1 STATISTICS OF CHOLERA: | (£, "ITU THE r/ I) 8 SANITARY MEASURES |? ft" lOOPTKO I.v ii i s i r( 3 THE U() ARD OF II RALTH, S i t 'i\ PRIOR TO, AND DURING THE PREVALENCE OF 3 \| THE EPIDEMIC IN PHILADELPHIA, <> J3 IN TIT E ST T M M E1? OF LB4 0. |; « JJ ;? p ' M PHILADELPHIA: |i J^ KINO & BAIRD, PRINTERS, No. 9 SANSOM STREET, & STATISTICS OF CHOLERA: WITH THE SANITARY MEASURES ADOPTED liV THE BOARD OF HEALTH TRIOR TO, AND DURING THE PREVALENCE OF THE EPIDEMIC IN PHILADELPHIA, IN TUE SUMMER OF 1819, CHRONOLOGICALLY ARRANGED. y>H Prepared by the Sanitary Committee, approved by the Board, and ordered for publication, October 10th, 1849. PHILADELPHIA: KING & BAIRD, PRINTERS, 9 BANSOM STREET. 18 4 9 measures for the cleanliness and health of the City and Port of Philadelphia, adopted by the Board of Health, prior to, and during the prevalence of the late Cholera Epidemic; together with a statistical history of the disease as it, appeared among us. The whole subject of preparing a report, having been referred to the Sanitary Committee, they submitted the annexed document to the Board, on the 10th of October, 1840 j when it was read and approved by them, and ordered to be published, as set forth in the following resolution : " Resolved, That the Beport read be adopted, and referred to the Sanitary Committee to prepare for publication, and report to the Board the number of copies necessary to be published." At the meeting on the 17th of October, the Board resolved, " that fifteen hundred copies be published in pamphlet form." ?SUS NATIONAL LIBRARY OF MEDICINE BETHESDA 14, MD. / REPORT. The progressive advance of Cholera throughout continental Europe, during the years 1817 and 1818, md its appearance in England in the autumn of the atter year, claimed the serious attention of the Board of Health as early as November, 1848, and led them to he immediate adoption and rigid enforcement of a syscm of sanitary appliances, for the purpose of checking he progress and shortening the duration of this formidable Epidemic, in the event of its arrival in the Jnitcd States. To wit — by the careful removal of all hose agents or accessory causes, which experience has >roved, arc abundantly fruitful, in favouring the promoion and spread of zymotic diseases. By a resolution of the Board, the Sanitary Committee had the whole subject of Asiatic Cholera under consideration, and after reviewing and investigating its history and progress, from its appearance in the Spring of 18 16, at Kurrachee, in the delta of the Ganges, down to its outbreak in Sunderland and London, a course of travel parallel to that of '30 and '32, and having every reason to apprehend its irruption among us at no very remote period, submitted to the Board on the 11th of November, 1848, a report, embracing the most important characteristics of the disease, and all that was necessary in a sanitary point of view, to be observed 4 at that time. Among other recommendations in that report, the committee offered the following sanitary resolutions for the action of the Board: — " Resolved, That the attention of the City Councils and the Municipal Authorities of the Districts of the County, be especially called to the subject of sewerage; and that said authorities be recommended to adopt measures, as early as practicable, to avoid surface drainage altogether ; also to attend to street paving, so as to avoid inequalities of surface, whereby water and refuse matters accumulate ; as a sanitary measure of paramount importance in the prevention and mitigation of Epidemic Cholera and other diseases. "Resolved, That the attention of the City Councils and the Municipal Authorities of the several Districts of the County, be called to a thorough and more frequent cleansing of the streets and gutters before 12 o'clock in the day; and to the cleansing of courts and alleys, and the prompt removal of filth and garbage therefrom: and that they be respectfully requested, with citizens generally, to notify the Hoard of Health of any accumulation of filth or rubbish, of foul courts or alleys not within their jurisdiction — also of foul privies, pig-sties or piggeries, or any yards or cellars of houses where offensive matters exist ; so that by co-ordinate action we may establish a sanitary police, whereby the Epidemic influence may be in a great measure, if not entirely, counteracted. " Resolved, That the District Committees of this Board be requested to report to the Board of Health, all houses or places n their respective districts, suspected of being in an unhealthy condition, or likely to become so ; and diligently to inquire and report all causes or suspected causes of diseases in their leighborhoods, and particularly imperfect drainage of gutters n low situations, and the causes thereof — and that they be authorized to employ one or more agents to attend to or carry out the above important sanitary suggestions, when necessary.'' In offering these resolutions the committee were governed by the broad and well known principle, that all Epidemics are generally obedient to the same laws, governed by like influences, and warmed into lively activity by certain atmospherical changes, yet modified by local 5 posing animal and vegetable substances, crowded and illy-ventilated dwellings, bad drainage and sewerage, noxious gases, and other baneful agencies. These resolutions received the unanimous and hearty co-operation of the Board, and prompt measures were immediately adopted, to carry out the spirit and intent of them without delay. Copies of the two first were forwarded to the City Councils and to each of the Municipal Authorities of the districts in the county, while the third was referred to the several District Committees of the Board, by whom it was executed with the utmost zeal and promptitude. So that by the thirteenth of December, there were five district sanitary agents at work in the field, to each of whom the following code of directions, approved by the Board, was presented, with strict orders to give it their faithful attention; to " That they visit all houses, cellars, yards, schooliouscs, factories, slaughter-houses, streets, lanes, alleys, courts, and all other places within their respective disricts, where nuisances may exist, for the purpose of examining if there arc thereon, any nuisances tending to affect the health of the citizens, and to report to the Board, all hog pens, ponds of stagnant water, and such other nuisances as they may find/ It is with the liveliest emotions that we acknowledge he zealous co-operation of the City Councils and the everal Municipal Corporations, in the above measures, or the general good of the community. And it becomes us to say, that a common sympathy for the public weal pervaded the above bodies, and that a marked disposition to put in force, from month to month, during 6 the past season of calamity, the various recommendations of our Board, as far as they were compatible with other interests and claims upon their official position. While it is flattering to the Board, it must be gratifying to their fellow-citizens to know, that the adoption and enforcement of the above preparatory sanitary measures for the promotion of cleanliness and the preservation of the health of our city, were neither esteemed unnecessary nor premature. Scarcely had the work of purification commenced, ere the fearful tidings reached us that the Cholera was on Staten Island, at the New York quarantine ground, and, a very few days after, the intelligence was conveyed to our city on lightning speed, that this desolating Epidemic had made its appearance in New Orleans. On the 20th of December, the Board appointed a committee to visit the quarantine station on Staten Island, for the purpose of obtaining official information as to the character of the disease, (it having been questioned,) and all the facts connected with its appearance on the Island. This committee was received by the Health Officer at the quarantine station, with demonstrations of kindness, and every facility was afforded them through his politeness, and that of his medical staff, for acquiring all such information on the subject of the disease then prevalent among the inmates of that institution, as their mission contemplated ; nor can less be said, for the courtesy and manifestation of kindness on the part of the City Authorities of New York and the Sanitary Committee of their Board of Health, with whom the Committee took counsel in an official interview, at the Mayor's office in the City Hall. 7 The report of this Committee, drawn up with much care, was presented and adopted by the Board on the 30th of December, and embraced a wide field of inquiry and information, the result of which was, that Cholera, in all its undisguised integrity, had reached our shores, and that nothing now remained for the Hoard of Health, but to prepare to meet and combat this strange and mysterious enemy — an enemy which disregards all established laws of Epidemics, sets at nought all preconceived theories, leaps over sanitary cordons, (lies with the speed of the locomotive, or the ship, over land and ocean, destroying one in every three upon whom it fastens its pestiferous poison. The appearance of the Cholera at Statcn Island, and its almost simultaneous outbreak at New Orleans, is one of those peculiar coincidences which will forever be shrouded in obscurity. Carried into both ports by emigrant ships from Havre, where, when they sailed, there was no Cholera known to exist — the one leaving on the 3d of November, and the other on the 9th, following nearly the same track, the disease appearing at sea on the 2.3 th of November, in one, and in the other on the 28th, when most probably in the vicinity of each )ther, crowded with emigrants, uncleanly and badly ventilated — the inference is, that they must have passed through a stratum of atmosphere, loaded with sonic )eculiar influence, which, under favorable circumstances, )roduccd in both cases the cholera poison. Indeed, all he facts connected therewith, possess intrinsic Value, )oth to the medical profession and the advocates of sanitary reform. The advent of Cholera into the United States bavin"-been 8 fully confirmed and established, the Board of Health resolved, so to exercise the prerogative of their position between the disease and the community, that they might be competent to discover the first impression from a tainted atmosphere and arrest the inroads of a pestilential habitude. On the 3d of January, 18J9, the Board passed the following resolution, persuaded that the accumulation of filth, arising from the deposit of refuse meat and vegetables with other extraneous matter in the streets, involves a nuisance injurious to the public health, and should be corrected. " Resolved^ That it be recommended to the Municipal Authorities, holding markets for the sale of meats and vegetables in their respective districts, to have the streets, in which the market-houses are located, cleansed within such market squares as early as possible after holding such markets." The continuance and increase of the Epidemic at \cw Orleans, becoming a subject of apprehension, owing to the frequent communication between the two )orts, the Board issued a proclamation on the Oth of Fanuary, requiring all vessels from New Orleans, or rom any other port in the United States, where Cholera prevailed at the time of their sailing, to be detained in the stream, in order to receive a visit from the Port Physician, in the same manner and form, and subject to like penalties, as prescribed by law, in case of vessels from foreign ports. While the adoption of this measure, and its enforcement, seems to involve the proposition of the contagiousness of Cholera, the Board would express no opinion for or against the doctrine of contagion, a question which has puzzled medical philosophers in every age, and which aided by the lights of 9 science and experience, is now undergoing an alteration which may eventually merge the strict contagious theory into a higher generalization. The object of the proclamation was strictly a sanitary one, a public safeguard, to allay undue solicitude in the community, to cleanse the ship, dilute the poison, and take proper care of the sick. At the same meeting, January 6th, 1849, the Sanitary Committee were directed to report as early as practicable, what arrangements were necessary in regard to the location of Dispensaries and Hospitals, and the employment of physicians, and nurses, &c, in the event of the appearance of Cholera in our City. On the 7th of March, the Sanitary Committee reported a plan of Cholera Dispensary and Hospital arrangements. By the Ist of April, the Sanitary agents had competed their work of visitation. It would be impossible 'or the Board to enumerate the cases and causes of nsalubrity discovered by them, and the numerous localiies which, by their exact investigations, were found to >c fruitful sources of filth and disease. Their labours nvolvcd the Board in an amount of duty unparalleled n all former years, and heaped upon its officers an accumulation of multifarious business, of sufficient magnitude for twice the number then engaged. Every nuisance was reported by them to their District Committees, who were intermediate between them and the Board. The Committees examined their reports, and if satisfactory presented them to the Board, who, upon sufficient cause, declared the same to be nuisances prejudicial to health ; whereupon a notice was served upon the 10 owner, agent, or occupant of the premises complained of, requiring the removal of the same within a specified time, according to the :27th Section of the Act of Assembly, passed January 29, IS 18, and if not then done, to be done by the Health officer at their expense, and they prosecuted for the penalty. It was made a part of the duty of the agents to follow up these notices, and when not complied with, according to the act of the Board, to give the same into the hands of the Health Officer, who would have the nuisance removed, and forthwith commence a prosecution for the penalty. This explanation is made, in order to exhibit some considerable portion of the vast burden imposed upon the Hoard and its various oilicers, after the nuisances have been ferreted out.