TREATMENT OF THE SICK 
IN TENTS 
AND TEMPORARY HOSPITALS. ON THE TREATMENT OF /THE SICK IN TENTS AND 
TEMPORASM HOSPITALS. 
By Edward Cowles, M.D., of Boston. 
Read before the Massachusetts Medical Society, June 3d, 1874. 
There are very many instances upon record that furnish ample illus- 
tration of the truth of the assertion that temporary hospitals are the 
best ones. A few of them may be cited. It is related that, in 1755, 
some men-of-war carried out from England to North America a malig- 
nant jail-fever. The fever continued to spread while at sea, but at 
Halifax the sick “ were lodged in tents, or in very old shattered houses 
that admitted the air very freely, which put a sudden and effectual 
stop to this disorder.”* 
In 1758, says Sir Richard Brocklesby, a greater number of sick 
were landed out of transports on the Isle of Wight than could be con- 
tained in all the spare out-houses, barns and empty cottages that could 
be procured. A very rudety-built temporary shed of deal boards was 
constructed to hold 120 patients, and, though apparently inadequate 
to the end proposed, it was found that, notwithstanding much extraor- 
dinary cold and moisture, remarkably fewer died of the same disease 
than died anywhere else; and all the convalescents recovered much 
sooner than they did in the warmer and closer huts and barns, where 
fires and apparently better accommodations of every kind could be 
procured for them.j' 
The instance is often quoted of the use of the abattoirs at Paris, 
during the invasion of France in 1814 and 1815, when the sick and 
wounded were put in these simply constructed buildings, which had 
neither doors nor windows, so that the wind blew directly through ; 
yet the mortality in them was only one half of what it was in the 
hospitals. 
The same facts were observed by the Prussians in 1812 and 1813, 
and Sir James McGrigor fully recognized the immense importance of 
the distribution of the sick and wounded of the British Army in the 
Peninsular War.| Sir John Pringle had a great and wholesome fear of 
general hospitals for the English service, and strenuously advocated 
the dispersion of the sick in small establishments^ 
Very many such instances may be found among the recorded obser- 
vations of medical men of the past century, indicating that the edu- 
cated opinion and experience of the profession has always been against 
the agglomeration of the sick in large numbers. In our own times, 
and within the personal knowledge of every one here present, there 
* Parkes. Practical Hygiene, 4th ed., p. 327, 
t Ibid, p. 328. 
t Sir James McGrigor on Diseases of the Army. Medico-Chirurgieal Transactions, 
vol. vi. 
§ Pringle. Observations. 2 
have undoubtedly been notable illustrations of the truth of this 
matter. 
Since 1854, the sick of the Austrian army have been largely treated, 
during eight or nine months every year, in well-ventilated tents, in 
preference to field hospitals. The results were very satisfactory, and 
Dr. Krause reports that “ the most severe maladies ran their course 
much more mildly in the free air, i. e. in tents, and recovered more 
perfectly and more quickly than in the confined space of hospitals.” 
When, in following years, tents were kept open farther into the win- 
ter, it was noticed that when, by a sudden onset of cold weather, the 
temperature fell to the freezing point at night, the sick were in no de- 
gree damaged, and the men themselves, though severely ill, declined the 
offer to move them from the tents into the hospital. In the experience of 
six years (1854 to 1860), typhoid fever, in its severe forms, was treat- 
ed more successfully in tents than in the hospitals, the rate of mor- 
tality being 20'9 per cent, in the former and 30'5 per cent, in the lat- 
ter. The most favorable results were observed also in cases of small- 
pox, pyaemia, hospital gangrene and wounds. When, in 1859, a num- 
ber of wounded (189) were sent from Italy, there was no death among 
any of those treated in tents, where all the severe cases were sent. 
No case of pyaemia occurred in tents, and in no single case could it 
be made out that hospital gangrene originated there, though there 
were such cases in the wards of the hospital building.* The story is 
well known of the terrible losses, in the Crimean war, of those treated 
in the large hospital at Scutari, with at one time 2,500 sick and wound- 
ed under its roof, of whom two in every five died, while there was 
afterwards not one half the mortality among those in the hospital tents, 
though badly fed and clothed and without proper medicines. The 
yearly death rate of 60 per cent, of the strength of the army, from 
disease alone, in the first seven months of the campaign, was reduced 
to a yearly average of ly per cent, during the last five months.f 
Wooden barrack hospitals were for the first time made use of on a 
large scale during that war. 
