedy convalescence, but In a few by a debility out of all proportion to the severity and duration of the paroxysm. A papular eruption, appearing principally on the chest and limbs, was noticed in a number of cases ; in all the six cases in which the fact is recorded, the eruption appeared on the fourth day. Not satisfied that these were cases of yellow fever, they were recorded, with quite as little confidence, as remittent fever, or as dengue. The difficulty of exact diagnosis was increased, when it was soon after found that some cases, seized with the symptoms just briefly described, would die in six or eight days with unequivocal symptoms of yellow fever, and which, in their inception, their symptoms and course, for the first two or three days, could not be distinguished from the cases which recovered in from two to six days, or, in other words, from the mildest cases. The uncertainty of prognosis was strongly impressed upon me. But, further, it was observed that in September a number of these men who recovered from the disease so inadequately described were seized with epidemic yellow fever. A record of fifteen of these cases is embodied in table No. 5, herewith appended, of whom six died. The brief description given of these cases makes it proper for me to say, that I gave much personal attention to them, and that the increase of exacting duties and my illness made it impracticable to keep more than brief memoranda of their details. It may be considered that these fifteen cases were ."inalogous to those which have been met with in the commencement of several recorded epidemics, wherein there was supposed to be a blending, or, rather, a confusion of types; but leaving it to abler hands to draw deductions from these facts, I will remark, that if it be inferred that they were cases of dengue, or, as they were less accurately recorded, remittent fever, the experience of the whole epidemic furnished no means of distinguishing their early symptoms from those of yellow fever, and proved that its occurrence -afforded no immunity from subsequent attacks of yellow fever. The appended table, marked No. 6, gives a record of tlie temperature and weather for the period. It was observed that a cold storm of rain had a bad effect upon critical cases. Of twenty-one men of the colored cavalry temporarily attached to the battery of artillery during the height of the epidemic, but one suflFeredfrom the disease, and none of the colored servants in the garrison were affected by it. All the ladies and many of the laundresses had the disease, and a child ten years of age, member of the family of an officer, died of it within three days after the attack. It was noticed thatbut few of the habitually intemperate men recovered, though, on the other hand, of the few who wholly escaped the disease, several were notoriously old inebriates, who found in the excitement of the epidemic favorable occasion for keeping constantly drunk. Until about the 13th September, when the epidemic became so general, a rigorous isolation, by removal to a separate building a third of a mile distant, was practiced in every case when the diagnosis was certain ; in addition, the wards were very fre- quently fumigated, and all articles of bedding and clothing were at once placed in tubs or barrels containing water with a sol ution of pei-manganate of potash, or, when badly soiled, were burned ; the bedsteads were washed with a dilute solution of chloride of zinc, and the floors in the vicinity of the patients were scrubbed with the same solution. It has been already stated that disinfection of the evacuations of the sick was habitually practiced; and though very few of the command escaped the disease, it may be justly inferred that these measures must have lessened its communicability and diminished its severity ; and in this connection it may be stated that several men patients in hospital during the whole epidemic with other diseases did not contract the yellow fever. But, at the date above mentioned, so numerous were the seizures and so great the demand for hospital acconnuodations, that isolation of the cases was no longer practicable, and it became evident that NEW OELEANS, LOUISIANA. 