* A careless observer of tliQ actual condition of our City as regards its cleanliness, would not fail to overlook the serious number of concealed nuisances, which are continually acting as the foci of an unhealthful atmosphere and disease, to be found within and adjoining the premises, not only of the poor, but of those whose condition in society would place them far above suspicion. And whilst our City may enjoy, and well deserves the credit of being the cleanest in the Union, it must not be denied, that there do exist localities, and there may be found spots, hidden from the public eye, * The passage of a supplementary law, April sfh, 1840, and which was read before the Board on the 18th of the same month, has greatly facilitated the sanitary operations of the Board of Health, by enabling them nnt only to destroy hog pens, but to .seize upon the hogs, and leliver them as forfeited to the Guardians of the Poor, and lias conferred upon them the same power also to remove the cause of nuisanoes, is they before possessed to remove nuisances. 11 wliorc nuisances of the worst kind abound, generating and entailing disease, and sowing the seeds of physical death upon all around. It is to these nuisances that we desire to advert, in rder to furnish the public with some feeble idea, not nlv of the investigations of a sanitary character, which lave received the attention and occupied the time of ie Board and its officers, but to place before our fellow itizens, the amount of remediable evils, which have vistcd at their own doors as it were, and which have )ecn removed during the past year. TAIUiK. OF NUISANCES REMOVED, KKoM OCTOBER Iv:^.1 v :^. TO OCTOBER 1849 IMSTRICTB. '• cleaned. Yards cli aned. Cellars cleaned. Privies purified. Ponds filled or draim d. Hog pens removed. Filthy li ¦ l-'iltliv alleys cleaned. Manure In apt removed. Sin-it- and gutters ordered »I<-miiiml. Courts, do. do. Slaughter houf Hinka cleaned. l',;i,i :cinl bone Bhope closed, closed. Tnru.. City Proper, L 122 35 173 90 265 j 251 42i328 19 27 138J15 59 24 262 Spring Garden, ! SO4 1 20 6fi 09 7" 62150 022 2918 <> 40 4 14:. Moy&menalng, 116 15 BO TO 41 45 13 220 18 0 1" 4 13 41- 18 3 »» i ; Southwark, 119 2 19 49 39 39 11 LO2 4 '.' 7 r. v 7 -j i4l Northern Liberties, 467 16 47 37 48 3 24 4 3 Bill 12 10 2 !'¦¦> Kensington, 257 10 33 01 76 4fl •¦ B0 61! 2 6 19 11 67 Richmond, 6 •' B 19 Perm District, 4 West Philadelphia, 2 12 2 3 0 Total, 2970 U31340 :;M 661 sOl'lBS 918 59 81 194 59 11 11.;.'I 1 .;.' 4rated air, and alike destructive to health and offensive o every feeling of delicacy. The numerous ponds of stagnant waters, 198 of which lave been filled or drained, found principally in the suburbs and on the borders of the new districts, and in he midst of improvements, are another effectual means or producing disease. Sending forth their stinking and norbific matter, or loaded with the minute and invisible sporules of cryptogamous production, and carried by he prevailing winds, may settle down on some near or nore remote and favourable location, spending their venom in disease and death. It would fill a volume if we undertook to carry the reader through the thousand 'plague spots' in the list oi 13 houses closed, and houses, yards and cellars denned, cVc. &c, that have infested our city, and have undergone personal inspection by the Board and its officers, and which, as far as their ability and power extends, they have wiped away with the sanitary besom. Day after day in their personal visits, did they breathe the pestiferous atmosphere of some degraded or illy-ventilated purlieus, where extremes of filth and misery and loathsome disease met the eye; where horrid heaps of manure from hog and cow pens; putrefying garbage and refuse of every kind; carcases in disgusting decomposition ; filthy rooms and damp, dirty and mouldy cellars, full and foul privies in close and illy-ventilated locations gave off their noxious gases. Many of these localities were in close proximity to contracted and badly contrived houses, crowded by occupants, filthy and poor, without ventilation or drainage, or receptacles for refuse, or supply of water, or the common comforts of life. We cannot, however, omit a brief allusion to the rag md bone establishments in the immediate vicinity of the wretched neighbourhoods of Baker, Bedford and Spafbrd streets, Moyamensing, where moral debasement and )hysical disorder, set at defiance all law, and shame civilization ; the very hot-beds of everything offensive and disgusting. no In these bone establishments, 1G of which were removed, we found heaps of assorted refuse of every variety, gathered by the numerous poor and degraded )lacks who infest that vicinity, from the filth of streets and gutters, and vacant lots, and other receptacles for offal, 14 glass, and dog manure, which sent forth a most horrid odour. The whole of these disgusting premises, were immediately declared to be, in the most positive terms, nuisances of the worst kind, and every one of them were emptied, cleansed, and closed up. A single visit to these " store-houses of refuse" was enough to convince the Hoard, that they must be highly injurious to public health, and productive of diseases cf the lowest type. Besides these, there were other premises of a less objectionable character, but perhaps equally productive of an unhealthy and foul atmosphere, vacated and closed up. The condition of the block of buildings on the east of Front street, between Race and Vine streets, called loudly for the purifying hand of the Board of Health, and received their special attention. The crowded and foul state of these houses, and their entire unfitness for comfort and convenience, having neither yards nor privies, induced the Board to close up the worst of them for the season, and to have the remainder thoroughly cleansed and the population diminished in lumbers. Slaughter-houses and butchers' yards required and received the special notice of the Board ; many were visited, the foulest of them shut up and vacated, while others were thoroughly cleaned by their orders. It will scarcely be thought out of place, to glance at he numerous hog pens which have infested many neigh>orhoods with their noisome exhalations. Hitherto, here has been great difficulty in reaching effectually, these most disgusting and sickly receptacles of filth, but 15 Health to remove in a summary and by a very certain method, all hogs and pens within their jurisdiction.* During the year past, 918 hog pens have been rooted out, and thus our city freed from their pestiferous effluvia. The character of the nuisances removed were 19 in number, and are classified under the following heads : irivics cleaned, houses cleaned, houses closed, yards cleaned, cellars cleaned, privies purified, ponds filled or drained, hog pens removed, stables cleaned, filthy lots cleaned, filthy alleys cleaned, manure heaps removed, streets and gutters ordered cleaned, courts ordered cleaned, slaughter-houses cleaned, sinks cleaned, vaults cleaned, rag and bone shops closed, burial grounds closed. The whole number of nuisances removed within one year, has amounted to the enormous sum of 6573, of which, with the exception of 1 16, were on private pro)erty, and hundreds of them were entirely concealed rom the public eye. The table exhibits what may be thought a very unequal division of nuisances as charged to the several districts; and the question may very properly be asked — why Spring Garden, one of the newest sections of our city, should contain so many nuisances, while Southwark shows comparatively few ? — the answer is, that in those; listricts where the most nuisances are reported, the most active agents were found. While we have not attempted to show up the condition in which we found the inlets to the public sewers and the street gutters, we may be excused by the public authorities for venturing an opinion, that, collectively, they possess the materials for creating the worst form * Sec note on page 10. 16 of nuisance. It is admitted by all sanitary observers that the foetid emanations from foul sewers and gutters are highly dangerous to health. The constant exposure of the contents of these gutters, consisting in a great measure of decomposing vegetable and animal refuse, to the sun at mid-day, and the action of the rain and refuse water from houses, hastens decomposition and putrefaction, producing exhalations both pestiferous and intolerable. The attention of the public authorities were directed to these nuisances, and we are happy to say, that to hem we are indebted for their improved condition ; rendered so by the free use of the broom and water to he gutters, and the frequent distribution of chloride of ime for the inlets to the sewers. On the 11th of April, the Lazaretto Committee offered the following report, which was adopted by the board : Whereas Cholera is now said to exist at the Port of New )rlcans, and in all probability may extend to other ports of this continent, and whereas passenger vessels arriving at this Port luring the months of March, April, and May, frequently have on board cases of sickness of a contagious character, and inasnuch as this Hoard is frequently compelled to remove such ases to the City Hospital, which practice, although under the ircumstances dictated by the motives of humanity, is inaniestly improper, therefore, Resolved, That all ships or vessels arriving at this Port on and after the 20th day of this mouth, from any Port in Europe (having passengers on board) or from any Port where Cholera was known to exist at the time of her departure, together with any vessel having had, during her voyage, a case of Small-pox or infectious or contagious disease on board, shall stop at the Lazaretto, and there receive a visit, and be treated the same as 17 though such ship or vessel had arrived between the first day of June and the first day of October. Itcsolved, That the Health Officer be directed to issue a Proclamation addressed to the Captains and Owners of vessels and Pilots, in accordance with the above. In accordance with these resolutions, the Lazaretto Committee made the necessary arrangements to enforce the orders of the Board ; and on the 20th of April, a proclamation was issued by the Health Officer, giving notice to merchants, mariners and pilots, that the quarantine was in force, as to all vessels arriving from ports where the Cholera was prevalent at the time of their sailing. By the middle of May, rumors were in circulation, that the Cholera existed in our city. This impression, gaining credence in the community, and pervading the timid and those accessible to fear, with a gloom and terror, almost as alarming as the effect of the scourge itself, made it necessary for the Board of Health, in order to allay excitement and arrive at the truth, to address itself to a careful investigation of some of the causes through which the report may have originated. They were enabled to calm the anxiety which prevailed, by the publication in the daily papers of the following preamble and resolutions, which passed the Board, on the 23d of May. "Health Office, May 23d, 1549. " Whereas, reports are in circulation to the effect, that maliglant Cholera exists at the present time in the City and County of Philadelphia, which are unfounded in fact, the Board of lealth deem it a duty to disabuse the public mind, in regard o said rumors, at the earliest possible moment ; therefore, "Resolved, That having received no information ollicially, that malignant Cholera prevails in our City and County, the .) 