At the beginning of the civil war in the United States of America, 
as had been the custom in emergencies in all previous wars of modern 
history, public buildings, schoolhouses, churches, hotels, factories, 
&c., were used as hospitals ; but gradually one-story wooden pavilions, 
erected for the purpose, came into general use. It was prescribed, by 
orders of the War Department, that the pavilions should be 187 feet 
long, 24 feet wide and 14 feet high from floor to eaves. Two small 
rooms were partitioned off, at one end for bath-room and water-closet, 
and at the other end for medicine closet and nurses’ room. The space 
remaining, 165 feet in length, was occupied by beds for thirty patients, 
and there were sixteen windows on each side of the pavilion. Venti- 
lation was partially obtained by doors and windows, but principally, 
in summer, through an open ridge. In winter, the wards were each heat- 
ed by four stoves, the pipe of which, passing upward through wooden 
shafts, formed ventilating flues for the extraction of foul air. Fresh 
air was introduced through air-boxes opening under the stoves. The 
floors, roof and walls were of a single thickness of boards, with the joints 
* Report on Hygiene by Dr. Parkes. British Army Medical Report for 1862. 
t Report of the Royal Commission on the Sanitary State of the Army, 1858, p. 361. 3 
in the walls battened outside, and the roof made water-proof with 
some cheap material. The floors of the buildings were required to be 
at least eighteen inches above the ground, with an open and free pas- 
sage for the air beneath.* 
The military hospital system was developed and perfected as had 
never before been done, and, at one time, in 1864, there were 202 
general hospitals, with 136,894 patients in them. The average yearly 
mortality rate among the sick, of the whole period of the war, was less 
than 6 per cent, of the whole strength of the armies, a result obvi- 
ously due to an excellent and efficient hospital organization. 
Compare with this the annual mortality from disease of the British 
Army in the Crimea, which was 23.2 per cent, of its whole strength, 
and with that of the French Army, which was 30 per cent. 
It is well known that great numbers of our sick and wounded were 
treated in tents in the field hospitals during the War of the Rebellion, 
and it was not the least important among the achievements of the 
Medical Department that it was proved beyond question that tents 
afford all necessary protection against unfavorable atmospheric influ- 
ences, at least during all but the winter months, and that wooden bar- 
racks furnish entirely adequate protection and shelter all the year 
round in temperate climates.f Dr. Hammond, in his treatise on 
Hygiene, says, in writing of the earlier years of the war, that “ no- 
thing is better for the sick and wounded, winter and summer, than a 
tent or ridge-ventilated hut. But in one instance that has come to 
my knowledge has hospital gangrene originated in a wooden pavilion 
hospital, and in no instance, so far as I am aware, in a tent.”| 
The history of the Franco-German War, in relation to this subject, 
is exceedingly interesting, and an examination of the hospital system, 
in each of the two countries, give additional proof of the superiority 
of special temporary structures. Tent hospitals were not so much 
used as in the war in America, their proper management being, ap- 
parently, not understood. The American Ambulance, in Paris, attract- 
ed great attention, by its remarkable success and its demonstration 
that the objections believed to exist against tent-hospitals for winter 
service were not well founded. One of the earliest barrack hospitals 
to be erected as a result of American military experience was de- 
signed by Dr. Esse, and annexed to the Charity Hospital at Berlin, in 
1867. It was only 84 feet in length, and contained 20 beds, but 
otherwise resembled the American pavilion, with the addition of a 
gallery, feet wide, on each side, and a verandah at each end, and 
being constructed somewhat more substantially, with double walls 
and floor, as it was designed for use in winter, as well as summer. It 
was warmed by two stoves, and, by a peculiar and effectual method of 
ventilation, the foul air was drawn through the open space in the 
hollow walls and floor, and passed upward through pipes near the 
stove, escaping through the roof. The Germans afterwards built many 
barrack hospitals, differing chiefly from the American system, in use 
during the civil war, in being smaller, containing fewer beds, and 
* Circular No. 6, Surgeon-General’s Office, p. 152. 
t See Medical and Surgical History of the War of the Rebellion, Part I., Appendix, pp. 
148, 149, for a description of the winter huts and hospitals used by the troops of the Army 
of the Potomac in 1864. Report of Surgeon T. A. McParlin, U.S.A., Medical Director. 