127 the disease was then too wide-spread to he materially limited by this measure. I did not observe, nor have I heard of, any case whose occurrence could he clearly traced to personal contact. Only hrief mention will he made of the symptoms of the disease as it appeared here; the absence of detailed records of the cases, which circumstances made it nearly impossible to keep, will not allow that exactness which would be desirable in a strictly professional report. The disease was often sudden in its onset. A man would go on guard and within an hour would be in hospital. My orderly, a stout, healthy-looking man, complained at noon of feeling badly, was sent to hospital, and died within three days. A soldier. Private John Cleaves, Co. " H," 1st Infantry, was remarked for his vivacity early one morning ; at night he was pros- trated, and died by reveill6 next morning before he could be sent to hospital. On post mortem examination his stomach was found to contain a pint of grumous fluid, which was believed to be altered blood; there was no other lesion, and though the case was not recorded as yellow fever, I now believe it to have been such. The most prominent symptoms were pain in the head. In the limbs, and excessive restlessness ; the latter was mai-ked, and it required unceasing attention to prevent the men from leaving their beds, and justifies the suggestion I have made that a very large proportion of nurses is necessary. I did not observe any appearance of the tongue that could be considered distinctive ; it never presented the dryness of typhus, but the appearance and feel of the skin were unmistakably peculiar ; there seemed to he a want of vitality in it; it felt and looked like moistened parch- ment, but it was generally only after the critical period that it assumed a decided yellow hue. I observed in a number of cases that black vomit was preceded by a peculiar restlessness and expression of countenance indicative of a hopeless seeking for aid. In passing through a ward I noticed this expression in the case of Sergeant McGuirei 1st Infantry ; even then he asked to be allowed to get up. I had not left the ward before the nurse showed me a towel containing a stain of black vomit, which he had at that moment gulped up, and he died of black vomit in 24 hours after. Such cases were not infrequent. Oozing from the gums and nostrils was often observed ; in a number of cases, which were generally rapidly fatal, delirium occurred, and in some^f these death ensued immediately after a paroxysm, in which the patient would strive with violence to break away from his nurses, as in the cases of Lieutenant Hubbell and Private Hands, 1st Infantry. Early in the epidemic, I tested the urine in a number of cases, but wdthout results worthy of note. Enlargement of the liver, evident on palpitation and percussion, was observed in the majority of cases that I personally attended, and tenderness over the epigastrium was the rule. It was noticed that boils were very frequent as sequelae in the cases that recovered, and several patients had large cold abscesses in their thighs. It was found necessary to forbid the making of autopsies. As to the treatment pursued, but little medication was practiced. A dose of oil at the commencement, and when the state of the tongue indicated disorder of the alimentary canal, calomel or blue mass in a purgative dose, and subsequently hot foot- baths with mustard, was the general treatment ; but it was found necessary to restrain, in some cases, the civilian nurses from the too frequent use of hot foo^-baths. Quinine I did not find of any marked advantage; but in some cases diaphoretics, generally the citrate of potash and sweet spirits of nitre, were of service. Mustard plasters to the epigastrium were beneficial from their speedy action, though I think blisters to the epigastrium were preferable. But it may be strongly stated that careful nursing is of the first importance. Nothing but personal observation can convince one of this. The disease, as has been aptly said by that sound physician. Dr. Metcalfe, of New York, is, "to he managed, to be led, but not to be driven violently, towards a favorable issue." There is no disease with which I am acquainted in which minute attention to the comfort of the patient is so necessary ; it can hardly be overrated. Instances were frequent where a slight imprudence caused relapse and death ; indeed, it is attention to the minutest details, such as not allowing the patient to raise his head or put his arms from under the blanket, that often determines the issue of life and death. I conclude this report by stating that the medical officers of the post. Acting Assistant Surgeons M. Stovell, Z. P. Doehnler, and J. T. Payne, U. S. A., performed their arduous duties most satisfactorily. Brevet Major White, Assistant Surgeon, U. S. A., assuming the duties of the post at the most trying period, evinced much energy and devotion during the short time he was on duty, and his overexertion doubtless hastened the attack from which he suffered so severely. Acting Hospital Steward Edward Lettson, 1st Infantry, performed his arduous duties very faithfully, and many enlisted men employed as wardmasters and nurses showed a most commendable zeal and interest in their duties. Brevet Major White, in his report which he has kindly furnished