18 Hoard entertain the belief that there is nothing in the general state of health, within the bounds of its jurisdiction, calculated, in the least degree, to cause alarm, or excite apprehension of present or immediate danger to our citizens, and that our city enjoys in every respect its usual exemption from disease." At the same meeting of 23rd May, the subjoined re solutions were adopted. " May 23 rd. "Resolved, That the Municipal Authorities of the City and County be requested to cause the gutters of the streets and alleys to be thoroughly washed and brushed every day, either before sunrise or after sunset during the present season ; also, to collect daily the kitchen garbage, &.C., and likewise recommend to families to have their houses, cellars, and yards cleansed and whitewashed." "Resolved, That the President and Secretary be directed to confer with the proprietors and editors of the several newspapers, in respect to publications of rumors as to the existence of Cholera in our City and County, and suggest to them the propriety of suspending any publication of reports on the subject, unless officially from this Hoard." The first of these enactments, met the entire approval of the municipal authorities, who sustained the board n the excellency and in the exigency of the proposition, and without a moment's delay practically carried it out, to the great improvement of public cleanliness and the lealth of the citizens. The latter resolution was received >y the editorial department with the same spirit which dictated its adoption, viz: the public good; and from that time forward, they embraced every suitable opportunity to allay the cholera excitement, and to commend and favour the sanitary measures presented to the public yy the Board of Health. The preceding were the principal sanitary police regulations instituted by tho Hoard of Health, in advance 19 of the appearance of Cholera in Philadelphia. In all which administrative measures, they were influenced solely, by an ardent desire to place the city in the nost favourable condition, in a sanitary point of view, to meet the scourge — adopting the great and acknowledged principle, that "prevention is better than cure," and that the removal and abatement of all those causes, which are calculated to feed and foster Epidemics, are of far more importance to the vital and health\ll condition of the community, than can be, the most rigidly enforced and best regulated medical treatment of the pestilence, when in our midst. The announcement, that three cases of Cholera were n the city, was made to the Board of Health on Wednesday, the 30th of May. Upon inquiry, it was asccraincd that two of these cases were on board of a canal )oat at Richmond, which had arrived the night before rom Bridesburg, having on board three persons, two men md a woman, neither of whom had been to New York. One of the men had labored under diarrhoea for several lays, and on the 29th was seized with Cholera, and died about 12 M. on the 30th ; the other, (both of whom vere intemperate,) was attacked with Cholera after >reakfast on the 30th, without any premonitory sympoms, and died about 3P. M. the same day. The boat was extremely filthy, confined, and damp. After the death of these men, the woman, who was not sick, being refused admittance into any of the houses at Richmond, owing to the panic, was taken care of by the Board of Health, conveyed to the City Hospital, and in a few days left the city for her residence, at Trenton, N. J. 20 The boat was hauled to a sand-bar opposite the city, and sunk. The third case, was in Fourth street above Shippcn, Southwark, that of an Irish emigrant, who had been in the country but a short time, and had, within a few days prior to his attack, arrived in the city from New York. He died within ten hours from the commencement of the disease. On the 31st, one case was reported in Barclay street, City, a man who worked at Market-street Ferry, on the Delaware. On the 2d of June, two cases were reported in the City, one on the eastern and the other on the western section, near the Schuylkill. From this date, the cases gradually increased. It was now evident that the Epidemic influence was being felt in the community. Three cases had simultaneously occurred at two extremes of the eastern section of our city, while others were traced to intermediate points. There was a very general excitement and anxiety manifested among the citizens to learn the extent and the location of the disease, while rumour was actively engaged in multiplying cases. The people looked to the Board of Health for correct information, they being the only official organ of communication. The board, on the other hand, felt their responsibility ; they looked abroad, and beheld Cholera as the all-absorbing subject. They saw mingled fear and distress depicted in the countenances of the people. Their position was embarrassing. But their minds were soon made up to give the truth — to conceal nothing — as the best and most certain course to tranquilize the public mind, and 21 thus effectually guard against the influence of exaggerated and unfounded statements of the Epidemic. At the meeting on the 30th of May, the Hoard resolved to publish in the daily papers, the cases of Cholera that had been already reported ; to meet daily thereafter, and to issue a daily bulletin of all Cholera cases that should be reported to them. They also passed a resolution, requiring practising physicians in the city and several districts, to report daily, in writing, at the Health Office, by 12 m. their cases and deaths from Cholera, and the districts in which they were located. At the same meeting, they considered the propriety of making timely arrangements for furnishing medical aid to the necessitous and labouring classes; and, having satisfied themselves, that the most judicious relief would )c obtained, by the establishment of local dispensaries throughout the city and districts, adopted the following resolutions : " Resolved, That local Dispensaries be immediately selected and established by this Board in the city and several districts, or the purpose of affording aid, and furnishing whatever medicines or other remedies that may be prescribed for cholera paients, by any regular physician, either during the premonitory or more violent symptoms of the disease." "Resolved, That the several District Committees of the Board, >c requested to report at 12 M., of to-morrow, or as early as practicable, the names and localities of such persons in their espective districts, as may be proper to select, in accordance with the above resolution, and the terms upon which such medicines or other remedies as are required, may be furnished." I As a further sanitary regulation, the following was dopted for general and special application. Kcsolved, That when any case of malignant or contagious c; may be reported to this Board, the messenger, or such 22 officer as the Sanitary Committee may direct, shall forthwith visit the premises, and report to this Hoard what action, if any, may he necessary in reference to the removal of the patient, or the cleansing of the premises." The frequent applications made to the Board, from week to week, during the summer months, for permits to remove dead bodies from one church-yard to another, led them to inquire into the evils that might follow such disinterments, especially during the prevalence of an Epidemic, from the inhalation of the noxious gases, emanating from the decomposing bodies, by those who are compelled to reside in the neighbourhood of grave-yards. This inquiry, resulted in the adoption of the following resolution, on the sth of June. " Resolved, That no further permits be granted for the removal of dead bodies from one burial ground to another, until otherwise ordered by the Board." On the 3rd of June, a committee of the Board had an interesting conference with a sub-committee of Councils, " relative to the best means of securing the health and cleanliness of the city." In this joint committee there was a free interchange of sentiment, which resulted n the determination to co-operate with each other in the faithful performance of those high functional duties devolving upon them, for promoting the health and preserving the cleanliness of the city, during the prevalence of the Epidemic. At this juncture, the question of watering the streets, during the heat of the day, absorbed the mind of the Board, which resulted in the adoption of the following resolutions : 23 horitics of the several districts, have their attention directed to the improper and constant practice pursued by many of the citizens at all hours of the day, of scattering the filthy and muddy water from the gutters, and otherwise wetting the streets, as a nuisance productive of humidity, and dangerous to lealth at this season of the year." " Resolved, That they be earnestly requested to pass forthvith an ordinance, prohibiting this unhealthy and indiserhnilate application of mud and water, believing that a faithful ompliance on their part with the recommendation of this Joard for washing the gutters and collecting kitchen offal, is equired to preserve cleanliness and health." Copies of these resolutions were forwarded to Councils and to the several municipal authorities in the districts; and the Board not only take pleasure in expressing their sense of the prompt manner in which these recommendations were complied with by the diferent authorities, but that their judgment, as regards watering the streets during the hot days of summer, s borne out by the most respectable medical and scicnific evidence that our city can produce.* The overwhelming accumulation of business (brought nto the office,) occasioned by the co-operative labours of the Councils, and the City Police, the District Committees and the agents of the municipal authorities, ogcther with the fears and apprehensions of an excited >eople, rendered it highly expedient for the Board to engage the services of several assistants, in order to carry out promptly and efficiently their orders in the timely removal of nuisances — accordingly, by the ith of Fune, there were five additional assistant messengers actively employed in pursuing reported nuisances. The * See Report of Sub-Committee of Councils on Cleansing the City, 24 services of these men were invaluable ; and the best evidence we can furnish of the arduous labours of all our out-door agents is, the number and variety of nuisances removed, as recorded in this Report. (p. 11.) On the 11th of June, the Board passed the following resolution. " Resolved, That application be made to the County Board, for the sum of Si o,ooo, to assist in defraying the expenses incurred in our plan of sanitary operations throughout the city and county, and other measures necessary to be adopted, with the view of preventing the spread of Asiatic Cholera in our community." The sth Section of a Supplement to an Act, relating to the Board of Health, passed February 10th, 1832, authorizes the Board to call upon the County Commissioners, by consent of the County Board, for funds to defray all necessary expenses incurred by them, in the execution of their duties, — whenever the fees paid into the office are inadequate to the same. The time had now arrived, for the Board to make a demand upon the County Treasurer — in consequence of the numerous Sanitary measures, necessarily devolving upon them at this crisis, to be enforced, for the preservation of the health of the City. The sum asked for, would appear to be large, and no doubt many will be disposed to question, both the propriety of the requirement on the part of the Board, and the need of abstracting an amount so great from the County funds. In answer, we would only reply, that the Board of Health are obliged to account publicly for every dollar expended by them, and that, in the language of another, " It ia only the purblind or the ignorant, who cannot see, that the largest sum that could possibly be required to carry out every 25 necessary improvement, is actually exceeded by the inexorable tax, levied upon the community, as the consequence of bad Sanitary arrangements." As early as the 4th of June, when the several committees of the Board had reported the names and locations of the Druggists whose stores they had selected as Dispensaries, the Board directed the Clerk to have the following resolution published, in connection with the names and residences of the District Committees and the locations of the Dispensaries, for the benefit of the public. Resolved, That the several District Committees be directed to make the following arrangements with the Druggists and Apothecaries, whose places of business they shall select as local Dispensaries during the prevalence of cholera, or until otherwise ordered by the Hoard. Ist. That the said proprietors of the Dispensaries shall ailbrd aid, and furnish medicines, or other remedies, (at the usual rate of prescription charges,) as may be prescribed by the practising physicians for cholera patients, whenever in the judgment^of the physician such patients are not able to pay for their own medicines, provided, these prescriptions are endorsed with the date, the residence, and wherever practicable, the name of the patients, accompanied with the letters B. 11., signifying. " charge to the Board of Health," which they shall preserve as their vouchers. i2d. That the Dispensaries shall be kept open all hours of lie day, and be accessible at all hours of the night, for the Lccommodation of the sick. 3d. That in the event of persons being suddenly attacked in he streets, and who are without homes or friends, they shall )e received into the nearest Dispensary, and the proprietor of such Dispensary shall give information, as soon as possible, to he Chairman, or any one of the members of the Committee of he District, in which the case has occurred, who shall take such action as may be necessary. ------- j - _. 4th. That bills, accompanied with the prescribed vouchers, shall be presented to the Board monthly, by the several proprietors of the respective local Dispensaries. 