tion was subsiding, and in a day or two the wound began to granulate; and on the 4th of August, it being entirely healed, she was discharged well.

A medical patient who had been laboring for a long time under ascites and general anasarca to such an extent as to render her case hopeless, but who was in a much more comfortable state than she had been for a length of time, was suddenly attacked on the 21st of July with erysipelatous inflammation on one of the lower extremities. It spread with great rapidity, and assumed a violent character, and proved fatal on the 23d.

It may be proper here to remark, that the first case was the only one that had hitherto occurred in the ward in which the disease originally appeared, though all the cases mentioned had been confined to that side of the house. 7. On the 9th of September, however, a man was admitted with a scrofulous disease of the testis, into the room in which the first patient died, and on the 17th he was attacked with erysipelatous inflammation about the ankle of the right leg. This extended to the thigh, and afterwards appeared on the head and face. It began to subside on the 23d, was very slight by the 26th, and on the 30th he was entirely well.

8. On the 29th of September, a man, of a bad habit of body, with an ulcer of long standing about the tendo Achillis, was admitted into the upper ward of the other side of the house, as remote as possible from the place in which the disease had hitherto appeared. On the 3d of October, erysipelas was discovered on the leg about the ankle, and in

the course of the day extended up to the groin. It was more extensive on the following day,the mind was wandering, the pulse feeble and rapid, the tongue parched, and the skin hot and dry. All his symptoms had gradually become worse till the 7th, when vesications appeared on the limb, and he continued to sink till the 10th, when he died. This patient's system was much impaired by intemperance.

9. A medical patient, who was convalescent, was attacked with erysipelas about the right ear on the 26th of October. It extended to the side of the face and temple, down the neck, and to the scalp, with considerable redness and swelling, and some vesication. In a day or two the disease subsided in some measure on this side, and appeared in a much milder form on the other. It never assumed a very serious aspect, and entirely subsided by the 31st, and he was discharged well on the 11th of December.

10. A girl, of about 15 years of age, with scrofulous ophthalmia, was affected with erysipelas on the face about the last of October. The disease in her case was comparatively mild, and nothing unusual occurred in the course of it. It continued four or five days only, without any violent constitutional symptoms, and at the end of this period, she was as well as usual.

11. A healthy girl, 18 years old, who had been in the hospital a few weeks with an ulcer on the leg, was attacked with erysipelas about the head, on the 7th of November. It extended over the whole face in the course of two or three days, so as to close the eyes, and produced an enormous

swelling of the head, attended with deafness. In this case however the symptoms were not of the worst character; the mind was not in the least affected, and in a fortnight from the attack, the patient had recovered her health entirely.

12. The next case of this disease occurred in an unhealthy man, of a scrofulous habit, 34 years of age, who had his left testicle removed on the 23d of December. For a few days after the operation, everything appeared to be going on well, and the wound was rapidly healing; but on the night of the 31st he was seized with a violent rigor, followed by a hot fit, and pain in the right arm, though there was neither swelling nor redness. On the morning of January 1st, the arm was considerably swollen and discolored, the color however was much darker than is usual in erysipelas. The pulse was very rapid and feeble, the tongue parched, and the skin hot. In the course of the day he became delirious, and died in the afternoon. 13. A man 32 years of age, who had been in the hospital about three weeks for an abscess on the head, of which he was nearly well, in the same ward with the last patient, was attacked in the night of the day on which the other died, with a chill followed by great heat. In the morning the disease appeared about the head and face, which were much swollen, and almost covered with vesications. The disease began to subside on the sixth day, and by the tenth was nearly gone. During its progress, suppuration took place in the upper and lower eyelid of the right eye, and in the lower eyelid of

the left eye, and openings were made in them, by which a considerable quantity of pus was discharged. An abscess also formed on the head behind the right ear, which was opened; the original one, on account of which he came to the hospital, was on the left side. After all the symptoms of the erysipelas had disappeared, and the patient was about taking his discharge, he was attacked in the night with an epileptic fit, to which he had been subject. He stated in the morning that he had had a slight one the preceding night; he seemed as well as usual; a light diet and a cathartic were ordered for him, and he intended to go home the next day. In the night following he was seized with another fit, and expired in a few moments, before any one in the ward could get to him.

14. On the night of the 6th of January, four days after the attack of the last patient, a man in the same ward, laboring under chronic diarrhoea, in a state of extreme debility, without the slightest prospect of recovery, was seized with a chill, followed by heat, with soreness about the ear. He soon became delirious, and continued to sink, till the afternoon of the 8th, when he died.