J Treatise on Hygiene, p. 355. 4 
being more hastily constructed. Many of them were so constructed 
that, in pleasant weather, the walls could be removed, and they could 
be thrown open on every side, with the galleries and verandahs screen- 
ed and protected by canvas curtains.* 
The English model-hospital barrack is constructed with double walls, 
and is raised above the ground, for the free circulation of the air be- 
neath. Great pains are taken to prevent the deposition and accumula- 
tion of organic matter in the cracks and joints of the woodwork. The 
inner walls are made of hard material, which can be washed, and the 
floors are of hard wood, kept clean by waxing, with the joints filled 
with cement. Latterly paraffin has been used by being melted and 
poured upon the floors, and ironed in with a hot box-iron. It is also 
applied to the walls and furniture as a paint, dissolved in turpentine 
or paraffin oil.f The recent experience of the English in the treatment 
of epidemic diseases in such hospitals is not less remarkable than the 
instances before quoted. 
The plans for permanent military hospitals at army posts, J adopted 
by the U. S. Government, carry out the essential principles of the 
barrack hospitals of the war. They provide for an administration 
building and attached pavilions, to hold from 12 to 24 beds each. They 
are to be built with double walls and quite substantial, but still are 
comparatively inexpensive. They are generally wooden structures, 
but sometimes they are built of brick upon the same plan. One of 
these brick hospitals may be seen at Fort Independence, Boston Har- 
bor ; it has a capacity of 24 beds and cost $13,500. 
Dr. Billings, in his Report on Barracks and Hospitals, in 1810, 
writes of the U. S. Army Hospitals then existing, “ they are satisfac- 
tory in one respect, that they are almost all temporary hospitals. This 
I consider a decided advantage, as I believe that no hospital should 
be constructed with a view to its being used as such for more than 
fifteen years. If the money required to put up such structures as the 
New York civil hospitals, the Rhode Island hospital or the Cincinnati 
hospital, were divided in two equal parts, one-half being used to erect 
frame hospitals of the same capacity as the stone and brick hospitals 
actually built, and the other half being put out at interest at 6 per 
cent., a complete new hospital could be furnished every twelve years, 
for an indefinite period to come.Ӥ 
Many objections are generally believed to exist against the use of 
tent and barrack hospitals—that they furnish inadequate shelter, are 
wet and bold, and cannot be properly warmed in bad weather, that the 
ground around and beneath them will become infected, &c. These 
objections must be considered as proved to be quite unfounded, by the 
very extensive and successful use that has been made of such hospi- 
tals. Proper management will overcome all these difficulties. The 
tent wards which you have seen at the Boston City Hospital have ren- 
dered most satisfactory service in the past two years. They were in 
use during only about four or five months in each year, between May 
and October. They are constructed of U. S. Army hospital tents, which 
* History of the American Ambulance in Paris, 1870-71, pp. 207, 218. 
t Parkes’s Hygiene, p. 330. 
J Circular No. 2. Surgeon-General’s Office, 1871. 
§ Circular No. 4, Surgeon-General’s Office, 1870, pp. 22, 23. Report by Dr. J. S. Bil- 
lings, U.S.A. 5 
are 14 feet in length, 15 feet in width, 11 feet in height at the centre, 
with a wall 4 feet 6 inches, and a fly of appropriate size. The tents 
now in use have the two latter dimensions increased, being 12 feet 
high at the centre, and having walls 5 feet high. They are made of 
10-oz. cotton duck, and, with poles, cords and pegs complete, can be 
bought for less than $100 each. Tents of this size will hold very com- 
fortably six beds each. At the City Hospital, the tent-wards have 
been constructed in the following manner : A floor of planed and 
matched boards, 37 feet long and 15 feet wide, is laid so as to be about 
18 inches above the ground, and supported upon blocks at many points 
to give it firmness. A light and strong frame, just fitting the inside 
of a tent, is put up at each end of this floor, leaving a space of 9 feet 
in length in the centre between the tents. Two tents are then put 
upon the frames, and a narrow board placed between them to com- 
plete the ridge of the structure. A tent fly is then spread over each 
tent and fastened on eacli side by its cords to a rail on a level with the 
eaves of the tent, and about two feet distant from it. Below these 
rails and near the ground are others to which the cords from the eaves 
of the tents are attached. A third fly is then spread and fastened to 
the rails on each side to form an awning over the open space between 
the tents. In this space are placed a table, chairs, refrigerator, &c. 
