VEGETABLE MALARIA OSK 07' THE EXCITING CAUSES OF ASIATIC CHOLERA: ni-iNo A REPORT ON THE IMMEDIATE OR EXCITING OATJSH OF THE ASIATIC CHOLERA, WHICH APPEARED IN ELLIOOTT BTBEET, UI'FFALO, JULY 26, 47, AND 18,1859. READ BEFORE THE "BUFFALO MEDICAL ASSOCIATION," AUGUST '2, 155.. . PRANK HASTINGS HAMILTON, M. P. ALSO THE UKI'.HIT r OF A COMMITTEE APPOINTED BY THE "ASSOCIATION" "TO INVESTIGATE rilfi RELATION OF UPTURNING OK THE SOIL TO THE CAUSATION OF THE CHOLERA." READ SEPT.*, 18S2, AND ORDERED TO BE PRINTED, BUF F A L 0 : STEAM PRESS OF JEWETT, THOMAS &. CO 1552. UEPOKT ON THE IMMEDIATE OR EXCITING CAUSE OF THE ASIATIC CHOLERA, WHICH SUDDENLY APPEARED WITH GREAT MALIGNANCY, ON ELLICOTT ST., IN BUFFALO, ON MONDAY, TUESDAY, AND WEDNESDAY, JULY 20, 27, AND 28, 1852. READ BEFORE THE "BUFFALO MEDICAL ASSOCIATION," AUGUST 2, 1852. BY FRANK 11, HAMILTON, M. D. On Monday, Tuesday, and Wednesday of last week, the 2Gtb, 27th, and 28th ult., the Asiatic Cholera made a sudden and fearful irruption into one of our most healthy neighborhoods: and after a brief but fatal sojourn its departure was announced almost as suddenly as its accession. In this simple event, those who have read the history, or themselves witnessed the eccentric wanderings of this scourge, will see nothing new or extraordinary. The circumstances which herald its approach, and the laws which determine its direction, have hitherto been only feebly ascertained, It has defied everywhere, at certain times, quarantines, cordon sanitaires, climate, season, and meteoric influences — no person can be so vigilant and prudent in his habits as to secure an insurance —no place is so favored as to possess an unqualified immunity. If to-day it seems to be restrained by natural or artificial limits, to-morrow it may overleap all barriers, and swift as a passing cloud, it may throw its shadows successively upon the valley and the mountain, upon the city and the plain. Yet, notwithstanding all its apparent irregularities, no intelligent man doubts, I presume, that the Asiatic cholera possesses habitudes as precise and distinctive as those which belong to any other disease; and that all its movements are directed by laws as exact and inviolable as those which control any other events. All its paradoxes are the common results of consistent causes. It never makes a foray without provocation, or retires until com pellod by overpowering forces. The causes exist, and it only remains for ub 4 KEPORT ON ASTATIC CHOLERA. to ascertain, and having ascertained, to remove them, that the effects may cease. I remind you, gentlemen, of these indisputable truths, which no one is simple enough to question, because we do not always act as if we fully believed them. We see in the cholera so many phenomena yet unexplained, that we are inclined to distrust every thing pertaining to it — and to doubt those rational explanations which fortunate coincidences, and careful investigations have furnished us. We become perplexed and bewildered in its seeming inconsistencies, and finally declare the whole a mystery — and refuse any longer to accept of arguments. Tn this way I seek to explain the incredulity which some of my professional brethren, whose opinions I am accustomed to respect, have manifested in relation to the immediate source of the cholera as it appeared on the 26th, 27th, and 28th ult., in Ellicott street. To me it seems too palpable to admit of a question, that it had its cause in the ditch which, commenced at Eagle street on Saturday, was finished through to South Division on Wednesday morning. Permit me, gentlemen, if you please, to give my reasons for this belief. Not many years ago a marsh occupied the ground where this street is built, covered with a deep, soft, alluvial mould. The marsh extended from near Washington street to about where now Michigan street lies, and from Goodell street to Swan. It had its outlet toward the corner of Swan and Michigan, or in that direction. This marsh was the result of a peculiar formation of the clay bed, which to the depth of ten or twenty feet underlies nearly all that portion of the city which is east of Main street and below High street. The strata having a dip from Main and Michigan, from Goodell and Swan toward a common center. To this clay basin, only partly filled in its deepest portions with sand, there was no actual outlet, except the slight depression toward the south-east: and it remained therefore, until intersected by ditches, the depot for all the surface drainage of the higher neighborhoods — a general receptacle for water, alluvium and sewers. Where the Irish catholic church now stands the water formed a pond, and lower dow 7 n along where Ellicott extends toward South Division the ground was nearly, but not quite as low. Upon this soil much of that portion of the town is built; for in paving the streets, with few exceptions, none of the surface earth was removed, but the sand was deposited for pavements, above it. The streets thus became higher than the adjoining lots, and the water being thrown back upon them the owners found it necessary to fill them up. So this whole bed of alluvium, was at length buried up, and there it has remained to the present time. No 5 REPORT ON ASIATIC CHOLERA. less rich and fertile, and redolent of disease, however, to-day, than before it was inhumed — when it was regarded as unsafe for any family to live within the reach of its miasms. Since the pavements were laid, the lots filled up and the sewers made, this part of the town has been as healthy as any of those portions which are underlaid with clay — indeed much more so, I think. Ellicott street, especially, and particularly at this southern extremity, has been regarded as healthy. In 1849, fewer deaths from cholera occurred in this street than in Washington, Elm, Oak or in any other parallel street of equal length east of Main ; and I am informed by a resident that not one death occurred from this cause, in that portion of the street of which we are now speaking. And this fact may be explained by the size and comfort of the dwellings, which are mostly brick ; by the neatness and spaciousness of their yards, which affords them sufficient ventilation; by the cleanliness of their street, and the completeness of their sewerage, which last possesses also, I am told, this remarkable advantage over other sewers, that it has running through it most of the year, if not constantly, a fresh current of Avater, which finds its supply in springs around the foot of court house hill, and from other parts of the clay basin in that vicinity. In short, for several years the occupants of these houses have enjoyed that immunity from epidemic and other diseases which the science of etiology would have taught us to expect for them, and to which their own diligence in the abatement of the usual causes has eminently entitled them. During the present season the reputation of this locality for healthfulne.ss remained unchanged. While the cholera has been here and there in other portions of the city, and especially in the low parts of the town, and at the eastern extremity toward the " Hydraulics," where the same geological structure prevails, viz., a clay subsoil, with less pavements and sewerage, and less comfort in the style of the tenements, still here were no indications of disease; not even the ordinary diseases of summer were known to have prevailed. The long and persevering drought, with an unusual degree of heat brought no change. On Saturday, July 24th, a ditch was commenced at Eagle street, four and a half deep, and two feet wide, for the purpose of laying water pipes. The work was regularly carried on through Saturday, Monday, Tuesday, and a part of Wednesday forenoon. On Monday night it was partly open near the corner of North Division and Ellicott. Wednesday morning it was opened to South Division street. (See diagram in Appendix A.) 6 REPORT ON ASIATIC CHOLERA. The length of the ditch was about 200 yards, and the number of dwellings fronting upon the street, from Eagle to South Division, was twenty. The soil through which the ditch was dug, was, directly underneath the pavement, a coarse sand of about one foot in depth, then a rich loam averaging about one foot also; and underneath this, sand of a reddish or yellow color, either coarse or fine at different points. The clay bed beneath was not reached. Mr. I. P. occupies a recently built and very comfortably constructed brick house, on the north-west corner of Ellicott and North Division streets. His house is well ventilated and his cellars sufficiently drained. On Monday evening, July 26th, Mrs. P., who had been in feeble health for some months, but with no intestinal disease, was attacked with a slight diarrhoea. On Tuesday it returned with increased severity, and on Wednesday during the forenoon, cholera was distinctly announced. She died Friday morning at 2 o'clock. No other members of the family