hinges on the correctness of the diagnosis in the case of the Gould children. Now, without for a moment presuming to cast a doubt on the ability of Acting Assistant Surgeon Gould to make a correct diagnosis in the premises, it should be borne in mind that it has been the uniform history of every epidemic in the Gulf region that great differences of opinion have existed in regard to the earliest cases. The oldest and most experienced physicians, even those who have made yellow fever a special study, are often deceived in regard to the phenomena attending the first appearance of an epidemic. The cases in the Florence Peters, in New Orleans, in 1867, were confidently pronounced to be typhus fever by several medical men of distinction, and it was not until black-vomit had actually occurred in more than one case that they were disposed to change their opinion. Morever, this difficulty especially would exist in the case of children, in whom the symptoms of yellow fever are never so well marked as those of adults. They rarely have uræmia and black vomit; the stages of the disease are seldom distinctly defined, and its course more closely resembles that of dengue than true typhus icterodes. Add to this the unwillingness to admit of the introduction of so dread an enemy into an isolated post like the Dry Tortugas, and especially to the father of a large family, and ample reason exists why yellow fever should not have been considered among the possibilities by Dr. Gould in pronouncing his diagnosis. Nevertheless, I am decidedly of opinion that Charles Gould had yellow fever and not bilious-remittent, although I was not present at the post and did not see the case. The case of Lizzie Gould occurred the same day as that of Private Banmstock and Mrs. Coleman, both of which were unmistakable, and though Dr. Gould considered his child's case to be bilious-remittent, Acting Assistant Surgeon Porter, the senior medical officer present. thought it yellow fever, and so informed me.

So far as I could judge from the description given me of the cases as they occurred among the Gould children, few of the phenomena of bilious-remittent fever were present. Briefly considered, the fever was of a mild type, extending over but two or three days, accompanied by decided pain in the head and limbs, unaccompanied by vomiting, and followed by a period of quiescence or stage of calm, leaving the patient much prostrated, but followed by rapid convalescence. This is not at all the history of a case of bilious-remittent, especially of the severe type so universal in the Southwest, while it is a common picture of either mild yellow fever as it prevails in children, or of dengue. The latter disease is excluded by the subsequent history of the post; dengue, so far as 1 am aware, never prevailed sporadically.

I think, then, that the weight of evidence is on the side of the propo sition that Charles Gould contracted the fever in Key West, in some unascertained manner, probably from the Norwegian bark before mentioned, or some of the cattle-boats or small Havana traders. Why he should have done so, and there have been no cases occurring from the same source in Key West, does not invalidate this opinion, such eccentricities being by no means uncommon in the history of the disease. Lieutenant-Commander Mitchell, United States Navy, died on the United States ship Pawnee, in Key West Harbor, on the 14th of September, and a yeoman, from the same ship, died on shore a few days afterward, both with undoubted yellow fever, (the latter with black vomit.) The Pawnee had had on board, for ten days previously, an unusually large number of cases of "bilious-remittent." Were not all these cases probably yellow fever, the diagnosis only being corrected when a fatal case took place? And, if so, where could they have contracted

the infection, except from the same source that Charles Gould did, viz, from the Norwegian bark, which was decidedly infected, or from some other extramural source of disease, imported most probably from Havana or Matanzas in some of the numerous traders between those places and Key West? This view of the subject has an added probability in the following circumstance: A man by the name of Barnes, resident at Miami River, Florida, left Key West for home, in a schooner, on Saturday, the 20th of September; on Monday, the 22d, he was taken sick on board; reached home on Wednesday, the 24th, and died the same night with black-vomit. No other cases followed; but let it be supposed that the disease had shortly afterward broken out among the Key West commaud, (then encamped at Fort Dallas, about a thousand yards from the residence of the deceased,) can any one doubt that it would have been considered a clear case of importation from Key West, the vehicle for the transportation being the person of the aforesaid Barnes? That such spread of the disease did not occur is due to the prompt and judicious precaution to secure non-intercourse, taken by Captain W. M. Graham, in command of the troops, and Assistant Surgeon R. S. Vickery, the medical officer in attendance.

On the 5th of September I arrived at Key West, pursuant to War Department special orders, and found awaiting me a telegraph dispatch from the medical director Department of the Gulf, directing me to proceed, without delay, to Fort Jefferson, which I accordingly did, arriving there on the morning of the 6th. I found that the command had been transferred to Loggerhead Key, two miles and a half distant, some days before, and that the only persons remaining at Fort Jefferson were the sick and some few soldiers, retained for the necessary duties of the post, together with the families of Doctors Gould and Porter, and the light-house keeper and some other citizens, in all about thirty persons, exclusive of sick.