15. A healthy man, on whom the operation of tying the external iliac artery had been performed on the 25th of November, was the next subject of this disease. All his symptoms after the operation had been favorable till the 25th of December, when a swelling appeared between the spine of the ilium and the wound; this suppurated and was opened on the 31st. In a few days after, erysipelatous inflammation made

its appearance in the neighborhood of the opening, extending for a few inches on to the abdomen; it yielded however soon to the remedies employed, though the wound was slow to heal, and the patient was not discharged well till the 16th of February. This patient was in a part of the house very remote from the three last.

16. A medical patient, in a ward adjoining the one in which the disease first appeared, was attacked on the 7th of January with swelling and redness of a deep color of the left eyelids. In the course of the day the redness and swelling did not increase, though he complained of great soreness of the face. The erysipelas in this case never assumed a very threatening or severe character, but subsided almost entirely in the course of three or four days. The patient was a man of regular habits and good constitution, and not much debilitated by his previous disease.

17. About the time that the last patient was attacked, a female, in whom the brachial artery had been tied, was affected with erysipelas. It appeared particularly about the arm, though it extended somewhat up the neck, and there were some slight appearances of it on the body. She recovered in the course of three or four days. It should be observed, perhaps, that she had been in the house several months, and during this period had had several attacks of the disease, all of which however were mild.

Thus it appears that no less than six cases of this disease occurred within a week, three in the ward in which the first patient died, one in the adjoining one, and the other two in remote

parts of the house. This was a very large number, when compared with the number of patients in the institution, as it constituted. onetenth of the whole. Hitherto the disease had excited but little alarm, as there had rarely been more than one or two cases at the most at a time, and usually a very considerable interval elapsed between them, so that not a suspicion had been excited that it was owing to any peculiar state of atmosphere in the hospital. The aspect of things was now however entirely changed, and the medical attendants recommended to the trustees that no more patients should be admitted at present; that all who were in the house should be discharged as soon as it could be done with safety and convenience; and that, if necessary, a house should be provided in the neighborhood, to receive for a time those who could not be otherwise disposed of. These recommendations were promptly attended to, and on the 15th of January only twelve persons remained, all of whom were on that day removed to a house in Vine Street, in the immediate neighborhood of the hospital.

The first inquiry then, was, in what way this erysipelatous inflammation had been kept in existence in the house for so long a time, or to what peculiar circumstance was this singular fact owing? The situation of the Massachusetts General Hospital is remarkable for its salubrity and adaptation to the wants of such an establishment; and it will not, I am confident, be thought hazarding too much, by those who have been coversant with its internal arrangement, to say, that in point of cleanliness it may chal

lenge a comparison with the best regulated hospitals in Europe or this country. There was one circumstance however in which it differed from other institutions of the kind; I refer to the manner of warming and ventilating it. All the wards, with two or three exceptions, were warmed by furnaces placed in the cellar. The hot air, which was external air heated by the furnace, was admitted at the upper part of the ward, and at the bottom there was an outlet for the escape of the foul air. This was considered better than to admit the air from below, both for the purposes of warmth and ventilation, and it answered the first purpose perfectly at all times, and the other in a great measure so long as fire was kept in the furnaces. But when this was extinguished, the patients, to prevent the wards from becoming cold, shut the ventilators, and there being no fireplaces in the rooms, there was consequently little or no circulation of air during the night.

The following fact may be mentioned in corroboration of the opinion, that the disease was probably owing to a want of complete ventilation. The almshouse in Leverett Street was, till the erection of the hospital, the only public receptacle for the sick poor, as well as the paupers of the town, and though it was far from being clean, I cannot learn that any case of erysipelas occurred there from the time of its erection till its removal in 1825. For several years I was well acquainted with the state of this house, part of the time as a student of medicine, and a part of the time as the physician, and during the whole of this period

there was not a single case of this disease. It is not improbable that there may have been one or two solitary instances at other times,-it would be remarkable if it were otherwise; but that it never prevailed there to any extent, I am absolutely certain. The reason of this exemption I conceive to be the fact, that the rooms, in which the patients were kept, were spacious, well ventilated, and had large open fireplaces.

In the house of industry at South Boston, on the other hand, which, besides having every advantage of situation, is far cleaner than the old almshouse, and is intended only for the reception of paupers, erysipelatous inflammation, of the same character precisely as that which appeared in the hospital, has already occurred several times. The rooms, appropriated to the sick in this house, are small, have but one window, communicate with an entry warmed by a furnace, and a part of them are not provided with fireplaces.

It seems to me to be no objection to this opinion, that several of the cases in the hospital occurred during the summer; for the windows in the patients' rooms being all closed at night, and there being of course no fire in the furnaces, there was consequently but little change of air. It is a fact also, and certainly a striking one, that not a single case appeared in any room in which there was a fireplace; and it is not less remarkable, that not a case has occurred in the house since the patients have been readmitted, though nearly five months have elapsed since it was reopened, a period of exemption