were attacked. Mr. 0. H. P. W., with his family, consisting of himself and wife, three children, an apprentice and a servant girl, lived in the new brick house, No. 35 Ellicott, on the east side, and three doors north of North Division street The house is two stories and a half high, with an open, clean yard, and is well constructed for ventilation. The cellar is well drained. Monday night the family all slept in the house, with more or less of their windows open. Tuesday morning Mr. W. arose feeling ill, and with a diarrhoea. During the day he had ten or twelve copious watery evacuations, but having taken medicine and rest, the disease was arrested, and never returned with severity. On the same morning, Tuesday, Mrs. W. awoke with a severe headache, and early in the afternoon a diarrhoea commenced, which followed her, accompanied with unequivocal symptoms of Asiatic cholera, until the next day, at o, P. M., when she died. The signs of cholera did not supervene, however, until about midnight of Tuesday. i O v John Berry, the apprentice, slept at Mr. W.s Monday night, and Tuesday morning went to the Falls — returning Tuesday night on the boat, he felt sea-sick, as he thought. He reached home between 9 and 10, and retired without mentioning his illness. In the night, about 11 o'clock, he had occasion to get up and the family discovered his condition. From this time until 10, A. M., of Wednesday, when he died, he had unequivocal Asiatic cholera. No other members of the family fell sick on Tuesday. It has been thought that the currant pudding eaten by some of the family 7 REPORT ON ASIATIC CHOLERA. on Tuesday, at dinner, might have caused the cholera ; but Berry was not at dinner at Mr. W.'s. Mr. W.s diarrhoea commenced in the morning; and Mrs, W. awoke quite ill, although her diarrhoea did not commence until after dinner. Nor was it a thing unusual for the family to have currant puddings and other similar fruit desserts at dinner. Wednesday morning I. W., about two years old, was attacked as early as 6 o'clock, with vomiting and purging. In the afternoon he was sent out of the house, and died on the Sunday or Monday following, the Ist or 2d of August. His symptoms were finally those of dysentery. H. W., aged about four or five years, was attacked at his father's house, as early as 12 o'clock, at noon, of Wednesday — perhaps earlier, and died about 5 o'clock the next morning. M. W. was attacked some time during the day on Wednesday — probably in the forenoon. He was removed from the house, and is now, August 2d, convalescing. Mr. E. C, aged about sixty years, was attacked at 2 o'clock, A. M., of Wednesday, and died at half past lof the same day. He occupied the house No. 27, east side of Ellicott. Mrs. C, his wife, was attacked about 11, A. M., of same day, Wednesday, and died at 11, A. M., on Thursday. Mks C, daughter of Mr. C, aged twenty-four years, returned from a visit of a week at the Falls, on Saturday afternoon. Tuesday, before the cholera had appeared in the family, she felt quite ill, but had no cholera symptoms. Thursday she left town with the family for Lima, and was taken with Asiatic cholera at this latter place, on Friday evening, and died about one week after. Elizabeth Tres, the servant girl of Mr. W., (35 Ellicott,) aged seventeen years, was attacked Wednesday night, or early Thursday morning, and died at about 5 o'clock, P. M., on Thursday. Mi; J. R. E. resides at 31 Ellicott, N. E. corner of North Division and Ellicott, in a two and a half story frame house. Mr. E. and two of his children were attacked, I am informed, with diarrhoea and dysenteric symptoms, on Wednesday or Thursday, and are recovering. Mr. E. T. B. resides at 24 Ellicott, on the west side. His daughter, aged nine years, was attacked with diarrhoea, copious and watery, on Thursday, P. M., at about five or six o'clock. Mrs. B. was attacked Thursday at midnight, in the same manner. Both are now convalescent. Mr. U. resides at 25 Ellicott, east side. Mrs. M. was attacked Thursday morr ing at three o'clock, with nausea, prostration and diarrhoea. 8 REPORT ON ASIATIC CHOLERA. Her daughter had a slight illness of tho same character and at the same time. It is entirely pertinent to include in this enumeration the case of Mrs. T., who having eaten freely of cherries on Sunday, was attacked at her house, No. 22 Ellieott, west side, with a very profuse diarrhoea of the rice water character; and the same returned, with more or less severity, on two or three successive days. I think on Monday, Tuesday, and Wednesday. Mr. P. resides at 37 Ellicott, and Mrs. P. was ill on Sunday with diarrhoea ; and the servant girl fell sick about Thursday noon, with the same malady. The dwellings to which I have referred, are all, with one exception, brick, and generally new. They are also, I believe, all well drained and well ventilated, having generally spacious yards, and in most cases being detached from the adjacent buildings. I have heard of one other case as having occurred a few doors above Mr. W.s, on Wednesday, but I have not been able to learn the facts. We have thus occurring within the distance of a few rods each way from the centre of the ditch, near the intersection of North Division with Ellicott, nineteen cases of diarrhoea, with manifest cholera tendency, (all being so il[ as to require medical attendance) or with actual cholera; and of these, nine have died. Of the six whose illness commenced on or before Tuesday, fuur have died. Of the six attacked on Wednesday, five have died ; and of seven attacked on Thursday, none have died. Since Thursday no new cases have occurred in that neighborhood, In twenty families living upon the street the epidemic has shown itself in nine, possibly in others. Early Thursday morning the attention of the Board of Health was called to the probable connection between the opening of the ditch and the existence of the cholera in this street, and they promptly issued an order to have it closed. The contractor had, however, commenced replacing the earth at the request of several residents of the street; and by one o'clock, P. M., of Thursday, July 29th, it was completely closed. My conviction is, under all these circumstances, that these cases, all had their source, more or less directly in tho miasms from the ditch. I have no doubt other causes may have concurred and materially promoted the result — eating sour, or unripe fruit — alarm — even contagion I admit; yet neither one nor all of these are sufficient to explain many of the cases. They did not all eat fruit — several were attacked simultaneously in the night, before it was known that the cholera was in the neighborhood — children and almost infants were in many instances its subjects. The weather was very warm, and immediately when this old bed was 9 REPORT ON ASIATIC CHOLERA. opened and brought to the surface, a rapid decomposition anJ elimination commenced. During the day the heat of the sun so rarifiecl the air, that the mephitic or poisonous gases arose rapidly and were borne off; but during the night, when most of the attacks commenced, these exhalations settled and hung upon the houses and their unsuspecting occupants, like the heivy vapors of a pit. The men who dug the ditch were unharmed, and I believe also that such as occupied these houses only during the day might have been comparatively secure. It is no reply, that the same has not occurred in other streets where ditches have been opened. It has occurred, as I think I have it in my power to convince you by an examination of the facts — but if it had not, it would only show that there did not exist in those cases the same catenation of circumstances. The soil thrown up, might have been more clean and destitute of vegetable matter — the heat to which it was exposed might have been less intense — the atmosphere might have been more disturbed by winds, by which the miasma might have been moved off as rapidly as they were evolved. For it will not be forgotten that during these days, from the 2 -4 th to the 29th, there was scarcely a breath of air. Thursday c ening there was a slight shower, and during the night a terrific thunder storm, with wind and rain. The wind, which for several days had blown gently from the south, changed now suddenly to a brisk west wind. Since then the temperature of the atmosphere has been much lower. I have no confidence in the electric origin of cholera, and should not, therefore, under any circumstances, ascribe its accession or departure to electric influences. But here it is certainly a very insufficient explanation of either event. The disease was too limited to have any connection with the general electric state of the atmosphere — and it had already nearly or quite disappeared when the electric explosions occurred. For myself, I do not doubt, but that the usual concurrence of wind with lightning, has led many to ascribe to the electricity the decrease