Acting Assistant Surgeon Porter, (though ably assisted by Doctor Joseph Otto, of Key West,) who, with a self-sacrificing devotion, worthy of special mention, bad volunteered his services at the commencement of the epidemic, was very much broken down with the anxieties and labors of the past two weeks, and I was desirous of relieving him at once of all his care, so as to give him needful rest, but he was so unwilling, and seemed so annoyed at anything like being superseded before he had completed the work which the exigencies of the epidemic had forced upon him, that at my request he was continued in immediate charge of the hospital, and Captain Langdon, First Artillery, commanding the post, issued an order, directing me to make an inspection of the sanitary condition of the post. The result of this inspection, which was made in the intervals of constant attendance on the sick, was very imperfect; but is given in a copy of my report to Captain Langdon, herewith appended. After completing this inspection I assumed charge of the hospital, and retained it until the 29th of the month, when I was relieved by Special Orders No. 148, dated headquarters, Department of the Gulf, September 10, 1873, and proceeded to this station.

The epidemic was at its height on the 2d of September, and from that time declined for want of subjects. Every person, with one exception, that came to Fort Jefferson from Loggerhead Key was taken sick, and thus the epidemic was kept up, with varying severity, until the 20th of September, after which no more cases were reported. The last death occurred on the 6th of October. The total number of cases, including the Gould family and other citizens, was thirty-seven; the number of deaths fourteen, or 37.83 per cent.

The epidemic was not wanting in those instances of high-minded devotion to duty, even at the sacrifice of life, which have been so marked a feature of previous outbreaks, both here and in other places. A mar. ble monument in front of the hospital commemorates the bravery and the loss of a distinguished officer of our corps in the epidemic of 1867. In this epidemic a hospital-steward, Samuel Horner, like him, offered up his life on the altar of duty, stricken down while faithfully and fearlessly attending to his duties in the dispensary and the ward. Lient. James E. Bell, who was the only commissioned officer at the post when the disease made its appearance, died on the 11th of September, of black-vomit-the fatal result, no doubt, confirmed by the mental anx iety and physical hardship he had imposed upon himself in his efforts to assist those placed under his command. The medical officers behaved well, were skillful, industrious, and faithful. Especially is this remark applicable to Acting Assistant Surgeon J. Y. Porter, upon whom tell the burden and heat of the day. The services rendered by a citizen nurse, James Dunbar, a colored man, were invaluable. He was acting hospital-steward after the death of Steward Horner, and performed all that was required of him to the entire satisfaction of the medical offi

cers.

The clinical phenomena noticed did not differ materially from those of other epidemics. The majority of the cases belonged to the inflam matory type, characterized by a high grade of febrile action for from seventy to ninety hours, followed by collapse, uræmia, black-vomit, and death. All the fatal cases had either uræmia or black-vomit. Delirium was by no means a constant symptom, some of the fatal cases retaining their intellect unclouded to the last; others passing rapidly into delirium soon after the inset of the fever, and dying comatose. In one case the delirium was very violent and maniacal. Generally it was gentle, and the patient could be easily roused to intelligence. Men of intemperate habits succumbed rapidly. There was no instance of recovery in one of this class. The pulse, in the stage of tumult, varied from 95 to 115; seldom above the latter. During the stage of calm, it was nearly natural; and in collapse it either fell to a remarkable degree, retaining its volume, or else rose decidedly, becoming weak, thready, and almost imperceptible. Both of these indications foreshadowed an unfavorable issue the latter, perhaps, the more so. The temperature ranged during the first stage from 102 to 105; fell to about 100 in the stage of calm; and, if collapse took place, rose again; while, if convalescence followed, it retained, for some days, the same degree as during the stage of calm. The temperature, at the moment of death, was 100 in a number of cases. All observations with the thermometer were taken beneath the tongue. The tongue was generally but moderately coated, and remained moist. In one case it became brown and cracked, and this case passed into a typhoid condition, and died on the sixteenth day. There was nothing of note observable about the bowels. They were generally regular. Yellowness of the skin was not noticed in any case until after death. Diaphoresis was not difficult to produce. The eyes were red, injected, and ferretty. The peculiar odor of the exhalations from the skin was most marked, and very offensive. Nearly every case had more or less suppression of urine, which was persistent only in those which pro gressed to a fatal termination. There were but few relapses-none of them fatal. The prostration, after the stage of calm, was very great, and emaciation very decided. Convalescence was slow.

I have the honor to be, general, very respectfully, your obedient ser

vant,

HARVEY E. BROWN,

Assistant Surgeon United States Army.

FORT JEFFERSON, September 8, 1873.