The walls of the tents can be raised on all sides and looped up in 
pleasant weather, so as to form an awning of the whole, or they can 
be closely fastened down to keep out the rain and wind. During the 
last two seasons, 50 patients have been treated in these tent-wards with 
the most gratifying results. 
The U. S. Army hospital tent has at one end a lapel, so that two or 
more tents being joined and thrown into one, a tent pavilion is formed, 
with a continuous covering or roof. In the field hospitals, during the 
war, it was customary to unite four or six tents together in each pa- 
vilion, and it was found to be an arrangement that was convenient and 
advantageous in many ways. 
Many different forms of hospital tents have been devised in other 
countries, but none seem to have rendered any more satisfactory ser- 
vice than those just described.* 
The heating of tents properly has been regarded as a matter of 
some difficulty. This has been accomplished quite satisfactority, how- 
ever, by the use of fireplaces, sheet-iron stoves, and by a plan called 
the “ California stove.” In this plan a small excavation is made in 
the ground, either within or just outside of the tents, and the fire 
being built in this excavation, the smoke and heat is carried along a 
covered trench, which passes under the floor of the tents into an up- 
right flue, outside and beyond the tent wall. The tents are thus 
warmed through the ground or floor. This method was perfected and 
very successfully employed in the American Ambulance in Paris, in 
the winter of 1870 and 
An important consideration that must never be forgotten is that per- 
fect cleanliness must be maintained around and about such temporary 
* Many different forms of tents and hospital barracks are figured and described by Dr. 
E. A. Crane in the History of the American Ambulance in Paris. See, also, Parkes’s Hy- 
giene, pp. 514-17. 
t A very interesting and instructive chapter on this subject may be found in the History 
of the American Ambulance, p. 519. 6 
hospitals. The ground about them should be thoroughly drained, and 
the surface replaced from time to time. Frequent and systematic 
policing must be enforced, and the location of tents must be changed, 
if long in use. The importance of this matter is generally overlooked, 
and the inattention to these very requirements at many of our popular 
summer resorts in the country, and at the seaside, has caused so much 
serious and fatal disease as to attract the general attention of physi- 
cians. 
In the light of such experiences as have been set forth, it must 
readily be seen how easy and simple a thing it is to provide good hos- 
pital accommodations, in any emergency, no matter how sudden and 
unexpected, that the prevalence of epidemic and infectious diseases 
may occasion. In England such emergencies are now anticipated and 
preparation is made for them. Dr. Parkes says that “ within the last 
few years it has become customary for all towns of any size to put up 
some temporary hospitals during an outbreak of cholera, smallpox, 
relapsing fever and typhus, and to remove persons ill with these dis- 
eases at once from their dwellings.” Under the provisions of the 
Sanitary Act of 1866, the Medical Department of the Privy Council 
points out in relation to providing “ hospitals or temporary places for 
the reception of the sick,” “ that villages should have the means of 
accommodating instantly four cases of infectious disease, in at least 
two separate rooms, and it is considered that a good cottage would 
answer the purpose.” “ For temporary emergencies, tents are recom- 
mended or huts are advised.”* If tents cannot be procured or practi- 
cably used, a hastily built barrack hospital of boards may, in a few 
days, be prepared. And not only this, but it will be one that will 
sufficiently shelter the sick, and will not be surpassed in its healing 
influences by the finest structure in the land. Every large town may 
have a well-built, wooden, pavilion hospital, which will fulfil all the 
requirements of a hospital, and still be cheaply built and supported. 
The principles upon which a hospital should be constructed cannot be 
better set forth than in the rules given by Dr. Parkes.f 
1. The sick should be distributed over as large an area as possible, 
and each sick man should be as far removed as possible from his 
neighbor. 
2. The sick should be placed in small detached and perfectly venti- 
lated buildings, so that there is no great number of persons in one 
building, and there shall be no possibility of the polluted air of one 
ward passing into another. 