of the cholera which has occasionally followed ; when the wind has been in fact the purifying agent to which we were indebted. In corroboration of the view which I have taken of this matter, I may mention that in 1849, during the summer months, a ditch was commenced in Genesee street, near Michigan, and carried through to Hickory. The ditch was deep and wide, being intended for a sewer. lam informed, by good authority, that as the ditch progressed up the street, the cholera accompanied it, or a little preceded it — and that the cholera continued in this 10 REPORT ON ASIATIC CHOLERA. street with extraordinary malignancy until the sewer was finished and the earth removed. The cholera has definite exciting causes, I affirm, and if we will look we shall sometimes see them. Although it occasionally seeks new localities in its successive annual returns, yet it soon and certainly finds out its old haunts, and there mainly fixes its residence. In this city we hear of it first, or very soon after it is announced, on the low grounds bordering the canals and the lake ; then it creeps along upward and slowly, through the "Hydraulics" to Batavia street, Genesee, and into that portion of the city known as the German quarter — and thence west toward Main street. Finally, as the dry and hot season advances, when its local causes are most intense and abundant, it is found more or less at all points of the city. But nowhere are its victims so numerous, or its attacks so fatal, unless, as in the instance before us, some special local cause is interposed, as in the portions of the town first mentioned. It prefers Rock street and Evans, because its inhabitants are for the most part poor and debauched, and ripe for any disease; and because its streets are dirty, and its dens reeking with filth. It visits most of the streets lying upon the flats, because the soil being underlaid with clay and not sufficiently drained, produces vegetable miasms, or because the land, by recent excavations and deposits, is so irregularly filled in that a multitude of pools are formed, from which similar emanations arise. It spreads itself tardily into the eastern portion of the town because, although the soil is the same as upon the flats, and although here also much of the water which falls upon it is compelled to disappear by evaporation, yet the land is more elevated and much better drained. It avoids, most of all, the western and northern portions of the town, because, from the peculiar exposure, the ventilation is there most complete. But not only because our prevailing winds are from the south-west, dees the north-western portion of Buffalo possess a comparative in m unity from epidemic diseases, cholera included, but also in part because in such streets as Pearl, Franklin, Delaware, &c, the soil is sandy and dry, *:nd water does not evaporate even where there are no drains, but rapidly disappears beneath the surface. The same amount of ventilation does not give the inhabitants of Fifth street, nor indeed, I am inclined to believe, of Prospect Hill, the same immunity as is possessed by Pearl, Franklin, and Delaware; and for this reason, that in the places first named the soil will not permit the water to percolate and escape with the same rapidity. It is probable that the usual concurrence of a clay soil with lime rock, has led to the very common belief that lime water produces cholera. The fact 11 REPORT ON ASIATIC CHOLERA. that cholera is found so frequently where lime water is used, is only another confirmation of ray belief that a clay subsoil, by detaining the water upon the surface produces cholera miasms. I Avish it to be distinctly understood tha* I do not regard the clay itself as a source of disease, but rather the water or moist alluvium, or other decomposing matters which lie above it. When.' clay is not present, this alluvium alone is sufficient to its production if it is exposed to moisture. The remote cause of cholera, like the remote cause of the plague, of the yellow fever, &c, has never been ascertained, and I venture to say never will be. It spreads over us like an invisible spirit, whose presence we mysteriously feel, but whose form we can never grasp. It is probable that at the same moment its breath overspreads broad territories, and that its influences are operating no less in the country than in the city. Yet alone and unaided, it is seldom sufficient to produce such results as enable us to recognize its presence. Of what consequence is it to us then, whether we are able to determine the remote cause or not ? Of how much less consequence, certainly, than that we determine well its near or exciting causes, without whose concurrence the arrows of this pestilence are pointless. The immediate sources of cholera are before us in this instance, and in a thousand others, and it is our duty as in some sense conservators of the public health, to see and understand them, and by explaining them fully to the people accomplish their removal. Clean and ventilate the houses; sweep often and thoroughly the streets; fill up the low basins, if possible, with sand; drain well the clay and alluvia) soils; remove early in the season all nuisances from the city; and do not leave the cess-pools to be opened and their contents carried through the streets in hot midsummer nights; expose as little as possible during the prevalence of this epidemic, or at the usual season of its incursions, the fresh soil to the heats of a fervid sun, especially where alluvium is known to have been buried; let the people live temperately and wisely, and I fully believe this dreadful pestilence would soon cease to visit us, or that at least it would return so shorn of its strength as no longer to baffle the science and skill of our art. I wish, gentlemen, if you are persuaded that these are truths, that you would do your duty, for this is no trifling matter, and to you the people look for direction. If the causes are visible, so represent to the public officials with whom the sanitary regulations of the city rest, and thus perhaps by your good and timely counsels save many valuable lives, REPOKT OF A COMMITTEE APPOINTED BY THE "BUFFALO CITY MEDICAL ASSOCIATION, ' AUGUST, 1852, "TO INVESTIGATE THE INFLUENCE OF UPTURNING THE SOIL IN THE CAUSATION OF CHOLERA." READ AT A SPECIAL MEETING, HELD SEPT. 8 1852, AND ORDERED TO BE PUBLISHED. Gentlemen of the Association: The committee appointed by you at your last regular meeting "to investigate the influence of upturning of soils in the causation of the Asiatic cholera/ would respectfully report. First. That upturning of the soil is a sufficient and frequent cause of intermittents, and of other forms of malarious disease. The correctness of this first proposition we presume no one will dispute ; yet as it constitutes in some measure the basis of our argument, we think it proper to refer you to a few of the very common and notorious facts by which it is sustained. The pioneer who builds his cabin in the wilderness seldom suffers in health until with his axe he has cleared away the forests from around his dwelling, and exposed the surface of the earth, covered with decaying vegetable remains, to the action of the air and of the sun. In this instance the soil is not disturbed; but removing the forests which have for centuries buried the surface of the earth in its deep shadows, is the same in effect as bringing to the light a similar soil, long hidden, with the spade or the plough. It is just as well known, however, that the emigrant who settles upon the prairie, lives in comparative health until the soil is broken; and that the surest protection against autumnal fevers is to place the garden and the ploughed fields remote from the dwelling. An extensive breaking of the fallow ground is almost invariably succeeded by a sickly season. Among a multitude of local incidents which might be adduced to further 13 REPORT ON" ASIATIC CHOLERA. corroborate our proposition, we will ask your attention to only that one which constitutes in part the subject of a memorial from the citizens of Rome, Oneida Co., to the Senate and Assembly of the State of New York: and especially to the letter accompanying the memorial, from Dr. H. H. Pope to Benjamin Enos, Canal Commissioner. Rome, 30th December, 1843. Hon. Benjamin Enos, Canal Commissioner, &c Dear Sir — By request of our citizens, I herewith transmit a list of such cases of sickness and deaths as occurred under my observation in 1842, the apparent result of the suspension of the then unfinished public works through our village: and I would first respectfully state, that the bed of the present enlarged canal, in most of its course, occupies the ground along side of the old Lock Navigation Co. Canal, and where most of the wood, timber, roots, and brush, graded from said canal was deposited. By excavating and exposing to the rays of the sun, this vast amount of decomposed and decomposing