26 The District Committees of the Board of Health are as follows : N. W. DISTRICT. — SPRING GARDEN AND PENN. Chairman, Wilson Jewell, M. D., No. 2:3S North Sixth street. Benjamin E. Carpenter, No. 215 Coates street. Joseph Wood, No. 443 North Seventh street, above Poplar street. J. I). Logan, M. I)., No. 27 Logan Square, Vine street, west of Schuylkill Fourfh street. N. E. DISTRICT. — KENSINGTON, NORTHERN LIBERTIES AND RICHMOND. Chairman, Jeremiah E. Eldridgo, Germantown Road, above Fifth street. Oliver Evans, William street, between Point-no-Point Road and Delaware. Charles Delany, No. 43 Queen street, Kensington. William Goodwill) No. 305 North Second street. NORTH CITY DISTRICT. Chairman, Edward Duff, No. 39 Race street, and No. 35 North Wharves. Samuel W. Weer, No. 117 North Twelfth street, and No. 21 South Eighth street. John A. Elkinton, M. D. No. 102 North Fifth street SOUTH CITY DISTRICT Chairman, John C. Martin, No. 319 Spruce street. John Lindsay, No. S Belmont Place. Edward C. Markley, No. 1!) Madison street, and No. 4 Minor street. SOUTIIWARK AND MOYAMENSING. Chairman, Benjamin Martin, No. 4fi3 South Second street. Robert G. Simpson, No. 12:3 Queen street. Robert F. Christy, No. 2SU South Ninth street WEST PHILADELPHIA. Henry Pleasants, M. D., Washington street, above Mary as The Druggists appointed under the above arrangement arc follows : RICHMOND. C. S. Pealc, William and Richmond streets. KENSINGTON. George C. Bower, Third and Gennantown Road. T. W. Vaughan, Queen and Hanover streets. R. Etris, Frankford Road, opposite Conmiissioners 1 Hall. E. Morris, Gennantown Road, Cohoeksink. NORTHERN LIBERTIES. John Horn, corner Third and Brown streets. Benj. 11. Sleeper, Fifth opposite George street. S. P. Shoemaker, Second above Noble street. George Snowden, corner Fourth and Noble streets. FAIRMOI'XT. Geo. S. Ilammill, Callowhill and west Schuylkill Front. FHAXCISVILLE. Dr. A. Leiper, Railroad and Schuylkill Seventh street. SPRING GARDEN AND PENN. Abraham R. Ilorter, corner Broad and Coates streets. John T. Farr, corner Twelfth and Callowhill streets. Thomas R. Hawkins, corner Twelfth and Coates streets. John Hooker, Jr., corner Eleventh and Poplar streets. Win. B. Webb &. Co., corner Tenth anil Spring Garden streets George W. Manson, corner Tenth and Thompson streets. J. N. Moore, Spring Garden street, below Eighth. Lay & Co., corner Eighth and Coates street. Dr. Joseph W. Farley, coiner Seventh and Poplar streets. Wm. F. Bender, 224 Callowhill street. Livermore & Co., corner Sixth and Buttonwood streets. CITY. IT. Erben, corner Twelfth and Vine streets. George Glentworth, Chester and Race streets. John L. Lippincott, 10 1 North Fifth street. 28 Thompson & Son, south side of Race, between Second and Front streets. A. H. Yarnall, corner Schuylkill Third and Lombard streets. John Goodyear, Schuylkill Sixth and Pine streets. Joseph 11. McMaken, corner Broad and Spruce streets. J. W. Sitnes, Schuylkill Front and Market Streets. J. Turnpenny, corner Tenth and Spruce streets. Charles Shivers, corner Seventh and Spruce streets. Thomas J. Husbands, corner Third and Spruce streets. George Mellor, Walnut below Fourth. Henry Zollikoiler, corner Sixth and Pine streets. Robert C. Davis, corner Vine and Schuylkill Seventh streets, W. J. Carter, Schuylkill Seventh and Chestnut streets. SOUTIIWARK. Giles Boulton, cor. Second and Catherine streets. Geo. W. Chambers, cor. Plum and Fourth streets. Wm. M. Reilly, cor. Second and Wharton streets. MOYAMEXSING. Charles Rizcr, cor. Shippen and Fifth streets. George F. Allen, cor. South and Thirteenth streets. WEST PHILADELPHIA. Banks & Walton, S. E. cor. of Washington and Mary streets. By order of the Board of Health. SAMUEL P. MARKS, Clerk. This humane and wise regulation, by which the poor of the community, attacked with Cholera, or its premonitory symptoms, could obtain medicine without charge, on the order of any respectable physician, and thus be enabled to receive attention at their own homes, proved of great advantage in ameliorating the condition of many, who would otherwise have perished for the vant of timely assistance. Hundreds of our citizens, >oor, though worthy, embraced this privilege, and we 29 have reason to believe that valuable lives were saved, by this judicious and wholesome sanitary arrangement. The Board would be neglecting an important part of their duty, did they fail here, in noticing the benevolent zeal and the meritorious conduct of the members of the medical profession, during this trying period. With no expectation of pecuniary reward, they stood ready to lend their aid to the suffering poor. By night or by day they were found in the pent-up chambers of the sick and the afflicted, breathing a loathsome and pestiferous atmosphere, cheerfully and assiduously administering to their relief. Exposed to contagion, if any existed, and at the hazard of health and life, with no other reward than the pleasure of doing good to Buffering humanity in a god-like profession. The continued and alarming increase of the epidemic, determined the Board of Health to carry out and to complete their plan of hospital arrangements. Accordingly the following Report of the Sanitary Committee was adopted on the 27th of June. The Sanitary Committee have had under consideration the subject of Cholera Hospitals, referred to them by the Board, and respectfully submit the following Report : 1. Resolved, That temporary Cholera Hospitals shall 1 v immediately established, and organized in suitable localities in the City arid several Districts, viz. : lor the northern and western part of Spring Garden, and the western part of Perm District, and north-west part of the City, the City Hospital at Bush Hill — for the eastern part of Spring Garden and Perm,* one — * There was no Cholera Hospital opened in this district. 30 for the Northern Liberties, one — for the eastern and western parts of Kensington, one each — for Richmond, one — for Southwark, one— for Moyamensing, one — for the City, three — for West Philadelphia, one — into which all Cholera patients, who cannot have attention at their own homes, shall be received upon the order of any practising Physician, or upon the order of the Clerk, or a Member of the Hoard of Health. 2. Resolved, That for each Cholera Hospital there shall be appointed one principal Physician, and one assistant Physician, and other assistants when deemed necessary, by the respective Committees, who may be either graduates or competent students of Medicine. The principal Physician shall have the entire control and oversight of the Hospital, as far as relates to the management of the sick ; he shall select his own male and female nurses, of whom there shall be one chief female nurse, or matron, and one male and female assistant nurse for every ten male or female patients, or for a fractional part thereof. The appointment, however, of these nurses, shall be reserved lor the Hoard, if they approve of the same. The assistant Physician shall be under the direction of the Principal, and shall remain in the Hospital day and night. He shall keep an accurate register of all cases admitted, under the direction of the Principal, in a book provided for the purpose, who shall report to the Hoard of Health, every day at 12 o'clock, M., all cases occurring in his Hospital. :>. Resolved, That the salaries of the Hospital Physicians shall be $5 per day, and the salaries of the assistant Physicians to the Hospitals shall be S:> per day, without board. That the wages of the nurses in chief shall be S"> per week, and the assistant nurses 53 per week, including board. It is understood hat the compensation will not commence at the time of their ippointment, but when their services are required, and to coninue until otherwise ordered by the Hoard. 4. liesn/red, That the location for the Hospitals, and the appointment of Hospital Physicians shall be determined by the Hoard. ."». Resolved, That the appointment of Hospital Physicians and Nurses take place as soon as the necessary preparation can be made for the same, with the express understanding that the salaries of the Physicians and Nurses, and the rent of the Hospitals, shall not commence until they are called into requisition by an order from this Hoard. 31 6. Resolved, That the necessary furniture and requisitions for the Cholera Hospitals he procured by the District Committees, an inventory of which shall be made and kept by said Committees. 7. Resolved. That the Sanitary Committee be instructed to have in readiness convenient litters lor the sick, collins ami hearses for the dead, and a suitable number of bearers and drivers, whese services can be had at any moment, (night or day) whose 1 compensation shall be fixed by the Committee, but who are not to be paid unless in actual service. S. Resolved, That the several City and District Committees shall have charge of the Cholera Hospitals in their respective Districts, subject to the general superintendence and control of the Board. Impressed with the fact, that large gatherings, especially in public and other buildings, during the prevalence of an Epidemic, where there cannot be a sufficient ventilation, is a fruitful cause of debility and exhaustion of the vital resources, the Board adopted the following sanitary recommendation. " Resolved, That it be respectfully recommended to the Controllers of the Public Schools to vacate, at as early a period as practicable, during the present prevailing epidemic, the schools under their supervision, and especially to close forthwith the primary schools that are located in the basements of churches, or in other confined or illy ventilated apartments.'' A copy of this resolution was addressed to the Controllers of the Public Schools. In view of the approaching National Anniversary, the too free indulgence in ardent spirits, and the many indiscretions that persons are guilty of, on occasious of public rejoicings and festival recreations, where thousands are collected together, the Board, on the 28th of June, passed the following recommendatory resolution : 32 " Resolved, That the Board of Health deem it advisable, and recommend to the various clubs and associations to dispense with the usual celebrations on the ensuing anniversary of the 4th of July." It is with sincere pleasure that the Board take this opportunity to state, that in compliance with this advice, many public gatherings were avoided, and numerous clubs and associations postponed their contemplated excursions. At the meeting on the 28th, a committee that had )een previously appointed to confer with the Controllers of Public Schools, on the subject of granting the use of certain school-houses for Cholera Hospitals, submitted he following report, which was unanimously adopted. " Resolved, That, the following proceedings be entered on the minutes of this Board, and a copy sent to the Board of Conrollers before 3 o'clock, P. M., this day, with a copy of the esolution of June 2Sth, to hold a special meeting this evening, Impressed with the propriety of the measure sanctioned )y the College of Physicians, City Councils, and a very general xpression of public opinion, the Board of Health unanimously greed upon designating certain public school-houses as suitable )laces for Cholera Hospitals, agreeably to the plan pursued in 532, should the present epidemic render the establishment of temporary hospitals necessary. And whereas, it is important as a sanitary measure, to avoid congregating together in large assemblies, which has a tendency to impair the salubrity of the atmosphere ; this Board believed the Board of Controllers would see the propriety of vacating at once most of the public schools for ihe education of children, and consent to their use as hospitals for destitute cholera patients, and thus by co-operating with the Board of Health in the present emergency, they would be carrying out the spirit of the law, .and be the wisest and best appropriation of public beneficence that could possibly be made at this time. And whereas, it becomes all public bodies to fraternise together and disregard all minor or technical considerations when the hand of God is upon the people, and chastening them by manifestations of His mighty power, and whereas but 33 three public school-houses have been designated in the city, viz., sth and Cherry Street, 6th and Lombard Street, and Ashton and Lombard Street on the Schuylkill ; one- in Spring (I;irden, on Huttonwood Street, one in Moyamensing, 11th below Carpenter Street, one in South wark, Carpenter Street above 6th, one in the Northern Liberties, :3rd and Brown, one in West Philadelphia, Chestnut near Margaretta street, with the probability that all will not be required, and perhaps a less number than in 1532, it is " Resolved, That the controllers be respectfully requested to allow and appropriate such public school-houses for cholera hospitals, as were used for that purpose in 1532, and an additional number as may be designated by the Board of Health." The Board have cause to regret the manifest unwilingncss, on the part of these public functionaries, to cooperate with them in the cholera emergency, as they would neither grant the schools for hospitals, nor close hem, in accordance with the united recommendation of the Board of Health, the City Councils, and the Colege of Physicians. !On the 29th of June the follow ing resolution passed he Board. 