me, refers in terms of high and grateful praise to the hearty support he received from Brevet Brigadier General Graham, 1st Artillery, temporarily commanding the post in the absence of the permanent commander, and I am personally aware of his earnest efforts to afford every assistance in his power to the medical oiBcers. I may be permitted to depart from the strict formality of an official report to express the sense I entertain, in common with many officers and men of this command, of the kind attention given by Brevet Brigadier General MoParlin, Medical Director of the district, to whose friendly and professional care I am indebted, under a higher power, for my recovery from the disease which has destroyed so many of our comrades. Verv respectfully, your obedient servant, B. A. CLEMENTS, Brevet lAeutenant Colonel, and Surgeon, U. S. A. Brevet Major General J. K. Baknes, Surgeon General, 128 EXTEAGTS FROM OFFICIAL REPORTS. Table No. 1.— YELLOW FEVER AT JACKSON BARRACKS, NEW ORLEANS, LOUISIANA. Appended to report of Dr. Clements, showing the relation of cases and deaths to strength. 1867. Month . Mean strength. Cases. Deaths. July August September... October November.. 312 322 477 436 3.55 2 22 303 45 2 1 2 79 27 2 Total-.. 380 374 111 ■• Ratio of cases per 1,000 of mean strength, 984.2 ; of deaths to mean strength, 293.1 ; of deaths to cases, 296.7. By adding a proper proportion of the average strength of Company "G," 6th U. S. Cavalry, (which company was not stationed at this post,) to the average strength for August, September, and October, the ratio of cases to mean strength is reduced to 912.1 per 1,000, and of deaths to strength to 270.7 per 1,000. Table Wo. 2.— YELLOW FEVER AT JACKSON BARRACKS, NEW ORLEANS, LOUISIANA. Appended to report of Dr. Clements, showing the number of cases in each month, the months in which these cases died, and tJie ratio of deaths for each month. 1867. ' 00 Months in which the cases of each month died. CO 1 1 □Q 1 O 1 Mouths. 1-5 1 1 1 02 rg s o 1 2 3 4 5 July August September October 2 22 303 45 2 1 1 11 89 10 50,00 50,00 29,37 22,22 2 8. 71 1 18 8 2 Total. 374 1 2 79 27 2 111 29,67 Table IVo. 3.— YELLOW FEVER AT JACKSON BARRACKS, NEW ORLEANS, LOUISIANA. Appended to report of Dr. Clements, showing the duration of the disease in days in the cases that recovered. NO. OF DATS. II a a, d *J £• . Ml a B i 3 1 1 d !t ■s! s 1 « ^ 3 « S 1 1 1 1 !> Q 1 ca fc> s t 1 B 1 .t •1 dl ..4 O H M H H b, f» ia m w K H H H b H ^ H tH H H t^ (4 fn 6 6 8 5 10 11 11 8 12 8 4 U 15 14 4 8 7 10 8 8 5 77 7 263 Table No. 4.— YELLOW FEVER AT JACKSON BARRACKS, NEW ORLEANS, LOUISIANA. Appended to report of Dr. Clements, showing the duration of the disease in days, in cases that died. NO. OF DAYS. Total deaths. Two. Three. Four. Five. Six. Seven. Eight. Nine. Ten. 4 13 14 14 15 10 11 3 7 20 Ill NEW ORLEANS, LOUISIANA 129 Tabic IVo. 5.— YELLOW FEVER AT JACKSON BARRACKS, NEW ORLEANS, LOUISIANA. Appended to report of Dr. Clements. List of men who had Remittent Fever, or Dengue, and subsequently Yellow Fever. NO. 10 11 12 13 14 15 NAME. McMahon, Edward. Bonahoe, George. . Rumto, Charles Farley, Peter Duffy, Patriot Burt, Julius Blacker, John O'Keife, Daniel. . . . Alexander, James. McPeali, Patrick. . . Mitchell, Leonard. . Flaherty, John Gorman, Daniel Burk, JohnH Young, Henry CO. REGIMENT. 1st Artillery. 1st Infantry , 1st Artillery. 1st Infantry.. 1st Artillery. 1st Infantry. . 1st Infantry.. 1st Infantry. . 1st Infantry. . Ist Artillery. Ist Artillery. 1st Infantry. 1st Infantry. 1st Infantry. 1st Infantry. DATE OF— Eeuiittent Fever or Deng-ue. Attack. July 1st " 7th.... " 27th.... August 3d.. " 12th. " 21st . " 21st. " 23d.. " 24th " 27th. " 29th. " 29th. " 30th. " 31st. " 3l5t . Recovery. July 12th... " 12th... August 1st... Sept. 13th... August 16th.. Sept. 4th August 23d.. " 25th.. " 26th.. " 29th. Sept. 1st August 31st. Sept. 4th " 2d " 3d Yellow Fever. Attack. Sept. 18th... Oct. 1st Sept. 28th... " 14th.... Oct. 7th Sept. 12th... " 24th... " 26th .. " 10th... " 23d " 25th... " 19th... " 15th... " 38th... " 15th... Recovery. Oct. 15th. " 20th. " 23d... Oct. 2d. Oct. 11th. Oct. 7th. " 13th. " 24th. Nov. nth. Death. Sept. 24th Oct. 12th 3d. Sept. 25lh Sept. 29th Table No. 6.— YELLOW FEVER AT JACKSON BARRACKS, NEW ORLEANS, LOUISIANA. Showing the temperature, weather, and mortality during the epidemic. Date. 9 10 11 12 13 14 15 TIIEKMOMETBli. 80. 81 82 82 85 84 85 85 85 87 83 •93 91 90 91 93 90 90 90 96 96 98 , 94 88 92 90 79 79 77 78 81 76 78 75 80 81 80 77 80 80 80 84.00 83.66 83.00 83.66 86.33 83.33 83.33 83.66 87.00 87.33 88.00" 86.33 84.33 86.33 84.00 Fair .. Fair... Fair. . . Fair... Pair... Fair. . . Fair... Fair. . . Fair... Fair... Cloudy Fair... Fair... Fair... Fair... Date. THERMOMETER. 9 E s B i