vegetable material, which had been covered in from five to eight feet of the swamp muck excavated from said canal some forty-five years since, a most prolific source of disease was produced. To the above, and the fact that in the partial excavation of the new canal previous to the suspension, the old canal was only partially filled up, leaving many places for pools of stagnant water, I attribute most of the sickness of that year: and by excavating and spreading over the vegetable matter above mentioned, the three or four feet of clean gravel and sand which forms the bottom of the bed of the enlarged canal, aided by the frosts of last winter, and the drain resulting from perfecting the bottoming out of the canal, I attribute our almost entire, exemption from bilious disease the past summer. Should it be desirable, I might furnish a diagram of the lots along the canal, and the names of their occupants, and thus conclusively show that from ten to fifteen cases of disease occurred in the immediate vicinity of the canal, where one occurred in the upper part of the village. I am, very respectfully, yours, Dr. H. H. POPE. LIST OF CASES OF SICKNESS AND DEATHS. Mrs. H. H. Pope and son, sister, and mother. Mr. John Eddy's wife and two children. Mr. Edward Eddy, wife, and family. Mr. S. Hungerford and two children. One death. Mr. Oliver C. Grosvenor. One death. Mrs. R. Woldby, son, sister, and apprentice Mr. John Stevenson and family. Mr. Luther Moltesar and family. Mr. S. Martindale and family. Mr. A. Seymour, wife and daughter. Mr. W. T. Hungerford, wife, and son. Mr. M. Rowley and family. One death. 14 REPORT ON ASIATIC CHOLERA. Wm, Young — Joseph Shield's son, wife, and father. One death, Mrs. Thomas Dugan and brother. One death. Mr. Sandford Adams and wife. One death. Mrs. Elonzo D. Lewis and family. Mr. Steel, and wife and daughter. One death. Mr. Snow — Mr. John E. Henderson and family. One death. Mrs. McConich and child. Mrs. Giles Hanby. To this list I might add very many cases mostly of a mild form, which submitted readily to medical treatment; and I should also add, almost every Irish family whose shanty was situated in the immediate vicinity of the public work. — (Sen. Doc, No. 90, p. 35, April 15, 1845.) The Hon. Henry A. Foster, senator, by whom the memorial was presented, and who was at that time a resident of Rome, informs your committee that all of this sickness occurred within twenty rods of the canal. Confident, however, that you do not deny the competency of these causes in the production of fevers, we shall proceed to affirm Second. In all these cases, where newly opened soil occasions fevers, it is 1 lie old and decaying vegetable matter thus brought to the surface, which chiefly or alone produces the diseases which result. (See Appendix, B.) We believe that you will not demand of us an argument in defense of this position. It is not quite certain, however, that aluminous soils freshly exposed, may not produce malaria; and if so we shall find, perhaps, an explanation in the fact that such soils generally contain more or less organic vegetable matter in an intimate state of mixture, especially where they lie underneath alluvium. To be more definite, then, we affirm that the malaria, or disease-producing emanations from a soil freshly exposed, and the malaria from low and marshy soils are identical — the results alike of vegetable decomposition. We shall have immediate occasion to apply this conclusion in considering the influence of upturning of the soil in the causation of Asiatic cholera. Third. Marsh malaria produce not only intermittent fevers, and various zymotic diseases, such as yellow fever, typhus, &c, but also Asiatic cholera If this proposition shall be sustained, and our reasoning has been hitherto correct, then, by a plain rule of logic, ia it at once established that upturning « >f the soil may produce cholera — the object of our commission is already reached and the question proposed by the "Association" determined. Whether marsh malaria may develop cholera is a point in our argument upon which we might easily occupy much time, since the facts upon which its elucidation depends, cover the progress and history of this epidemic from the day of its first irruption from Jesaore, in India, to the present time. 15 REPORT ON ASIATIC CHOLERA. Here again, however, your committee finding the question already and now for a long time decided in the affirmative, do not feel at liberty to detain you by a lengthy parade of testimony. But as the latest and by far the most complete summary of the causes of the cholera is contained in the British Registrar-General's Report for 1848-9, we shall copy from a critical notice which we find in the July No. for 1852, of the British and Foreign Medico- Chirurgical Review, such facts and remarks as seem pertinent. " Of all the causes influencing the spread and the mortality of cholera, none has so great an effect as elevation. This fact known for a long time," says the reviewer, " has been worked out by Mr. Farr so completely, that it may be received like the solution of a problem," " The mortality from cholera is in the inverse ratio of the elevation. The mortality of the 19 highest districts was at the rate of 33 in 10.000; and of the 19 lowest 100 in 10.000." (Report.) " On further examination," the reviewer concludes that in spite of other disturbing causes " the mortality from cholera bore a constant relation to the elevation." Density of population, over-crowding, poverty, general insalubrity, are all taken into the account as disturbing influences, yet by the side of elevation they have comparatively little effect, and not only in London but in the rural districts equally were the same conclusions obtained — still " in every place, elevation exerted a paramount effect." Finally, Mr. Farr proceeds to explain how this happens : "As we ascend, the pressure of the atmosphere diminishes; the temperature decreases, the fall of water increases, the vegetation varies, and successive families of plants and animals appear in different zones of elevation. The waters roll along the surface of the rocks, or filter through them and the porous strata of the earth, to burst out below — the sources of rivers or of tributaries, which carry disintegrated rocks with the remains and excretions of vegetables, animals, or men, in every stage of decomposition. The deposits in stagnant places, and at the estuaries, show the kind and quantity of mixed matter which the laden rivers carry down and deposit on the low margins of the sea at the tidal confluences of the fresh and salt waters. * * "As the rivers descend, the fall of their beds often grows less, and the water creeps sluggishly along or oozes and meanders through the alluvial soil. The drainage of the towns is difficult on the low ground, and the impurities lie on the surface or filter into the earth. The wells and all the water are infected. Where the houses are built on hill-sides and elevations, as in London, the sewage of each successive terrace flows through the terrace below it, and the stream widens, the ground becomes more charged, every successive step of the descent, until it is completely saturated in the parts lying below the high-water mark. " The river, the canals, the docks, and the soil of a port may be viewed as a. large basin full of an almost infinite variety of organic matters, undergoing 16 REPORT OX ASIATIC CHOLERA. infusion and distillation at varying temperatures; and as the aqueous vapor which is given off ascends, it will be impregnated with a quantity of the p oducts of the chemical action going on below, variable in amount, but necessarily greatest in the lowest and foulest parts. * * * The amount of organic matter, then, in the atmosphere we breathe, and in the water, will differ at different elevations, and the law which regulates its distribution will bear some resemblance to the law regulating the mortality from cholera at the various elevations. It has been seen how rapidly in London the mortality from cholera diminishes a few feet above the low ground on a level with the Thames, while several feet of elevation in higher regions produces no sensible effect. * * * "It is established by observation, that cholera is most fatal in the lowtowns and in the low parts of London, where, from various causes, the greatest quantity of organic matter is in a state of chemical action ; and it may be admitted that cholera, varying in intensity with the quantity, is the result of some change in the chemical action of this matter. Further inquiry must determine whether in England that change is spontaneous, or the result of the introduction of a zymotic matter from beyond the seas; whether the poison enters the human frame in air or water, through the skin, the mucous membrane, or the air-cells of the lungs." (pp. 69-70.)