1" Resolved, That it be recommended to the City Councils. nd the district municipal authorities, to have the contents of le carts collecting kitchen offal, intermixed with chloride of me during their progress through the streets, and when enaged in gathering the offal." On the 29th of June the Cholera Department of the Bush Hill Hospital was opened for the reception of Cholera patients ; and, by the sth of July, there were five Hospitals organized and in active operation, viz., Cherry Itreet, (City,) Southwark, Moyamensing, Northern Licrties, and Bush Hill. The energy and diligence displayed by the members 3 34 of the several district committees, in securing suitable buildings for Hospitals, fitting them up and furnishing them- with the necessary requisitions, after a notice so limited, deserves the highest commendation. On the 12th, the Richmond Hospital was opened; on the 14th, the Kensington and the Pine street, (City); on the 18th, the South street, (City); and on the 23d, the West Philadelphia ; in all, ten, including the Bush Hill Hospital. On the 9th of July, the Board adopted the following resolutions, and ordered them to be published for one week in all the daily papers, also in hand-bills to be posted at the corners of the streets, together wilh a list of the several Hospitals, and the names and residences of the several physicians attached thereto. " Ist. Resolve/}, That it be earnestly recommended to all persons affected with any derangement of the stomach or bowels, who cannot he properly provided for at home, immediately to ivail themselves of the hospitals prepared for cholera patients, )r the advice of hospital physicians, who will prescribe and furlish medicines at all hours, gratis." " 2nd. Resolved, That to prevent collapse and save life during the epidemic influence, it is of primary importance promptly to arrest the diarrhoea or first stage of cholera, which can only be done by rest and appropriate medicine." Anxious to meet every contingency, and overcome 11 the moral, as well as the physical exciting causes l the community, that might predispose the system to n attack of the Epidemic, the Board on the 10th of uly adopted the following resolution, which, they are ratified to say, met the decided approbation of the ire department. " Resolved, That it be respectfully recommended to the Presidenta 35 and members of the different Fire Companies of the City and County of Philadelphia, not to ring their bells, and not to run unless it is certain that fire exists, and their services are actually required, as excitement and violent exercise mpair the vital energies, and thereby increase the susceptilility, and predispose the system to an attack of cholera." On the 13th of July, the Board received the following resolution, in a communication from the Sanitary Committee of Councils. " Re»olved, That the Board of Health be respectfully informed, that this committee have heard a rumor that the number of cases and deaths by cholera, reported at the Blockley Alms louse is incorrect, and that the same should be inquired into, vhich was referred to Messrs. Boswell,Snowden and Christian, o confer with the Board of Health, and obtain information on he subject." Warned of the unfavourable reports floating in the community, prejudicial to the interests and character ol i great public corporation, and the officers in their em)loy, the Board, without hesitation, in order to allay the anxiety occasioned thereby, referred the whole subject o the Sanitary Committee. This led to a searching nvestigation, and resulted in the adoption of the followng report from the said Committee. (See Appendix, It is needless, here, to multiply remarks upon the circumstances involved in the examination made of the llockley Alms House, by the Joint Committee of Councils and the Board of Health. The report tells the whole tory; and while we have ventured to place the Board in a disagreeable position with the conductors of that nstitution, by making ourselves and the public cognizant of its then existing evils, we take pride in announcing, hat after our visit and report, they were assiduous 36 n their efforts, to correct everything which could possihly affect the health or the lives of the inmates. Nor did they spare expense, to make every necessary provision for the trying emergency in which they found hemselves placed, during those terrible scenes of excitement, disease and death, into which they were surprised by a fearful onset of the Cholera. ]»V the Bth of August, it was apparent to the Board, rom the daily reports of cases in private practice, the ew cases admitted into the Hospitals, and other conrolling circumstances, that the Epidemic was gradually declining. With this view they passed the following resolution : " Resolved, That all the Cholera Hospitals except the Cherry street, Moyamensing and Richmond, be closed for the reception of patients by the different Committees, on and after the ninth So that after the 9th of August, there were only three lospitals open to receive patients, which were also discontinued by a resolution of the Board on the 28th of Vugust, there being no longer any need for them, as he Epidemic seemed to be passing rapidly away. This favourable change in the course of the Disease, ed the Board to discontinue the Dispensary arrangenents, by the adoption and publication of the following resolution : " Resolved, That the Clerk be directed to give notice in the everal newspapers publishing for the Hoard, and in the Public -ed^er, that the furnishing of medicines to poor Cholera palents, from the several Dispensaries established by this Hoard, vill be discontinued on and after Saturday, the 11th inst." 37 desire to enhance tlic welfare and comfort of their fellowcitizens, as well as to subserve the interests of the business community, and draw back again those streams of wealth which had been directed into other channels of commerce, led them, on the 18th of August^ to adopt the following preamble and resolution, which were published in the daily papers: "Whereas, In the opinion of this Board, Cholera no longer exists in our community as an epidemic, therefore, tt u j\esoli'ed, That daily bulletins will be no longer issued by his Hoard, unless our City and County should be visited by a eturn of Epidemic Cholera." This announcement gave general satisfaction, and lad its desired effect, both at home and abroad, by allayng all excitement, and restoring to our commerce its accustomed amount of trade. Fearful that the wholesome sanitary regulations for cleansing the streets, which had been so timely and wisely approved of by the several municipal authorities, through our recommendation, should be withdrawn, the Board, on the 24th of August, passed the following resolution, and had it forwarded to those concerned : " Resolved, That it be recommended to the municipal authoriies of the City and the several Districts ol' the County, to coninue their Sanitary operations, so far as respects the prompt ollection and removal of kitchen offal, and the cleansing of he gutters during the remainder of the present and the suceeding month of September." One of the most important sanitary acts of the Board during the prevalence of the Epidemic, was to visit the place of interment for the dead from the Alms House and the out-door patients. These premises had been reported to the Board, as requiring their immediate 38 and careful inspection, believing them to be a prolific agent in the concentration of the Cholera poison in a certain locality in West Philadelphia, where the disease had been rife. The Sanitary Committee, by direction of the Board, visited the ground, and made the following report, which was adopted, and a copy ordered to be forwarded to the Guardians of the Poor. (See Appendix, No. 2.) As on a former occasion, the Board of Guardians, desirous to remove every suspected cause for the promotion of a scourge from which they had so recently and most painfully sulTcrcd, followed the recommendation of the Board of Health, and at once set at rest the apprehensions of their fellow-citizens in West Philadelphia, by abating this most disgusting and revolting nuisance. CHOLERA HOSPITALS. The organization of temporary Cholera Hospitals, ocated in various sections of the city and districts, was i measure of precaution actually demanded in a city ike Philadelphia, when menaced with a fierce outbreak of Cholera. No provision for the poor and destitute, who could not be attended at their own homes, met with more general satisfaction, or conferred greater benefits upon those for whom they were intended, and vho shared their advantages; without them, many vould have perished who were otherwise rescued from a cholera grave. These hospitals were well furnished, and as well conducted as the nature of circumstances would allow. 39 respectable physicians, and were supplied with the best nurses. The Committees who had them in charge, spared no expense to make them convenient, with an eye single to the comfort of the patients, while the rules of economy were not entirely overlooked. In short, they were well provided for. The table in Appendix, marked (No. 3,) exhibits the number and location of the hospitals, the names of the physicians attached, and their statistics. It would have been gratifying to have presented a more full and detailed statistical account, but from the imperfection in statistics of many of the reports handed in from several of the hospitals, this must necessarily be defective in its details. The ten temporary hospitals were kept open in the aggregate, 408 days, a period of time equivalent to the services of one hospital for one year, one month and thirteen days. The whole number of patients received into them, amounted to 463, of these, 34 I were cases of epidemic cholera. The remainder were affected with cholera morbus, dysentery, diarrhoea, cramp, intoxication, fever, and other diseases, sent in by physicians and others, supposed to have been labouring under cholera. Of the cholera cases, 278 were whites, viz : 180 males, and 92 females— and 66 were blacks, viz: 33 males, and 33 females. Among them were 84 Americans, and 106 Foreigners. As far as the reports showed, there was an excess of Eits of intemperate habits of nearly 50 per cent., Df the intemperate, almost all the cases proved 40 Of the 344 cholera cases, 111 died, or about 32 per cent, of the whole — equal to one in every three, being a fraction greater than the deaths to cases in private practice. The fatality of the blacks and whites compared to cases, was about the same, viz. one in three. The Moyamensing Hospital received almost twice the number of cholera patients to any other, owing to its favourable location to that class of the population who would be most likclv to need assistance. The mortality to cases in this hospital was as Ito 4. In the Southwark, 1 to 9.14. In the Cherry street, 1 to 1.92. In the Northern Liberties, 1 to 2.13. In Richmond, 1 to 4. In Kensington, 1 to 3.40; In Pine street, 1 to 1.75. Bush Hill, 1 to 1.90. South street, 1 to 3. West Philadelphia, 1 to 2. The Medical Reports of the physicians-in-chief to the several hospitals, nre in many respects highly interesting, and creditable to the gentlemen from whose >ens they emanate. They contain much that is useful, ibounding in facts and observations that must be of ntrinsic value to the profession, while they tell of their assiduity and devotion to the duties of their hospitals, and the claims of their profession. As these reports ire of some length and strictly of a medical character, and will in all probability appear in the medical journals of the day, and as we have embraced their statistics in he form of a table in the Appendix, we have thought it unnecessary to publish them with this Report. The medical treatment of cholera, did not come within the wide range of duties belonging to the Board of Health. To provide for that treatment was alone 41 required from us, which we endeavoured to do; the results, some of which we have undertaken to furnish, speak for themselves. DAILY BULLETINS AND STATISTICS OF CHOLERA The Board issued their first official bulletin, May 30th, and continued them up to August 18th, inclusive, a period of 81 days. At their meeting on the 18th of August, they resolved, that Cholera no longer existing as an epidemic, the daily bulletin of cases should be discontinued. From this period a few scattering cases were handed in to the Board for several days, and the weekly bills of mortality reported deaths from cholera up to Sept. Bth. (See Table, Appendix No. 4.) During the 81 days, there were reported to the Board 2141 cases, and 717 deaths. The largest number of cases and deaths reported were on the 1 lth of July, viz: 81 cases, and 32 deaths. On the 12th of July the highest number of cases and deaths were reported from the Alms House, viz : 24 cases, and 11 deaths. tFrom the 11th to the 11th of July, inclusive, there ¦ere 328 cases, and 120 deaths reported, averaging 82 ases and 30 deaths daily, for four days in succession. The cases reported in June, including the two days in May, numbered 278, and the deaths 97 ; being 1 death in 2.8G cases. In July, 1 579 cases and 578 deaths, as 1 death in 2.73. From the Ist to the 18th of August, a period of IS days, 28 1 cases and 72 deaths, as 1 in 3.94 cases. In summing up the statistics of cholera in private 42 >ractice, affecting the population of those districts, naking returns to the Board of Health, and in estinating the changes that have taken place in the popuation since the census of 1840, embracing a period of line years, we have based our calculation upon the usual estimate of increase, which is supposed to be 3} )cr cent, per annum, adding thereto, an allowance for the increase by emigration. While we do not claim perfect accuracy for this calculation, we believe, all lungs considered, there is a sufficient approximation to he truth to serve the purpose of statistical investigation. According to this estimate, the present population of the city and the several municipal branches, amounts to about 330,000, embracing in all, ten districts. The following Table will exhibit the cases and deaths n private practice, as reported to the Board of Health, rom May 30th to August 18th, inclusive, with the •atios of cases and deaths to population and to each other. It is proper to observe here, that for the same period of time the weekly bills of mortality, published by the 3oard, exhibit the total number of deaths from Cholera o have been 1012. If from these we deduct the 3G2 cases occurring in the Hospitals, Alms House, and bounty Prison, we have left G3O cases, which will show an additional number of 264 cases more than the aggregate of reports of deaths in private practice made >y the Board in their daily bulletins. This discrepancy can be accounted for from the fact, that many physicians did not report daily the deaths occurring in their practice, and also, that numerous cases came under the notice of the Coroner, but one of which was reported to the Board of Health and included in their bulletin. In addition to these, some persons who died in the country were interred within the county limits, and were necessarily included in the weekly bills of mortality, while no reports were made severally of their deaths to the Board of Health. Nor have we any hesitation in believing, that all the cases of Cholera which actually occurred in private practice, were not reported to the Board. A number of practitioners declined reporting altogether, while others only reported those of their cases which collapsed, and others again, only those that proved fatal. The inference, therefore, is, that the results of the Table we herewith present, would have been in like proportions, had all the cases that were regarded as Cholera, as well as the deaths therefrom, been reported. ? Ratio of Ratio of Ratio of District. Popula. I Cages, § Case* to Deaths to Deaths to I 5* Population. Cases. Population. ¦ City, - --- 118,401 ' 3SB 127 |1 to 305.89 Ito 8.08 :1 in 933 Sonthwark, - - - 30,458 270! 