When we are called upon to devise a plan for a hospital, the prime 
object that should always be held in view is that it is for the healing 
of the sick. As far as its construction is concerned, we are to provide 
for the sick the best permanent shelter, and one that may be conve- 
nient for administration. Nothing more is needed, and when we begin 
to attach importance to other considerations, we begin to lose sight of 
and obstruct the attainment of our prime object. An infinite number 
of invincible proofs can be cited as positive evidence that temporary 
hospitals are the best. The reason why they are the best is simply 
because in them, better than in any others, we get pure air. Dr. 
F. H. Hamilton says, “ other things being equal, the best place to 
* Parkes’s Hygiene, p. 33j. 
f Ibid, p. 328. 7 
treat a sick or wounded man is, always, where he can get the most 
and the purest air.” Florence Nightingale has comprehensively stated 
the whole matter in the first words of her “ Notes on Hospitals,” in 
which she says, “ it may seem a strange principle to enunciate as the 
very first requirement of a hospital, that it shall do the sick no harm.” 
These propositions may be taken as the axioms of hospital construc- 
tion, and would undoubtedly be accepted as such by all who would 
build hospitals, from those who would treat the sick only in temporary 
and destructible huts and barracks, to those who would construct 
architectural monuments of their philanthropy. But when we come to 
inquire how we shall best provide the proper conditions for the treat- 
ment of the sick, give them abundance of pure air, and surround them 
with all the influences that can contribute to their recovery, then the 
difficulties begin, and the architects and the jhysicians are apt to 
disagree. 
The lamentable errors of the past, in the histories of great hospitals, 
with their crowded wards and terrible mortality, furnish instructive 
lessons, and warn us to seek to avoid the evils of the old hospital sys- 
tem, of which the old Hotel Dieu of Paris and St. Thomas of London, 
in the last century, are examples. We have the same evils in the hos- 
pitals of our own day, and do not need to go beyond the large cities of 
our own country for such examples. Even at so late a period as that 
of the Crimean war, the old system prevailed, and the disastrous 
events of that war may be said to be the starting point from which 
followed the great changes wrought by modern hospital reform. The 
extraordinary results that have been obtained in the treatment of the 
sick and wounded, in temporary hospitals, have given forcible demon- 
stration of the superiority of tents and barracks over hospitals of com- 
plicated construction. The rapid advances that have been made in 
modern times in all departments of scientific knowledge, the better 
understanding of the true nature of disease and the influences that 
propagate and control it, have contributed largely to the progress of 
hospital reform. 
A startling array of facts has been brought to light in regard to the 
bad management and high rate of mortality of the great hospitals of 
the past and of those still existing. Such facts point to an unmistaka- 
ble and inevitable conclusion. It is declared by Dr. Simpson, Dr. 
Kennedy and others who have most thoroughly investigated this subject, 
that a great portion of the high rates of hospital mortality is preventible, 
and due to defects in the construction of hospital buildings, and that, 
as the well are made sick by “ crowd-poisoning,”* so the sick, placed 
under the same influences, are surely hurried on to their death. The 
names “hospitalism” and “hospital influence ”f are given to these 
evil conditions, and it is declared that there are hospital diseases 
which have their origin in the hospital, that they generate therein an 
endemic poison which, by its “ cumulation and saturation,”| pervades 
the building, and surely kills many of the sick who come within its 
walls, who could get well elsewhere. 
It is not intended, in this paper, to discuss in detail the progress of 
* Dr. J. J. Woodward, TJ.S.A. Camp Diseases of the United States Armies, 1863, p. 42. 
f Works of Sir J. Y. Simpson, vol. ii. 
+ Dr. Evory Kennedy. Zymotic Diseases and Puerperal Fever. Dublin Quarterly 
Journal of Medical Science, 1869. Remarks at a meeting of the British Medical Associa- 
tion at Leeds. Galton on Construction of Hospitals, 1869, p. 57. 8 
modern hospital reform. The whole subject is clearly and ably review- 
ed by Dr. Derby in the “ Report of the State Board of Health of Mas- 
sachusetts, ” for 1874, recently published. The summing up of the 
whole matter in relation to the evils of “ hospitalism ” and “ hospital 
influence ” is, that the old system of hospital construction is bad and 
utterly to be condemned. 