— (p. 44.) " This law of elevation," the reviewer remarks, " is perhaps the most important practical point brought out in the Report, and is well worthy the attention of the authorities of the East India Company; for the fact, though long recognized, has never been so definitely shown before." And he concludes by saying, " The readers of our journal need scarcely be reminded how frequently we have advocated views identical with these, and how we have ever and over again pointed out, that all observers who have regarded cholera with an unprejudiced eye, from the days of Jameson downward, have adopted opinions of a similar kind. Let us hope that this reiterated assertion — an assertion based on observations so numerous and so accurate, may at last have some weight with the rulers of this and other countries; and that we may at length commence in good earnest those works of sanitary improvement, the neglect of which is the opprobrium of the present generation, and the fatal legacy which it seems is to be inherited by the next." (p. 44.) Your committee believe, and we think you will fully concur with us, that while the statistics and tables of Mr. Farr establish conclusively the general relation of elevation to the cholera, yet as the summaries only show the re- Milis of aggregates, it is very probable that among the materials from which the whole is gathered, might be found many exceptions. Our own experience would show that such exceptions do occasionally occur, in which elevation affords little or no immunity. The site of Bellary, in India, upon which i ii English fort is built, " is a granite rock, half a mile in diameter, and 500 feet in height. In its neighborhood are no marches, no rivers, no dense and 17 REPORT ON ASIATIC CHOLERA. exuberant vegetation, which may afford to cholera a congenial soil ; and yet, for thirty years, the pestilence has never been absent a single season from Bellary." (Trans. Amer. Med. Assoc. 1849. Report of committee on Med. Sci., p. 72.) But we shall find a sufficient explanation in other circumstances which are present. The barracks are over-crowded and uncleanly; close by are "two dirty bazaars, which have long been considered a public nuisance. A large tank, which becomes dry during the hot season, taints the air tvith its effluvia." "When we take into account the climate of the country, it is not surprising that these causes are productive of cholera from one year to another. The heat during the months of March, April, May, and part of June, is described as being insufferable. The unclouded sun glares from a sky of brass upon the parched earth, and its fierce rays acquire additional force by being reflected from the granite rock; the thermometer rises, at midday, to 90°, and even 98° in the shade, and to 130° in the sun; and the heat is rendered more oppressive by the sultry stillness of the atmosphere. The winds which occasionally interrupt this calm, burn as if they had passed over a furnace, and are more intolerable than the still atmosphere itself." (Idem p. 73.) We would infer, therefore, that the condition of elevation upon which the immunity from cholera depends, is certainly not the diminished pressure of the atmosphere, to which Mr. Farr has, among other conditions alluded, since this condition is uniform. One other condition, however, we find here, which is unusual to such localities, and which is so constant in lower situations, viz., stagnant and putrid water. To this, therefore, in the present instance, most intense cause, with the concurrence of several other causes, such as idio-miasm, filth and excessive heat, your committee choose chiefly to refer the existence of the cholera at Bellary. It is the drainage, ventilation, and complete absence from malaria, which give to elevated situations their remarkable immunity; and where these accompanying conditions are absent, we venture to say, the same immunity will not be found. For the same reason, also, the observation of Dr. Jackson, will be found generally true, viz., that the epidemic has never been destructive in granite regions ; while others have remarked that in the spread of the cholera through the western states, "it has seemed to assume its highest malignancy in regions of country where the older limestone rock is the geological formation." Granite regions are not generally miasmatic regions; but where lime-rock prevails the soil is mostly alluvial and is underlaid with clay, presenting thus the very conditions most essential to exuberant vegetation and to the detention of the water upon the surface. Lime-rock regions are therefore most 2 18 REPORT ON ASIATIC CIIOLEK.4. often malarious, and, as others have observed, and as we have observed also, most often the chosen regions for cholera. Bellary is built upon a rock of granite, yet granite separated from those other conditions which elsewhere so almost universally accompany this formation, affords her no protection. Nor is it necessary that towns built in valleys, at the estuaries of rivers, or upon the margins of basins of water, or, indeed, wherever the geological formations are alluvium, clay, and lime-rock, should suffer perpetually the visitations of this pestilence; since money and labor, judiciously expended, may always conquer these natural disadvantages of situation. But we need not look abroad for attestations of the fact that cholera seeks miasmatic regions. Its terrific assaults upon our neighboring towns, Sandusky and Toledo, in 1849, are well enough remembered. Sandusky, especially, was more than twice decimated. Nor have these places escaped during the present season. Wherever, also, in this state or in the neighboring states, in the city or the country, like causes exist and in equal intensity? there you shall learn that the cholera, true to its instincts, has not failed to pay its unwelcome visits; and if any places escape now that did not escape in the previous epidemics, it has been because some essential improvement has been made in their sanitary system, or in some way ancient malaria have been made to cease. Of this fact we might easily furnish you with several marked illustrations. In our own city, each successive return of the epidemic has found it earliest and in greatest severity on the "flats;" in the vicinity of the canals, and stagnant pools which every where dot that portion of the town; at the "Hydraulics," and over that broad, level, yet quite elevated section which reaches eastward from Main street — throughout all of which localities there has always been, and there remains to the present day, when the cholera is not present as its substitute, intermittent fevers. In other parts of the city, also, might be indicated many similar localities^ which furnish similar evidence of their insalubrity; and investigations instituted by the vigilant officers who composed the "Board of Health " in 1849, seldom failed to discover, wherever the disease for a time 6xed itself, an und rained cellar, an unfilled lot, an obstructed street gutter, or some like circumstance, as the source of the sickness. It is not alone those, however, who live above or adjacent to these causes who are made to suffer; but if the winds are favorable, those living remote, and in the more salubrious portions of the town may fall under their poisonous influence. So now there are operating about up, and surrounding us in such a manner Hfc'^OfcT OX ASIATIC cftOLEftA-. 19 that we cannot for our lives escape them, a thousand efficient causes, in all those standing pools covered with green fungi — of whose pestiferous agency few have thought, and for the removal of which none have cared. We will not omit to mention, also, as having a clear relation to the point under consideration, that the cholera occurs oftenest in those houses which are destitute of cellars, and in which the floors are laid close upon the ground, or in dwellings the cellars of which, are damp, not ventilated, or contain vegetables in a state of decomposition, (Appendix, C.) Equally pertinent, also, is the well known fact that cholera, like malarial fevers, makes its attacks most frequently at night, or early in the morning, when the atmospheric vapors, holding miasmatic poisons in suspense are nearest the surface of the earth Those employed, therefore, in the excavation of alluvial earth during the day, have relatively little or nothing to fear — the vapors heated and rarified by the sun, arise rapidly and pass oft". Hence the argument which has been occasionally urged before us, viz., that the workmen employed in these excavations do not fall sick, has no weight. The same is known to be true in relation to marsh fevers. It is the inhalation of the marsh atmosphere at night which proves so especially fatal. There is more ,seeming value, however, in the statement that men have been known to work all night over these ditches and in the midst of beds of vegetable mould, who have yet continued in excellent health. Mr. Brick, the intelligent superintendent of the