60 I 1 to 182.09 Ito 5.52 lin 729.16 Kensington,- - - 47,697 218 54 Ito 218.79 Ito 4.03 lin 883.27 Spring Garden, - - 54,532 108 33 Ito 504.02- Ito 3.27 lin 1062.48 I Moyamensing, - - 25,705 191 52 Ito 134.58 Ito 8.67 lin 496.25 Northern Liberties, - 49,321 147 38 Ito 335.51 Ito 8.86 lin 1297.92 Perm District, - - 7325 11 41 to 523.21 Ito 3.50 lin 1881.25 I Richmond, - - - 6529 39 13 Ito 141.77 Ito 3. lin 435. G0 West Philadelphia, - 3413 21 11 Ito 102.52 Ito 1.90 lin 810.27 Passyunk, - - - 1529 10 3 Ito 152.90 Ito 3.33 lin 609.66 Unknown, - C l ! I ! I Total, - - . I 350,000 1418 ' 886 Ito 246.8 a '1 to 3.00 lin 900.73 | From a dissection ot this Table, we derive some information 44 of a sanitary character, which not only possesses interest, but may prove useful in the event of a recurrence of Cholera, or some other equally alarming epidemic. That the Epidemic was not confined to any one portion of Philadelphia, but that all Buffered a share of its malign influence. That Southwark, Moyamensing and Richmond, in the order they stand, show the most unfavourable ratios of cases to population, the mean ratio being about one in every 130 inhabitants; while Perm and Spring Garden present the most favourable, — one in every 514. West Philadelphia shows one in every IG2. The Northern Liberties gives one in every 3355. The City one in every 3().").!i9 and Kensington one in every 218.79. The increased ratio of-cases to population in Southwark must be attributed to its want of cleanliness, its locality, to the character of a portion of its inhabitants that reside in the more densely populated neighbourhoods, and to its numerous, confined, and illy ventilated courts and alleys. That of Moyamensing, to the depraved condition of hundreds of its inhabitants, to the filthy and crowded condition of many of its small houses, inhabited cellars, and their vitiated atmosphere, to the noxious exhalations from their persons and clothing, and the numerous collections of offensive bones and rags, and other offal, heaped up and arrayed for sale in many of their small streets. In Richmond, to its locality along the river front, its want of proper drainage and sewerage, and also to the character, habits, and occupation of a large portion of its population, viz : canal and river boatmen, coal-heavers and labourers. In Kensington, the chief cause lies in the unpaved, ungraded and undrained condition of many of its streets. Perm, almost a rural district, elevated and dry, and to the X. W. of the city, with a population of ?32.">, reported only 14 cases and 4 deaths, whilst West Philadelphia, situated along the western border of the Schuylkill river, with a population of only 3413, gave 21 cases and 11 deaths — locality in these two instances must explain the comparative exemption of the former from the Epidemic, and its increased prevalence in the latter. Spring Garden, next in point of hcalthfulness to Perm, exhibiting only 1 case to every 504.92 of its inhabitants, is situated high above the two rivers bounding the city, is well improved, its streets wide, well paved, graded, its under-ground sewerage many miles in extent, free from a population degraded and depraved, and exempt from an excess of crowded and illy-ventilated courts and alleys that exist elsewhere. I The mean number of cases reported to the Board in ?rivate practice was 1 118, and the deaths 380. The lopulation being 350,000 — the ratio of cases to populaion was 1 in every 246.82 — the ratio of deaths to lopulation was 1 in every 90G.73, and that of deaths to ases as 1 in every 3.(50. The table of mortality, (see Appendix No. 4,) which s taken from the weekly bills of mortality issued by the Board, and differing from the daily bulletins, exhi)its the average ratio of deaths from Cholera during he season of its prevalence, at thirteen periods of life. The sum total is 1012; of these, the males amounted o 510, and the females to 172, showing an excess of 46 deaths of one-eighth males over females. Hut during the three weeks from June 30th to July 21st, when the disease raged to the greatest extent, the proportion was reversed, so that the mortality among females was onesixteenth more than amonjj males. The period of life between 30 and 10, presents the greatest mortality, and this ratio is exhibited in all medical statistics, showing a less resistance to disease at this age than at any other decimal period. Of the whole number who died, 386 were attended at their own houses; 111 at the several hospitals, under charge of the Board of Health; 229 at the Blockley Alms-house, 20 at the County Prison, and 1 unknown. We have not been able to gather the statistics of the Epidemic, as it occurred among the coloured population, separate and distinct from the mass. This, however, is no fault of the Board of Health, the censure must fall upon the practising members of that profession, who should be most interested in such tables, but who, we regret to say, are far too neglectful in making their returns, both of deaths and births, with that accuracy which is desirable. All we have accomplished under this head has been to ascertain that 106 people of colour died of Cholera, and were interred in grounds within the districts making returns to the Board of Health, between the Ist of June and the Bth of September, a period of 100 days. Estimating the coloured population at 25,000, would give us about one death for every 337, which it will be discovered shows a (greater mortality from Cholera among the coloured than the white population. 47 By a reference to the weekly bills of mortality issued by the Board of Health for the last four consecutive years, embracing a period of the summer months, from the Ist June to the Ist of September in each year, it will be seen that since 1810, there has been an annual aggregate increase of mortality from the four bowel diseases — Dysentery, Diarrhoea, Cholera Morbus, and Cholera Infantum, as the following table will show. Years, Dysentery. Diarrhoea. Choi, ftlorb. Choi. Infant. Total 1847, 87 83 1") 867 552 1848, 10:5 68 25 888 689 1849, 3:37 137 G2 512 lots The great increase in the deaths from the four bowel affections, for the past season, and during the prevalence of the Epidemic, affords a striking contrast to those eported for the three former years, constituting nearly 50 per cent, more than either of those years — to which, add the mortality from Asiatic Cholera, amounting to 012 deaths, and we have an increase over former atcs of more than 100 per cent. An evidence, not only that while an Epidemic is prevalent, other disases may prevail with undiminished force ; but that iseascs of the same class, or partaking of the same ongeneric character, arc augumented almost 50 per ent. And further, that Epidemics do not always swalow up, in their mighty grasp, other diseases. CHOLERA OF 1832. According to the Statistics in Hazard's Register, Vol. 10, 1832, the Cholera appeared in this City, July 11th, when there was one case reported in the City proper, which terminated fatally. No others occurred 48 until the 16th, when there were five cases reported, four in the Northern Liberties, and one in Southwark, three of which proved fatal. On the 17th there was one in Southwark ; on the 24th, one in Kensington ; on the 27th, one in Southwark; on the 28th, one in Southwark; on the 29th there were four: two in the City, one in the Northern Liberties, and one in Moyamensing; on the 30th then 1 were eight cases, and from this date they rapidly increased, up to August the 6th, when it reached its maximum, 176 cases and 71 deaths. Although the proportion of deaths to cases was greater on the 7th, when the deaths reported were 71>, and the cases fell below the maximum of 17i>. From this date, August 6th, the cases ranged above 100, until the 1 Ith, when they gradually declined until September 25th, when there were no cases in private practice reported ; but it lingered in the Hospitals up to the 4th of October, making a period of 8(5 days from its commencement, on the 1 1 th of July. The following table, will exhibit a summary of cases and deaths, in private and Hospital practice, for the 80 days of its prevalence in 1832. City, 411 Southwark, - - - - -•">! Kensington, - - - - 112 Northern Liberties, - - 147 total. Perm Township, ... 56 Moyamensing, - - - 198 "*¦"• mam. West Philadephia, - - - 0 1181 271 Hospitals, 888 040 Alms House, 174 02 Arch Street Prison, .... 86 ¦)<> COMPARATIVE RESULTS BETWEEN CHOLERA OF 1832 AND 1849. The recent visitation of Cholera as an Epidemic in our City, according to the bulletins of the Board ot Health, continued for 81 days, or eleven weeks and four days. In 1832, according to the same standard of calculation, it prevailed for 86 days, or twelve necks and two days. From its first appearance, May 30th, M 9, it continued o increase up to the 11th of July, when it reached its icmc, showing an augmentation of 1(> days — when, oscillating for three or four days, it began to decline, and 35 days elapsed before its disappearance. In 1832, it appeared July 11th, and its augmentation was 27 days, while its decline was 59 days, — showing that in 1832, during its first invasion, it reached its naximum in almost half the time that it did the past season, while the period of its decline was one-third onger than the decline of the late Epidemic. During the whole period of its existence the past season, there was reported to the Board of Health, 2141 cases, and 747 deaths, that is for 81 days, averagng 2(5 ' cases, and 9\ deaths, daily. In 1832, the cases reported for 86 days, amounted to 2329, and the deaths, 754, exhibiting an average of 27 cases and 9' deaths, daily. The following tabular view, gives the comparative results between the two Epidemics, in the ratio of their cases and deaths to populations, and their ratios to each other. 1 NATIONAL LIBRARY OF MEDICINE BETHESDA 14, MD. 50 lUtio Rntio Ratio ofoauei ofdeathl of deaths Population. Cues. Deaths, to population. tooauMi to, population. 1802, 160,000 2829 754 lin 69.1 lin 3.06 lin 212.2. 1849, 350,000 2141 747 lin 104.24 lin 2. 50 lin 470.4. Thus it will be seen that while the population has doubled itself since 183*2, the whole number of cases and deaths as reported for 1849, stand numerically, about as they did in 1832, but when compared with the difference in the population, they are in reality less by almost one-half than they were in 1832. While the nortality to cases, during both Epidemics, stands about alike. As in other places, the deaths in both Epidemics, in proportion to the cases, were greater during the onset, than the decline. The following tables show the number of cases and 3 their locality in private practice, also in the Hospitals, Almshouse and County Prison, the past season, as compared with those of 1832. PRIVATE PRACTICE FOR THE YEARS 1549 AND 1532. 1849. 1832. City, 388 - - - - 411 Southwark, - - - 27G - - - 251 Kensington, - ... 218 .... 112 Spring Garden, ... 108 ... , Perm District, ... 14 - - • • ( Moyamensing, - - - 191 - - - 198 Northern Liberties, - - 147 - - - - 147 Richmond, ... 39 ... West Philadelphia, - - 22 G Passyunk, ... 10 ... Residence unknown, - - 6 TOTAL > { bJJJJj ss!) foapAI * I DttSi 271 51 HOSPITALS, ALMS HOUSE AND COUNTY PRISON. 1849. 1832. Cherry street, - - - 27 Pine street, ... 14 South street, ... 3 Southwark, ... (34 Kensington, - - - 17 Moyamendng, - - - 116 S T orthern Liberties, 47 Uohmond, ... 10 West Philadelphia, - - 2 Bush Hill, ... 33 Vims House, - - - 314 - - - - 174 Py Prison, - - - 63* - - - -80 »,--•- 1 is 1, 3, 4, 5, 15, 17, 10, 10 City Hospitals, - .... 