Many new hospitals have been built in the last twenty years, in which 
the principles enunciated by the advocates of hospital reform have 
been partially carried out. In all pei’manent hospitals, however, the 
plan has almost invariably been to build pavilions three or four stories 
in height, and not the true pavilions of one story each. As an example 
of these, and one of the first to be erected in this country, is the Boston 
City Hospital, which was first occupied ten years ago. It was then 
considered to be quite perfect in its general plan—that of detached 
buldings, &c.—and was copied in other cities. Not less than five or 
six civil hospitals, upon essentially the same plan, have been construct- 
ed in New York city alone during the last few years. Other examples 
are the celebrated Lariboisiere Hospital of Paris, the new St. Thomas of 
London, and many more; but though a great advance upon the old 
hospitals, these and many others have now been long enough in use to 
have shown that many of the grave evils still exist in them which it 
was sought to avoid. 
The great desideratum of the sick, pure air, is not obtained in them. 
All systems of supplying it in needed quantities, in hospital buildings 
of more than one story, have failed. The elaboration, complication 
and expensiveness of all the artificial systems of ventilating hospitals 
condemn them, making them difficult to manage, or practically un- 
manageable, and altogether unsatisfactory. One of the most elaborate 
systems of ventilation that has been developed by modern science and 
skill is that of the famous Lariboisiere Hospital. In relation to this 
hospital, Dr. Evans, in his recent “ History of the American Ambu- 
lance/' quotes the words of a celebrated French surgeon as follows :— 
li Of all the Parisian hospitals, the best arranged, the one which has 
been constructed with the greatest care, according to all the rules of 
science, is the.hospital Lariboisiere, and the mortality there is fright- 
ful. In other words, it is a great hospital. It is vain to ventilate ; 
the miasms penetrate the floors, incrust the walls, dance in the air 
which is breathed, and transform in a twinkle an illness of little con- 
sequence into a mortal malady/’* From one, know all. If our best 
modern hospitals do not stand the test of experience, do not give us 
the results we can surely get in other ways, what are we to infer, and 
what* is the mistake in them ? The money invested in them makes 
large and satisfying returns, in the admiration their noble proportions 
excite. The good done in them is great and not to be despised. But 
something more is demanded—simply that “ they shall do the sick no 
harm,” that the rate of mortality in them shall be no higher than in 
tents, barracks and sheds, the use of which emergencies have some- 
times compelled. We know now that in these last-named structures, 
and by the segregation of the sick and wounded, we can get a lower 
rate of mortality than we would dare expect in any of our modern per- 
manent three or four-storied hospitals. The truth, then, is, that the 
* Cp. cit., p. 62. 9 
nearer we approach to simplicity of construction, the better are the 
results and the more sick get well; and the mistake is, that most mod- 
ern hospitals have been only an architectural compromise between the 
old system and the new one of the future. 
The practical lesson for us to learn to-day is, that any small town or 
village can have, within forty-eight hours, by erecting one of these 
tents or a board barrack, as good, or rather, as we have shown, a better 
receptable for the sick than hitherto has been attained in the largest and 
richest cities. It is not to be understood, however, that a good hospital 
is declared to be necessarily a hastily built temporary barrack or shed. 
When greater permanency is required, the building may be as well and 
neatly finished as the comparatively cheap wooden cottages in which 
so many pleasant and comfortable New England homes are made, 
and it may always be of simple construction and temporary, as distin- 
guished from costly edifices of brick or stone. 
The history of hospitals and hospital reform shows that the tendency 
now is, and has of late unmistakably been, towards simplicity of con- 
struction and the segregation, rather than the aggregation, of the 
sick. The most rapid and real progress has been made in the last few 
years, and is still going on. 
We may soon find that the hospitals of to-day are to be regarded as 
only an approximation towards sound and enlightened principles. It 
is safe to predict that the hospital of the future will give no inferior 
results to those we know have been obtained in temporary structures ; 
and till as good results have been obtained in other ways, it is fair to 
regard the temporary as the best hospital. 
It will be wise for us, then, to leave architectural adornments to 
their fitting use in such buildings as our churches, court houses and 
government halls ; and to build for our sick what they need, what is 
best for them, and what is within our means; and what we hitherto 
have been without in too many of our towns and villages, at the risk 
of propagating epidemic and infectious disease. It will be wise for 
us to seek rather to heal our sick than to build enduring and costly 
structures that may be the pride of their projectors and the monu- 
ments of their philanthropic zeal, but of which it has been predicted 
(by Dr. Derby) that “ they will, in the future, be regarded as the 
monuments of those who have needlessly died within their walls.” 
Reprinted from the Boston Medical and Surgical Journal, July 2,1874.