Buffalo Gas Works, assures us that he lias thus employed a number of laborers during the present summer, where mould was three feet deep, yet they have escaped the cholera. But may not these facts only corroborate what has been a generally received opinion, also, in relation to the influence of marsh miasms in the production of disease, viz., that the system is more susceptible to their influence during sleep, and that they are comparatively inoperative during wakefulness. The traveler on the Pontine marshes, in Italy, is cautioned constant! v against yielding to the seductions of sleep, lest he should thereby fall a victim to the malaria, and medical men, with others, have long sanctioned the belief. But if no such explanations could be offered of these apparent exceptions, their number is too small altogether to weigh a feather against the cumulative and overwhelming evidence opposed. In short, we are row prepared to reaffirm that marsh malaria do prove an exciting cause of Asiatic cholera; and indeed, your committee are disposed to regard such malaria, if not the most energetic, at least as of all others the m >st widely operating cause, 20 KEPORf ON ASIATIC CHOLERA We thus arrive again at the conclusion which we had already anticipated, and which constitutes our fourth proposition, viz: That upturning of the soil may prove an exciting cause of Asiatic Cholera. This conclusion, it must be seen, is the inevitable corollary from our argument. We suppose that in the strict interpretation of the resolution under which, we act, we might properly have here terminated our inquiries. But we believe that the spirit of your instructions extended farther — and that you proposed also, that we should inquire whether in cur city there had been any cases in which the upturning of the soil had produced cholera; or whether, indeed, the soil was generally of that character from which in future danger might be apprehended, if the practice of opening and exposing the earth in the season of the cholera should be pursued. To this subject we have therefore diligently addressed ourselves: yet we are forced to confess that here our labors have been less fruitful of results than we could have desired. First. In relation to the cholera as it appeared during the last week in July, in Ellieott street, and its probable connection with the opening of a ditch in that street at about the same time, we find no farther room for investigation, The facts are before you in a report presented, at the regular meeting in August, by the chairman of this committee. Second. In consequence of a refe just mentioned, to a similar occurrenc at once all the sources of information to determine the facts, rence made incidentally in the report i in Genesee street, in 1849, we sought which at this late day were accessible From Miv Harraden, the contractoi in Genesee street, at the intersection we learn that a ditch was commenced. of Michigan, about July 1, 1849, and that it was opened and completed through to Hickory by about the 20th of August ; the work of opening, laying on simultaneously — • so that it was ck the excavation was completed. The removed until about the 14th of Septe two feet wide and from eight to ten fe> the sewer, and refilling, being carried sed in its entire length very soon after excess of earth was, however, not mber. The ditch was 1200 feet lonffi it deep The soil through which the ditch was excavated was first one foot of paving sand, then clay to the depth of two or three feet, and finally hardened quicksand, or clay and sand in mixture. From the files of the cholera reports kept in the office of the city clerk, we ascertain that forty fatal cases of cholera were reported from Genesee street during the summer of '49; but in only three or four cases is the number of the house given, so that we were unable to determine from this sourceihe 21 REPORT ON ASIATIC CHOLERA. fatality of the disease along the line of the ditch. We will remark, however, that all the reports of fatal cases for this street were between the 19th of July and the 4th of September; a period wholly within that occupied in the opening and closing of the ditch. We have also addressed circular letters to all those physicians, chiefly Germans, who we supposed had been the principal medical men employed. in that district. But from none of them have we obtained any information which is of value, or pertinent to the question. Generally, they assure ue they kept no records of these cases. As the only remaining alternative, we secured the services of a very intelligent young gentleraaa, Mr. Augustus Jeyte, son of Dr. Jeyte, a German* -who, at our request, promptly undertook to ascertain the facts by direct, personal inquiry. Accordingly Mr. Jeyte visited every house on Genesee street, between Michigan and Mortimer, and in the tabular form which we had arranged for him, reported to us the following results. We give the tables as reported, that an opportunity may be afforded for correction, if there is any error. It will be seen that there are*hi all seventynine families referred to, of which twenty-four have removed, nearly one-third ; among which number, doubtless, som-e sickness and deaths occurred. This must render the 'tables somewhat inaccurate, yet not sufficiently to affect materially their value. In company with one of the aldermen of our city, the chairman of your committee has visited many of the dwelling?, and we have confirmed, as fa? as we examined, the faithfulness of Mr. Jeyte's returns, with only two exceptions, which we have corrected. We also ascertained that from Michigan to Slim, the cholera occurred in but one family. In this family three died, 22 REPORT OX ASIATIC CIfOLKK^ FROM MICHIGAN TO HICKORY STREET— 2B FAMILIES. | Before July 1 1 j After Sept. 14: .No. Name of Occupant-. — r- , ¦ — — Sick, i Died. Sii-k. Died. Sick. Died. _ __! i _!__ = 157 Changed occupant, 158 " " 2-159 Lorenz Gillig 1 60 FrederickWuest, IGI Changed occupants, 1.64 168- — Loechler, 11 2 169 Changed occupants,. 171 Pete* Schtnal,. 1 172 Reinald, 3 1 174 Wepner, . . . 1 176 Angelmiller, .. 6 'A 178 Back,.. 1 179 Spengler, 9 4 180 Changed occupants, 181 " " | 182 184 Webster, 2 188 Washington, 2 189 Writ. Messing, 5 2 190 Jackson, .. 1 \ 190 Fried. Kibler, 3592 Bodamers House, 7 2 195 Joseph* Hailman, 1 199 Andrew Gueuther, .. .. .. 2 200 Vincens Messmer 2.02 John Sabel, 206 Joseph A sabs, 809 George Beckle, 1 210 M.ithiiis Lutz, 1 211 John Wolf, 1 212 Changed occupants, 214 Franz Droll, 216 - — Lutz, 2.18 Changed oempants, .. 1 1 219 Wm.D.Tute, 225 Friederich Emerich, 4 2 228 Bickel, 11 |20 | 4 138 14 j 3 ) 3~~ 23 REPORT ON ASIATIC CHOLERA. FROM HICKORY TO EAST SIDE OF PRATT— IO FAMILIES. t, j, Tii Between July 1 \a~- «,,nt v Before July 1 , md Sept J| After Sept. J4. No. Name of Occupant. Sick. Died. Sick. Died Sick. Died. 2.3.3 G. Fisher, .... 5 4 234 Chrishtopher Schmahl, - - 6 * 237 Bauer,.. ...8b 238 Changed occupants, 239 Schandall, ....4 1 241 Changed occupants, 242 " " 243 Uebelacher, 244 John Dechent, 246 llauenstein, -- 1 248 Nicholas Brick, -- 5 2 248 Klotz, 4 1 250 Fredeiick Geib, 4 1 130 16 2 j 1 FROM EAST SIDE OF PRATT TO MORTIMER— I 7 FAMILIES. 254 [ Peter Seibert, 255 Changed occi/pants, " " " 256 " " 257 Adam Schauf, 259 Philip Schauf, " Jacob Scheu, " Joseph Meyer, " Valentine Schneider, 262 Changed occupants, 277 Adam Guth, 279 Wm. Borger, " Heinrich Thai, " H. Ekel, 284 Andres Bodamer, -. 1 " Changed occupants, " Christian Dismal", 286 Wm. P>edinger, 287 Anton Trot, 288 Christian Vogel, 289 F. J acob, 295 Eeinhardt Philip, 1 Total from Mich, to Moit 20 4 69 30 | 5 ' 4 24 REPORT ON ASIATIC CHOLERA. The summary may be stated as follows: Whole number of cases from Elm to Mortimer during the season, 97, Whole number of deaths, 41. Of the deaths, 3 occurred between Elm and Michigan, 21 between Michigan and Hickory, 17 between Hickory and east side of Pratt, and none between east side of Pratt and Mortimer. Again, of the deaths, 30 occurred between the Ist of July and the 14th of September; four before the Ist of July, four after the 14th of September, and three are not determined. (See diagram in Appendix, A.) It will not escape your observation that nearly all the deaths were along the line of the ditch, or within 300 feet of its north-eastern extremity, in which direction our winds would be most likely to carry the miasms. If the water courses were obstructed also, the refluence would be in the same direction, as the street has a declination from east to west and south. Such are the facts as near as we have been able to ascertain them ; and while your committee do not regard such evidence as conclusive, yet, when taken in connection with all the circumstances, we cannot avoid a belief that to the presence of the ditch ought to be ascribed in some measure the extreme malignancy of the cholera in its neighborhood. Whether its agency depended upon direct emanations