888 TOTAL, \ .. ,i o^»j TOTAL, \ i-. i. .» ' ( Deaths, oOS ' ( Deaths, 483 From the above we learn, that in the late Epidemic here were only ten Cholera Hospitals in requisition, and the number of cases treated in them amounted to 344, while the deaths were 111, or 1 to 3. In 1832 there were 17 Hospitals in service, viz., ten organized by the Sanitary Committee of Councils, and seven by the Board of Health. In these Hospitals there were 888 cases of Cholera treated, out of which 345 died, or 1 in 2.57. The average number of patients in each of the ten Hospitals, in 1849, was 34 4-10ths, and the deaths, 11 1-lOth. In the 17 Hospitals, in 1832, the average to each was, cases, 52 2-lOths, deaths, 20 2-10ths. Therefore, it appears, that while the average of cases 52 in each Hospital, in 1832, was only l-3rd more than in 1819, the average deaths in 1832 were two to one, compared with 1819, showing that the success ot treatment in Hospital practice was in favour of that pursued in 1849. CHOLERA EXPENSES OF 1849 Whether our climatical condition the past year, found us better prepared to meet and repel the scourge, or whether the Sanitary measures and the plan of Dispensaries, Hospitals and other arrangements, as adopted by the Board, were the efficient agents — one thing must be evident to those who read this report, viz. that the cost of Cholera in 1849, is but a fraction over one-fifth the cost of the same Epidemic in 1832; or in other words — while it cost the City and Districts in 1832, with a population of 160,000, the sum of $105,285.91 for Cholera purposes — in 1819, the expenditures for the same object, with a population of 350,000, were only $22,635.37 — as per the following account. Ain't Exp'J by the Pine Street Hospital, $910 80 " « " South Western, " 084 27 " « « Northern Liberties, " 843 45 « « » Kensington, « 497 79 « « « Southwark, « 882 80 « <( " Cherry Street, tl 1382 0:5 « « « Richmond, " 970 14 « » « Moyamensing, " 1801 G8 « « " West Philadelphia, « 807 04 17784 59 « « " North West District Committee, 25 86 (t « « North East, " " 182 38 « « « North City, " " 26 69 « « « Smith, « " 102 Sit 53 Am't Exp'd by the Office for salaries of Sanitary Agents in November and December, LB4B, 01 66 " « « Office from January 1, to October 8, lS4i>, for salaries of Sanitary Agents, Assistant Messengers, Assistant Clerk, Litter Carriers, Chloride of Lime, Printing, Advertising, Posting Proclamations, and for removing nuisances on lot east of Eastern Peniten- tiary, - - - - 1181 50 Expenses of Committee to visit Staten Island, 71 -7 1 51252 77 Amount expended for salaries for Physicians and Nurses; board of Physician, Patients and Nurses; Medicines, conveying patients, bury- ing dead, repairing litters, blankets, muslins and calico for City Hospital, - - - 1202 61 110,635 87 Amount expended by Councils and several of the .Municipal authorities of the County, for Sanitary purposes, cleansing streets, &c, about 12 him $22,635 37 CHOLERA EXPENSES IX 1832. I In 1532, during the first visit of Cholera to our City s an Epidemic, there Mas expended for Cholera purposes alone, the enormous sum of $105,285 91. This amount was divided between the City proper, the Board of Health, and the several Municipal authorities, as follows : 54 By the Sanitary Committee, under the direction of the City Councils, for the City alone, - - - $10,414 70 By the Board of Health, 56,934 8G By the Corporations of Northern Liberties, Kensington, Southwark, Moyamensing and Perm, embracing Spring Garden, 7,036 35 $105,285 !H The two first items in the above table arc official, while in the last, there may be a slight variation from the official expenditure of the several districts embraced therein, but not enough to make any great difference in he ajnireuatc. oo o I In presenting this statement, and in order to do istice to those gentlemen who composed the several odies enumerated, and who were very actively engaged uring that memorable event, it may be necessary to make every proper allowance for the dreadful apprehension and fear which then prevailed among all classes of our citizens. The disease was to them a new one, iie most alarming accounts had reached the City of its ire effects abroad, and every one felt that the most mple provision ought to be made to arrest the ravages f the Epidemic, and as will be seen, no expense was pared by those in authority. CONCLUSION. In closing up this chronological and statistical account of the Cholera, as it appeared in our City during the past summer, it would not be improper for the Board to allude, for a few moments, to the gratifying results of their sanitary efforts, as measures of palliation, and 55 to the favourable contrast in which Philadelphia stands to her sister city, New York, and other large cities, where the Epidemic has been felt. It was a matter of surprise to the Board, after they had instituted the plan of house to house visitation, and received the reports of their agents, that there existed such an accumulation of nuisances prejudicial to health. It was a revelation, as unexpected as it was alarming, and for which they were not prepared. It presented an emergency under the circumstances, that called for the most energetic application of their time and abilities, in order to remove the one and prepare for the other. Now that the danger is >ast, and we breathe once more an uncontaminated air, ye look back upon the trying and laborious scenes hrough which we have passed, and congratulate ourselves, and the community at large, upon the results of our Hygienic efforts, in staying the hand of the pestience. By calling attention to the mitigated form of the Cholera, as it appeared among us, and to the limited >eriod of its duration, compared with other places where t prevailed, the conviction forces itself upon every ntelligent mind, that the efficient organization of sanitary measures for cleansing the city, and their practical application by the Board of Health, have been the ictivc and efficient means for lessening the ravages of he Pestilence; by removing and abating those procuring causes and conditions in the community, v\hich tended o depress the forces of life, thereby favouring the prevalence of the Epidemic, and adding to its mortality. Nor can less be said for the very excellent provision 56 made by the Board in the plan of dispensary arrangements, by which medicines for the poor, could be had gratuitously as well by night as by day. Timely aid being afforded, the disease was arrested in its premonitory stage in hundreds of cases, which otherwise would have become fully developed or hopelessly lost. The Hospitals established by the Board, also performed their full share, in rendering prompt assistance and in saving life. In conclusion, the Board would add, that they have felt both the delicacy and the responsibility of the position they occupied before the community, during the trying emergency of the past season, and that in all their sanitary actions, they have been governed by a deliberate and humane spirit. They also embrace this opportunity to express their thanks to those of their fellow-citizens, who so generously sustained and aided them in the sanitary measures they deemed it proper to institute for the public good, and the preservation of the health of the Citizens at large. 57 APPENDIX No. 1. The Sanitary Committee, to whom was referred tiik khso- LUTION FROM THE SANITARY Co.MMITTKE OF CITY COUNCILS) RESPECTING RUMORS AIJOUT THE IJLOCKLEY AIMSHOLSK, Report, Tliat they visited that institution on Monday the 6th of July, accompanied by members of the City Sanitary "ominittee. Your committee was very kindly received by the Joard of Guardians, and by the medical gentlemen connected vith the Alms House. Every facility was offered for a thorough xamination of the premises, and the condition of its inmates. So far as relates to the correctness of the reports of the mmi>er who die from Cholera, the committee believe the report of ie Alms House physicians to be essentially true, without any ttempt at concealment or exaggeration one way or the other, f any mistakes liave occurred, it is attributable to the fact, that ley report no case as Cholera, until the patient exhibits one r more asphyxiated symptoms, when all remedies arc imvailing. Entertaining this view, it changes the complexion f things in favour of the physicians. Diarrhoea in its worst brm is recognized as a disease contradistinguished from liolera ; whereas, in the opinion of your committee, during the pidemic influence, it should be regarded as a different stage f the same disease. We hold this proposition to be correct ud fair, as well to members of the medical profession as to the Ulblic generally, and as a basis on which sanitary measures an be established. If we can prevent or cure diarrhoea we eed not fear cholera. tVVhat then is the cause of the mortality prevailing among the aupers at the Alms House, and what sanitary measures will rrest its progress ? Better ventilation is required throughout the building, but it cannot be brought to bear upon the present incumbents so as to save them from present danger. A change of air by a system of distribution and transposition, however temporary, would doubtless bu beneficial. 58 The committee had an opportunity of inspecting the diet; the food given to the well, and saw preparations for supper in several rooms. A slice of fresh bread, and a large howl of black tea constituted the ration for one person. In one room, we saw ship biscuit instead of bread, covered with rancid butler, which was very offensive, and sufficient, at this time, to disorder the stomach and bowels of the most robust. Molasses was used for sweetening the tea ; and the committee cannot refrain from expressing their full conviction, that to this inattention or error of diet, may be traced one of the chief causes of the dreadful spread of cholera, and its fatality among the shattered constitutions of the pauper population at the lilockley Alms House. vi change of nutrition is demanded immediately. Annexed is the recommendation of the medical stall' to the Hoard of Guardians on that subject, in which we unanimously concur, and urge upon the Board its most prompt execution, as they value the preservation of human life. Let every pauper in the establishment be treated to a dinner of roast beef, with porter or brandy, followed up by corresponding regimen, and other suitable appliances for a few days, and the cases of cholera will diminish, and its mortality be lessened in proportion as this recommendation is complied with. Where large masses of paupers or convicts are crowded together, and confined within certain limits, a change of nutrition and better living is necessary, to enable them to resist the influence of an epidemic poison. The committee, in conclusion, would respectfully oiler the following suggestions :—: — LLet the diet be instantly changed, agreeably to the recomendations of the medical stall' at the Alms House. Let there be a periodical inspection of all the pauper inmates ndiscriminately, (during the epidemic influence,) particularly those most liable to an attack of cholera, say once every three or four hours during the day, and on the first symptom of derangement of the stomach or bowels, enjoin rest and medicine. tLet there be a mkdical police instituted in all the wards, rith directions to nurses to attend to this personal inspection nd supervision during the night. t Whitewash all the walls that will admit of it, where it can c done without injury to sick patients. Vacate immediately the present Cholera Hospital, and empty it of all its contents, and then thoroughly purify, whitewash, ventilate, and cleanse the building, and shut it up for the present. Abandon the cells or cubbies in the recesses of certain walls, and allow the inmates to sleep on the floor, corridors, or in the middle of the rooms, where the cubbies are constructed. Separate the dead and dying from the living as quickly as practicable. Forbid the use of molasses and rancid butter, and let every eatable be fresh and wholesome. Remove all cholera patients on litters to a hospital outside the walls of the building. Free ventilation, free bathing, frictions to the skin, and good diet will preserve the living, and prove the best sanitary measures against an attack of cholera. Early rest, early remedies, and prompt assistance, with proper system, will prove the best means of controlling the disease. That the patients be allowed to walk over the grounds. Resolved, That a copy of this report be furnished to the Guardians of the Poor, and the medical stall' of the Alms House, &c. John A. Elkinton, M. D.\ Wilson Jewell, M. D. I B. E. Carpenter, f Benjamin Martin, \ Joseph Wood, i S. Weer, \ J. E. Eldridge, / Sunilary Committee. Philadelphia, July 17, 1542. 