Captain L. L. LANGDON,

United States Artillery, Commanding Post :

CAPTAIN: In obedience to Special Orders No. 102, dated headquarters, Fort Jefferson, Florida, September 6, 1873, I have the honor to make the following report of the sanitary condition of the post:

An epidemic of yellow fever having prevailed at this post for upward of two weeks, and the majority of the command having been ten days ago moved to Loggerhead Key, leaving behind only the sick, convalescent, and those whose duties rendered it impossible that they could be spared, it follows as a matter of course that the general police of the garrison has been suspended during the above period, nevertheless, the appearance of the parade, the galleries, the wet ditch, the sea-wall, &c., is such as to force the conclusion that they must have been in admirable condition at the time of the outbreak of the disease now prevailing, and without entering into detail, it may be confidently asserted that there 18 nothing about the post, within the control of its commanding officer, which could unfavorably influence either the origin or spread of an epidemic.

In regard to the buildings within and without the work, a few words must be said. While the hospital, officers' quarters, soldiers' barracks, &c., are in good police and kept carefully cleaned, yet I would suggest certain alterations, which, though too late to be of any avail in controlling the present epidemic, will, in my opinion, if carried out, decidedly improve the sanitary condition of the garrison, and render it better prepared to meet future ravages of the pestilence. There are a large number of outbuildings at the post, many of which have wooden roofs which have decayed with time. This decay is hastened in this climate by the frequency of the rains, and the great consequent amount of moisture constantly in the atmosphere, All of these roofs should be removed and replaced with slate. At the west end of the officers' quarters is a shed apparently only used for the storage of lumber; this shed is decayed, and beneath it, resting on the ground, is a considerable quantity of old lumber, planks, beams, joists, all more or less in process of decay and covered with fungi. This shed and its contents should be destroyed or removed.

The same remark is applicable to a number of wooden shanties in the vicinity of the wharf outside the work. They are all in very bad condition, and should not be permitted to remain where they are. It is not thought that any measure short of their removal will be sufficient to put this portion of the Key in proper sanitary condition.

An important element in the development of disease at this post in former times has been the location of the sinks of the men and hospital directly in rear of the hospital cook-house. As these have been for some time closed, (at least those for the use of the men,) and new sinks of excellent construction, and outside, placed over tide-water, it is only necessary to remark that they probably have not been a factor in the production of the present epidemic, yet to guard against the possibility H. Ex. 85-2

of their ever being, in the future, it would be better that they should be entirely filled up and destroyed and the privy-sheds taken away.

The sewerage of this post, in my opinion, is defective; however much it may be in accordance with correct engineering principles, practically it is in defiance of true hygienic ideas. As I understand it, the sewers empty into the moat surrounding the fort, and are intended to be so arranged that the water will flush through them at high tide, a gate being fixed at the orifice so as to prevent the water from entering before the said gate is opened. Now there are two defects about this arrangement. In the first place the gate above spoken of is not water-tight, and consequently the water actually does not, when the gate is opened, flow with sufficient force into the sewers to flush them out; and in the second place, the orifice of the sewers is far below low-water mark, so that the tide rises gradually in them instead of suddenly, thus practically rendering any thorough cleaning of the sewers abortive. Without pretending to a practical knowledge of the construction of sewers, it seems to me that the indications called for may be best met by doing away with the gates before spoken of altogether, as they are entirely useless in their present condition, by having the orifice of the sewers some distance above low-water mark, and by flushing out the sewers daily by means of water pumped into them by steam power. So far as my experience goes, tidal cleansing of sewers is always insufficient, unless the water is kept entirely out of the pipes until the tide is at full flood, and then allowed to flow suddenly into them. This is not possi ble with the present arrangement at this post.

A further matter, which may have an effect on the sanitary condition of the post, is the decomposition of coral and other marine animals on the Key, in the neighborhood of the post. To what it is due I cannot positively say, but it is a fact, that whenever the wind blows from the Keys nearest the post, a most offensive and putrescent smell is noticed— so strong at times as to be almost insupportable. I do not know to what cause to ascribe it, unless to the death and decay of marine animals, as above indicated. Whatever may be the cause, it must be a decided factor in the development of disease, and unhappily is entirely beyond the control of the authorities of the post.

As regards the hospital, the management of the sick, the conduct of the medical officers, &c., I believe I can conscientiously make a favora ble report. Acting Assistant Surgeon Porter has been devoted and attentive to his duties. A very discouraging circumstance was the death of Hospital-Steward Horner, a most useful official in times of pesti lence; so that the records of the hospital have necessarily fallen somewhat in arrears, but no neglect in consequence of this calamity has been permitted toward the sick. A very competent man was fortu nately obtained from Key West, in the person of a mulatto, named James Dunbar, who was employed as a citizen nurse, and placed on duty as acting steward. This man has done his duty in the most admirable manner, and deserves the highest praise for his fidelity.

Dr. Otto, of Key West, came here as soon as it was reported that the fever was raging, and the command owes him a deep debt of grati tude for his services. Volunteering without pay, actuated only by those high principles of humanity which induce the conscientious physician to give his services to the suffering whenever they are needed, he has passed day and night by the bedside, and has been the means, not only of relieving Acting Assistant Surgeon Porter from much anxiety and labor, but also of causing much positive relief to the sick