from the upturned soil, or upon the obstructions caused by it to the water courses, we cannot positively determine; yet, considering the character of the earth disturbed, we think the latter altogether the most probable supposition. The malaria from a soil like that through which this ditch was carried must have been ? we apprehend, too inconsiderable to be regarded as in any manner an adequate source of the sickness. Attempting to carry our investigations into other streets, through which ditches were opened during the same season, and in which it had been said that similar consequences had followed, we found our inquiries ending in no satisfactory results, and we therefore soon ceased our examinations. Ditches were made generally for the purpose of removing nuisances, in many streets, and in one instance at least, by request of the inhabitants. Such was the fact in Cherry street. The street was covered in various places with stagnant pools of water, and the lots had no means of drainage. In this condition the cholera broke out among the inhabitants, and they soon petitioned the Common Council to have a drain built in the hope that the disease might be thus arrested — but the cholera contiimiag to increase in severity after the work was commenced, and the completion being somewhat delayed, they again petitioned hastily to have it closed.. 25 REPORT ON ASIATIC CHOLERA. In this instance, also, if the opening of the earth had any connection with the increase of the cholera, it was probably in consequence of its increasing the water accumulations along the street. If we had been disposed, we might have prosecuted our inquiries upon a larger scale, by an examination of the influence of the removal and deposit of many acres of earth upon the " flats ;" a circumstance which has resulted from the necessity of lifting that portion of the town to protect it from inundations, and from the excavations of the Hamburg street canal, and the Ohio basin. But we are persuaded that no conclusions of value could be drawn where so many modifying circumstances need to be taken into the account. Here was originally a marl covered with vegetable mould, and it is well known to have been a source of malaria. It is now in part the same, and in part it is composed of irregular basins of clay, containing pools of water, and we presume, also, that it is now, as before, a source of malaria : but to what relative or actual extent we have not the means of determining. One thing at least must have greatly favored this district during the present season, viz., the general prevalence of south-west winds, which, while they have swept off the miasms generated upon the fiats, may possibly have contributed materially to the greater fatality of the cholera in the north-eastern portions of the town, over which these winds must pass, bearing their vapors and their poisons. To us it seems that while few cities have grown as rapidly as Buffalo, in few cities, also, has it become necessary to the same extent to disturb the soil for the purposes of grading, filling, paving, ditching, &c, &c, a circumstance which might have proved harmless where sand was the earth removed, but which, as we have shown, must be directly or indirectly a source of disease where clay and alluvium preponderate. Recapitulation. — The conclusions to which we have arrived then are, First. That upturning of the soil, under certain circumstances, will produce certain forms of disease, such as intermittents, &c. Second. That in all these cases where newly opened soil occasions fevers, it is the old and decaying vegetable matter thus brought to the surface which chiefly, if not alone, produces the diseases which result. Third. Decaying vegetable matter may produce not only fevers, but also, probably as an exciting cause, Asiatic cholera. Fourth. That as an inevitable inference, upturning of the soil may, in the same manner, produce Asiatic cholera. Fifth. That in our own city there are many localities under which vegetable 2* REPORT ON ASIATIC CHOLERA. The summary may be stated as follows: Whole number of cases from Elm to Mortimer during the season, 07, Whole number of deaths, 41. Of the deaths, 3 occurred between Elm and Michigan, 21 between Michigan and Hickory, 17 between Hickory and east side of Pratt, and none between east side of Pratt and Mortimer. Again, of the deaths, 30 occurred between the Ist of July and the 14th of September; four before the Ist of July, four after the 14th of September, and three are not determined. (See diagram in Appendix, A.) It will not escape your observation that nearly all the deaths were along the line of the ditch, or within 300 feet of its north-eastern extremity, in which direction ouv winds would be most likely to carry the miasms. If the water courses were obstructed also, the refiuenee would be in the same direction, as the street has a declination from east to west and south. Such are the facts as near as we have been able to ascertain them ; and while your committee do not regard such evidence as conclusive, yet, when taken in connection with all the circumstances, we cannot avoid a belief that to the presence of the ditch ought to be ascribed in some measure the extreme malignancy of the cholera in its neighborhood. Whether its agency depended upon direct emanations from the upturned soil, or upon the obstructions caused by it to the water courses, we cannot positively determine; yet, considering the character of the earth disturbed, t we think the latter altogether the mos from a soil like that through which tl we apprehend, too inconsiderable to ; probable supposition. The malaria is ditch was carried must have been ? he regarded as in any manner an adequate source of the sicklies; Attempting to carry our investigatic ns into other streets, through which ditches were opened during the same season, and in which it had been said that similar consequences had followed, we found our inquiries ending in nosatisfactory results, and we therefore soon ceased our examinations. Ditches were made generally for the purpose of removing nuisances, in many streets, and in one instance at least, by request of the inhabitants. Such was the fact in Cherry street. The street was covered in various places with stagnant pools of water, and the lots had no means of drainage, In this condition the cholera broke out among the inhabitants, and they soon petitioned the Common Council to have a drain built in the hope that the disease might be thus arrested — but the cholera continuing to increase in severity after the work was commenced, and the completion being somewhat delayed, they again petitioned hastily to have it closed. REPORT ON ASIATIC CHOLERA. In this instance, also, if the opening of the earth had any connection with the increase of the cholera, it was probably in consequence of its increasing the water accumulations along the street. If we had been disposed, we might have prosecuted our inquiries upon a larger scale, by an examination of the influence of the removal and deposit of many acres of earth upon the "flats;" a circumstance which has resulted from the necessity of lifting that portion of the town to protect it from inundations, and from the excavations of the Hamburg street canal, and the Ohio basin. But we are persuaded that no conclusions of value could be drawn where so many modifying circumstances need to be taken into the account. Here was originally a marl covered with vegetable mould, and it is well known to have been a source of malaria. It is now in part the same, and in part it is composed of irregular basins of clay, containing pools of water, and we presume, also, that it is now, as before, a source of malaria : but to what relative or actual extent we have not the means of determining. One thing at least must have greatly favored this district during the present season, viz., the general prevalence of south-west winds, which, while they have swept off the miasma generated upon the fiats, may possibly have contributed materially to the greater fatality of the cholera in the north-eastern portions of the town, over which these winds must pass, bearing their vapors and their poisons. To us it seems that while few cities have grown as rapidly as Buffalo, in few cities, also, has it become necessary to the same extent to disturb the soil for the purposes of grading, filling, paving, ditching, &c, &c, a circumstance which might have proved harmless where sand was the earth removed, but which, as we have shown, must be directly or indirectly a source of disease where clay and alluvium preponderate. Recapitulation. — The conclusions to which we have arrived then are, First. That upturning of the soil, under certain circumstances, will produce certain forms of disease, such as intermittents, &c. Second. That in all these cases where newly opened soil occasions fevers, it is the old and decaying vegetable matter thus brought to the surface which chiefly, if not alone, produces the diseases which result. Third, Decaying vegetable matter may produce not only fevers, but also, probably as an exciting cause, Asiatic cholera. Fourth. That as an inevitable inference, upturning of the soil may, in the same manner, produce Asiatic cholera. Fifth. That in our own city there are many localities under which vegetable o* 26 REPORT ON ASIATIC CHOLERA. soil has been buried; and that in all those parts the exposure of this under soil to the air may become an exciting cause of cholera. Sixth. That upturning of a clay, or sandy soil, which is impregnated with vegetable matter, may also, in proportion to the amount of such organic materials contained, prove a source of cholera. We wish it to be understood, however, that we regard this cause as quite. inconsiderable in the great majority of cases. Seventh. That independent of the nature of the materials composing the soil the obstructions occasioned thereby to the free passage of water along the gutters, renders upturning of the soil indirectly a source of cholera; and not alone in the manner now indicated, but also by forming irregular basins which contain water, as in many ploughed and unpaved streets, and upon the " flats." Finally, the practical inferences to be made from all we have said, are, An active, and intelligent Board of Health, with the co-operation of the Mayor and Common Council and citizens, can do more for the arrest of the Asiatic cholera, than the most able body of medical men : since with them rests the task, so comparatively easy, of removing the causes; while with physicians only remains the work, so often impossible, of applying the remedy. To this end, and that our city may become again as salubrious as it was known to be before its rapid growth had turned its pastures into pools, and its streets into muddy sewers — as healthy, and as free from epidemics as Utica, Schenectady, Troy, Albany, or indeed as any of our elder sister cities, which are now enjoying an enviable exemption from the present epidemic; and for which they are indebted, no doubt mainly, to their complete drainage, and to the perfection of their public works, such as grading, paving, sewerage, &c. — to this end, we repeat, it is necessary that no narrow system of party interest, or mean economy should prevail; but influenced by enlarged views, which will esteem the lives of our fellowoitizens paramount to all other considerations, pecuniary or political, a plan must be devised, and a work carried out commensurate with the magnitude of the evil to be abated. Were it necessary, however, we might easily demonstrate that even in a pecuniary point of view, the owners of property would find such expenditures remunerative. The reputation of increased salubrity which our town must soon enjoy, would, we have no doubt, return a quick interest for every dollar thus laid out. 27 REPORT ON ASIATIC CHOLERA. By such measures as the following are these results only to be attained : By a system of sewerage, perfect and coextensive with the city limits, or at least with occupied dwellings. (Appendix, D.) By draining every cellar, and every lot whose level is below the street, or By tilling up vacant and und rained grounds. By paving every street and lane, at least in those portions of the town where clay or alluvium preponderate. By removing all obstructions which arrest or retard the flow of water through the gutters. For it ought to be strongly impressed, that a very small basin of stagnant water is, at certain seasons, the source of a very large amount of poisonous malaria. By sweeping the streets thoroughly, once or twice a week; and not allowing the dirt to be again sifted and scattered along the way by the loose wagons with which its removal is attempted. By requiring builders to occupy less room with their materials; and especially by requiring them so to contiue their sand, vered with thick masses of vegetable mould, or fungi, of the cryptogatnous order. It h, perhaps, rather a curious than practical fact, that a careful micro* s-copic examination made by Dr. Merriam j showed ten different species of cryptognmee. We did not doubt that in the vegetable malaria of this cellar we had found the source of the disease* D, In man} 1 respects our system of sewerage is eminently defective. The tnains are not sufficiently large — the branches are not sufficiently numerous, but esj ecially is it defective in the almost complete absence of stench traps Which alone, we are informed, can effectually prevent the return of the gases into tl.e f-treets and dwellings. This is a great and rapidly increasing evil, and while we wish to give due prorr.iiKi.c ¦ to tl.e other causes, and especially to the surface and underground niiaems, of which we have now spoken at length, we deem it proper to refer also to fuse sewer mi asms as, in our city at least, an equal, possibly it may 35 APPENDIX, be, a mucli more abundant source of disease. It is the more proper to speak of them in this report, because it not unfrequently happens that in upturning the earth to lay gas and water pipes, the inlets or mains of the sewers are cut across and their gases thus escaping may produce those diseases which result. Such, however, we ought to say, was not the fact in Ellicott .street, nor in Genesee and Cherry street. In Ellicott the inlets were below the bottom of the ditch, and in Genesee street and Cherry, the excavations were for the purpose of building sewers. These sewers receive a large amount of offal, chiefly vegetable; and to be convinced that they may eructate villanous odors, one has only to place himself over one of the open mouths, or inlets, at any corner of the streets. Most of the main trunks have their outlets above the surface of the water, on the creek or canals, open toward the prevailing winds, so that they are daily and hourly, when the winds are favorable, blowing their impurities up into the houses and into the streets. At all times, whether the wind favors or not, they do not cease to breathe out poisons and dispense it silently and imperceptibly into our dwellings. If we do not always recognize it, it is because Aye have in general become too much accustomed to it. We are informed by Mr. Brick, that his men often fall sick and are obliged to leave their work when accidentally or by necessity, they tap one of these inlets or house drains. That we should continue to be exposed to this source of disease, and of cholera no doubt, where the remedy is so easy, implies great neglect, if not actual criminality, on the part of our city authorities, as well as of the citizens themselves. Stench traps, constructed at a trifling cost, have been proven to be an effectual remedy. At the expense of the city they should be immediately placed at every street inlet; and no person ought to be permitted, under a suitable penalty for the omission, to connect his premises with a sewer without a similar sink. The expense to the city of keeping the street traps sealed by a sufficient supply of water from the hydrants, would be inconsiderable. How effectual these stench traps prove, a large experience in other cities has fully determined, and some of our citizens have ascertained by having laid them in their own premises. But many of you, perhaps, will remember that when the gas works were first completed in the fall of '48, our whole town was made to celebrate the event by a sudden irruption into every house and street having a drain, of an intolerable odor of sulphuretted hydrogen. The refuse gas from the gas works' establishment had been emptied by a chimney into one of the main sewers near its outlet, and a favorable wind APPENDIX. 36 liad carried it upward into every artery of the city sewers, and people were driven from their houses into the streets, and even there the stench followed them. Immediately, by order of the superintendent, Mr. Brick, the main sewer was cut off above the point where the gas pipe connected with it, and a stench trap was laid, and the offense at once ceased. Something might also be accomplished, and probably at a cost to the city of less than $300 annually, by flooding the sewers occasionally during the summer season by turning several hydrants simultaneously into a single main. CHOLERA, AND ITS CAUSES. BY DR. HAMILTON /rf * f 36 APPENDIX. had carried it upward into every artery of the city sewers, and people were driven from their houses into the streets, and even there the stench followed them. Immediately, by order of the superintendent, Mr. Brick, the main sewer was cut off above the point where the gas pipe connected with it, and a stench trap was laid, and the offense at once ceased. Something- might also be accomplished, and probably at a cost to the city of less than $300 annually, by flooding the sewers occasionally during the summer season by turning several hydrants simultaneously into a single main.