60 APPENDIX No. 2. ruE Sanitary Committee, in accordance with a Resolution of the Board passed on the 4th of August, Report, That tlicy visited the place of interment for the lead from the Alms House, and the out-door patients of the Guardians of the Poor, where they are deposited in large ranches ; and which ground is located about one-eighth of a nile in a southwardly and eastwardly direction from West Philadelphia. Here your Committee found a nuisance which alls loudly for immediate abatement. In superficial trenches, about eight feet wide by eighteen bet long, and six feet deep, have been deposited, since July Ist, nore than four hundred bodies, placed, it is true, in coffins, but by no means air-tight,) and covered with earth, but so ineeurely, that from the decomposing and putrid carcases, there vas emitted through the loose gravelly soil, a most horrid exlalation of an insufferable sickly and poisonous stench, while lies and other insects, were glutting themselves with the filthy bod, found in this pauper charnel house— in these " lodgings or the dead." From this condition of things it must be, in the opinion of your Committee, that the atmosphere for some coniderable distance around and beyond this cemetery, is highly charged with impure and unwholesome gases ; and from its iear proximity to that portion of West Philadelphia where the Cholera was most rife, and the constantly prevailing southerly Finds at this season, wafting this morbid atmosphere in that lirection, your Committee believe that it may have been, one of the procuring causes for the concentration of disease in the above described neighbourhood. To what extent this has been the case, when combined with miasma from the borders of the river Schuylkill, and the noxious emanations from the crowded and illy ventilated wards of the Alms House, with other exciting causes, your Committee are not prepared to determine. In adopting a proper remedy to remove this nuisance, your Committee 61 have been greatly embarrassed. Several suggestions have been made, but the difficulty has been to propose one, combining practical utility with a certainty of removing the nuisance. Your Committee believe that the present method of constructing the trenches, and depositing tin 1 dead therein, where they are sutFered to lay from day to day, sprinkled over with a iew inches of loose dirt, festering under a hot and mid-day sun, until such time as the trench shall become filled, and then covered with about three feet of porous earth, is in a sanitary point of view fearfully objectionable, and demands an immediate correction of the whole system. Had four hundred dogs been buried in a similar enclosure, in a similar manner, in the same period of time, and during the prevalence of the present epidemic, by the orders of the Hoard of Health, an outcry would have been raised against them, extending over the length and breadth of the land, which would have required herculean nerves to grapple, with, and the most rigid application of the moral and physical sanitary shovel to remove ; and yet, in the opinion of your Committee, the partial burial of one dead human body, dying from the present or any other epidemic, is more to be dreaded than half a dozen carcases of dogs ; for jesides the chemical poison from the decomposition of animal matter, we have other morbid poisons thrown oil' from bodies, laving died of pestilential and loathsome diseases, which, disseminating themselves into the surrounding atmosphere, assist n doing a deadly work. Putrid exhalations from dead bodies lave, in a concentrated form, caused immediate death, and lence, when diluted in the atmosphere, must be dangerous and mwliolesome, in proportion to the relative quantity dill'used, and the condition of the individual inhaling the same. In view, herefore, of an immediate removal of a nuisance prejudicial to he health of West Philadelphia, your Committee would recommend the following resolutions : Resolved, That the present method of interments pursued by the Guardians of the Poor, is a nuisance prejudicial to health. Resolved, That the Guardians of the Poor lie required to suspend until the Ist of October next, the present mode of burying their dead in trenches, and that they be directed to dig graves, deep and wide enough to contain four coffins, two abreast and two deep, between which there shall be placed at least, twenty-four inches of dirt, and room enough left t'ov four feet of earth from the surface. 62 Resolved, That they be required to fill the trendies now exposed, using fifty pounds of chloride of lime in each trench in doing so; and that, until the Ist of October next, twenty five pounds of chloride of lime shall be used for each grave be fore it is filled. John A. Elkinton, M. D.\ Wilson Jewell, M. D. I B. E. Carpenter, f Benjamin Martin, V Joseph Wood, I S. Weer, \ J. E. Eldridge, / Sanitary Committee. APPENDIX No. 3. 1. tfoyamensing, - - Dr. J. L. Adkins, - - Dr. H- Y. Smith - - r,r, 120 116 36 37 21 22 61 B•• 29 2. Cherry st, (City,) - " F.W.Sargent,- - "W. B. Wilson -5]8627178 1 1 It 16 1126 931 1 14 8. Richmond, -- - "W. C. McMakin, - "F. C. Smith --4y161616 12 4 4 4 ! 4. Southwark, -- - " 1). F. Condie. - - "M. W. Dickenson ir, 66 M3OlB 7 9 3i> 2H 6586 2 7 5. Northern Liberties, |"J. S. Zorns. -- - "H. W. Rilil - - Bit 52 47 89 62 17 -3d 36 12 19 322 6. Kensington, --- " J. McAvoy. -- . •' M. B. Senderling .30 17 17 14 3215 4 1 5 7. Pine St., (City,) -" J. Noill, - ... "R. B. Cole- --36 46 '149415912 2 5 2 1 8l 8. West Philadelphia, "S. C. Huston, .. Xo Assistant •311481 1 2 1 1 9. South st., (City,) - '"S. L. Hollingsworth, "E. Shippea --12888 » 1 3 1 1 10. Bash Hill, --- " J. I. Bethell, - - " 11. Ladd ---4343382214 i 12 7 1 20 ! I i TotaljJOS [463 344 186 <<2 33 33 84106 54 98 62 89 12 - 111 TABLE OF CHOLERA HOSPITAL STATISTICS. ! HOSPITALS. rnvsuiA.Ns. assist, phtsiciahs. X<>. of Days opened. No. of Patienti admitted. No. of Cholera Cases. Males, 4 I Females, F Males, a I Females, p — — [ Americans_ _ . r oreigners. I Temperate! I Intemperate. I Males, g I Females, f — ¦ Total Deaths, APPENDIX No. 4. TABLE OF CHOLERA CASES AND PRIVATE I'K.UTH'K. I$ t 4 t I I 1 a t i I it ti J? i § f I II I I I llt 8 £ iS I" s '* 3 i - _» E_ « c IStf). C. IT C I). ~V. D. 0. D. C. D. C. D C.ID.C D, C. I). C. » C.j D. lay 30 .j . 11 I ... 2 9 • • une l 1 l 1 ...... | •• • • • • ! .'::!::::: :|: : :|: :: ::::::: l\ I;!;;:- 1 ; ;;;;;; iil;;-;;; ! :.:::::.??:::::: io ! '. . '. I j ii • . ¦ • ....}¦••••• 1-2 .... 1 11........ 13 2. 11 ! 11l 1 .... 1 • • i is i ! • i .......•••• 16 I 1 . . 1 1 17 1 1 1 • : 18 .. . . 2 . 1 1 . | ! lit 2 2 2." 1 ....;• 1 2(.' 2 1 . . . . 11.!.! ! -2 1 . I 1 5 1 1 ... 8 «..»... 2231.. 1 ... 1 • 'I* I*'" 1 *'" 23 2 . ! . 1 1 1 ........ • 1 . . . • . 24 .! 11.. I ...-. 1 1 .•!••••• 80 4 8 82 52 11.. » 11.... 26332194 2 1 4 1 1 I • 27 10 2 14 3 8 2 5 3 1 . 4 2 ........ 1 . 2- 12 3 11 3 H 4 2 1 . . 6 . . . 1 1 . . 1 1 . . 29 11 2 17 2 2 . 0 1 6 3 4 1 . . . . 1 . 1 . 30 15 7 13 1 4 2 2 1 1 • 6 462.. 11.. 1 . July 1 4 4 62 31 l' 3 21 2. I J, 2 14 5 12 4 8 3 41 91 5 31. 1. 3937. 92 7 3 16: 2 3131 4 10 1 h 2 1 . 3 1 10 3 1 I 1 ... i 6 7 4 3 2 1112 3| 1 II 7 81.1.3..... 7 13 2 7 1 • ! . 3; . 3; . 2 . I . . • 94 3 10 2 *3 ." 1 . 32 3 11 in 13 1 4 . 8 1.. 3211.-11 ll' 2(t 2 16 f 6 1 1 . 13 4 1 . 2 1 . • 10 17 5 7 1 8 . 1 . S 4 !•¦•••• • 13 15 4 6 1 16, 6 4 1 6 - 5 11.3.1..... 14 6 2 9 . 7; . 3 17 3 9 6 3... 15 n " 4 a . 2 2 3 - 4 1 17 16 10 1 1 13 2 6 1 . . 7 . j 1 ... 1 1 ... I• 1 18 14 3 0 . 18|8 7 . 8 . 5_2 ? . . 1 . DE ATHB IN PHILADELPHIA IN 1X49. I HOSPITALS. S g o « ti. a"? 35 a ""• f-i Jsasfcig ? s^ s | := a II B Ss ss £a £ _?_ jl± ! _il_ _f : _fL ¦' ° '±- cTjIT. cT~»Ti C. D C D. C. D. C.i 1). I 1I 1 I). C « C D. C D.C. D. C D C. 1) . C. P. , . , Jo " \ \ ' ', \ ' \ 4 4 *81.8 1. '. . '. S3 20 | ) ".'].!'.... 1 3 10 5 .... 65 | 25 2 L 4 : :::w. 'i * * \ '.'..'. '. '- 1 - 1 J» . •• '• s3 l }g . I .: . 5 1.1 -2 . 8 7 1... 35 112 \'\ l , ' *3 2 } '.'.'.'.'.'.'. 1 1 9 9 1 ! '. '. 39 20 ', 'i ' 111 11 6 . . 1 1 46 Ifi 3 8 f 1 . 3 .. 1 ... 3 1 24 13, .... SO 26 9 3 1 1 ... 1 .... 17 14 .... 81 30 1 "l 3"l " " 2. 5 3 4 2 1 2 1 20 12 .... 84 32 .1111 -2131 1 • 21 7 . . . . 55 16 12 1 i 2120 14 • ... 59 23 1.1..'! 1 . 2 . . 1 1 1 1 ... 2 1 20 14 .... 73 32 PRIVATE PRACTICE. I I'll I v 1 i 1 ij li 1849. !C. D. C. D. C. D.. C. D.l C. |D. C. D. C. D. C. D. C D. C D. C.ID. July 19> 12 2 2 2 6 1 5 1 8 1 2 . . .i . . 1 20 11 4 1. 8 3 3 . > 5 1 1.2.1 91 6 S 7 S l6 l . . 112 i 221 2 2; . . l! . . .48..1.....1... 23 10 2 4 . .! . 2 I! 4 2 1 1 2 1 . . 1 24 9 . 10 1 4 98.84 418. 1 . . 25 3. 1.98 8.617111..] 96 6 9 1 . 8 . 2.12. 71, . i 27 9 2| 3 . 3 2 1.1 3 1 6. I . . I 2S 2 2 2. i . 1 3 1' 1 1 1 ....... 9 9.. 29 6 5, 4 3 .. 2 1 C . 9 ....... 9 1 . . 30 7 4! 4 . 31 1 4 1 1 . 5 • ¦ • 31 6 3; 4 . 2 ! . 2 . 3 . 3 ....... 62 .. August 1 3 1 9.9. . . 1 2 1 . 1 2. 15. 9 ........... 8 9*1.1. 1. 41 21. . J 4 1 19.11. 1 1 . 1 91.. 5 1 . ! 1 . . . | 1 . ..1.1... 6! 1 14 1.. . . 3 . 4 . . . ! 7 1. 4 . 4| . 1 . 1 8. . 3. 9 1 . 2. 11 3 1. .....32.. 9 1 1 8.91 | 11 10 . . 5 . . . 1. ! 1 1 . ! 11 3 1 4. ! . . 12 11 1 . 1 1 Ll2 1 1 i 13 1 3 4 3.. . . 31 1 146...1. 1 . 2 12 2 15 2 . 1 . 2 ... 1 I 16 . . 1 . 11.. 1 | 15385!127 27G 50 218 54 108 33191 52 147 38 ! 39 13 10! 3 4 4 1 l| 6 l| APPENDIX No. 4.— Continued. HOSPITALS. 17717 * flji I 1 4s4 s - I * 1 i i fi ¦] i] i 1 I! J I *i i I f I C. D. C d! C D. C. D C. D. C D.j C. D. C. D. C. D C. D C. D. iC D. C D. C. D. 1 . . li . . 3 . 3 . 2 1 . . lj . . . 3 . 6 14! • ... 53 23 .... 1 ... 1 . I 1 1 IT) 11 i 2 ... 49 20 . . 1 . . . 3 . . .I . 1 . . 1 . . . 1 1 6 51 .... 32 14 . . 1 . . • . . 4 . 2 1 ....... 1 12 5 .... 2S .12 1 1 . 1 . . 1 . 2. | 1 1 .... 1 1.. 5 9 .... 85 SO . . 11.. 3 . Sllll I . 12 6! . . . .64 IS 3 2 . . 1 . 1 ... 2 1 5 6 .... 43 15 1 2. 4 ... 1 4 5. ...40 9 ...1..4. 21.... 3 2. ...35 9 .2.1 3 . 1 2 . . . 3i . 5 6 2 ... 30 13 1 ...12. 6 . 3 ... lj 1 .... 5 321 4 . . 61 19 . . 1 . . . 1 . 5.11. 1 • | .... 1 4 2 4 3 .. 40 14 2 4 . 2.1 5 1 ... I .... 1 . 1 . 4 . . 39 12 1 . . 1 . . 1 . 1.1112.1: 3 . . . 20 5 ..11. .3. 4.211. 31. .21 4 5.1.11 3 3 2 2 . . 23 8 .! . 1 . . . 2 . 1 .. 1 2 ... 1 ... 2 . 3 1 . . 20 6 3 . 1 . 2 . 2 . . . . . i; . . . 1 2 . . 15 2 2 . 7 . . . 1 . 1 1 . . l' 24 3 2 1 4 1.. 1 2. 5... 25 2 ! . ! 4. 311.221...... 111. .26 9 > . I 3 . 1 li . . . • 2 13 4 1 1 . 4 .. 1 ... 1 .... 1 . 4 ... 18 3 2 1 . . . I 1I 1 . . . 1 ... 16 4 11 I .......... 1 7 1 1 S 1 .... 1 ...... . 5 1 . . 17 10 1 1. i ....-....! 15 3 2; 11 1 . . . .i . 2 lj .... 12 2 !.!!'.'.'.! '2 i 1i 1 '..l..... '.r.. r . '. '. s*i! '. 5 2 [27,14 14 8 3 164 7 116294722 7 5 61 4 2! 138 20J315 229 63120| 1 1 141 747 __ SUMMARY OF CHOLERA CASES AND DEATHS. PRIVATE PRACTICE. _ HOSPITALS. s ti I .j I . ~ city. tc~w O d 3lay and June. I Total No. of Cases, 74 77 44 23 15 2112 2 4 2 3 1 ... 278 \ Total No. of Cases, 289 159 157 7G 155 109 25 8 9139 13 12112 3 43 5 73 40 8 133305 33 11579! Total No. of Cases, 25 40 17 921 17' 2.16;2; 6 2 . |f>l 12 43 781410 30 . 284! Total No. of Cases, 3SB 276 218 108 191 147 39 1014 21 6 27 14! 3 G4 17 110 47 16 2 38 315 63 1 2141 j May and June. Total No. of Deaths, 29 1G 16 10 6 7 7 2 3 1; . i 97 Total No. of Deaths, 80 30; 34 20 38 27 6 1 1 7 . 12 6 1 5 2 22 18 2 120 22411 1 578 August. Total No. of Deaths, 9 4 4 3 8 4 . . ! . 3 l' 2 2 . j 2 3 7 4 2 . . ! 5 9 . 72' Total No. of Deaths, 127 50 54 33 52 38 13 3 4114 11 114 8 1 7 5 29 22 4 120229 20 1 747 ! APPENDIX No. 5. TABLE OF MORTALITY FROM CHOLERA. I 5 10 15 20 30 40 I 50 60 I 70 1 80 . 90 00 Fo- Under to to to to to to to to to . to I to to £ 1849. Males. ma i,, s . Boys. Girls. 5 years 10 15 20 30 40 50 00 70 > j 90 100 Oj £ May 30th to June 2d, . . 3 . . . 2 1 3 June 2d to June 9th, .. 2 1 . . .... 1 1 . 1 3 June 9th to June 16th, . . 4 1 1 1 • 2 1 . . . . 5 j June 16th to June 23d, . . 8 6 . 1.1.. 1 6 6 14 June 23d to June 30th, . . 55 25 13 4 1 4 6 6 10 13 14 9 6 5 ... 80 June 30th to July 7th, . . 94 76 11 13 2 6 7 9 26 30 32 25 16 9 2. . 170 July 7th to July 14th, . . 74 105 13 8 4 0 3 8 28 30 31 28 23 10 5 2 1 179 July 14th to July 21st, . . 102 93 12 15 8 5 7 7 26 38 32 31 191111 . . 195 I July 21st to July 28th, . . 71 65 8 7 4 3 3 5 19 31 32 10 1 2 3 1 . 136 j July 28th to August 4th, . 52 43 7 7 7 4 1 2 14 22 13 18 1 2 ... 95 August 4th to August 11th, 2C 14 5 2 4 1.2 5 15 6 2 4 1 ... 40 j August 11th to August 18th, 23 19 3 5 15 2. 9 7 11 4 2 1 ... 42 August 18th to August 25th, 10 0 1 2 . . 2 1 5 6 2 16 | August 25th to Septem'r Ist, 6 12 . 1.1.. 4 7 4 1 1 .... 18 Septem'r Ist to Septcm'r Bth, 10 6 2, 3 3; 2 . . 13 2 • I • j • • j 16 ~540~4T~75~6~^4 38 ! 31 I 40: I 40: 156 218 ! 1871 139; 103^41 21 1:1012 j * This table, referred to on page 45, .a there incorrectly marked as No. 4. BOARD OF HEALTH, 1849-50. City John Lindsay. No. H Rclmont Place. Edward 0. Marklcv, No. 13 S. Schuylkll] Scvonth st, and No. 4 Minor st. John A. Elkinton, M.D., No. 103 North Fifth street. Edward Duff, No. 3D Race street, and No. 86 North Wlnirvcs. John C. Martin, No. 319 Spruce street. Samuel W. Weer, No. 147 North Twelfth street, and No. 21 South Eighth st. Northern Liberties. — Benjamin E. Carpenter, No. 215 Coates street. William Goodwin, No. 305 North Second (itreet. Spring Garden.— Wilson Jewell, M.D., No. 238 North Sixth street. J. D. Logan, M.1)., No. 27 Logan Square. Southwark. — Renjamin Martin, No. 463 South Second street. Kobert G. Simpson, No. 123 Queen street. Moyamensino. — Robert F. Christy, No. 239 South Ninth street. Kensington. — Jeremiah E. Eldridge, Gcrniantown Road above Fifth street. Charles Delany, No. 43 Queen street. Richmond. — Oliver Evans, William st., betveen l'oint no Point Road and Delaware Perm. — Joseph Wood, No. 443 North Seventh street, above Poplar street. West Philadelphia. — Henry Pleasants M.D., Washington above Mary street, W. P, OFFICERS OF THE BOARD. President. — John Lindsay. Secretary. — Benjamin E. Carpenter. Tbjubuub — Samuel W. Weer. Clerk.— Samuel I. Marks, No. 878 South Fifth street. Solicitor. — I. A. Phillips, No. 66 South Sixth street. Steward of Lazaretto. — Martin Kocheriperger, l.a/.aretto. Physician of City Hospital. — Wni. It. Wilson, M.D., No. 103 Arch street. Matrox of City Hospital.— Lydia Tomlinson, Hospital. EXECUTIVE OFFICERS. Health Officer. — George P. Little, No. 120 Catharine street, ahove Third. Pout Physician. — Willirm Henry, M.D, No. 821 South Second street. Lazaretto Physician. — James S. Rich, M.D., Lazaretto. Quarantine Master.— John H. Clieyncy, Lazaretto. Messf.noer. — Charles F. Thicsen, Redwood street. 1 clow Fifth street. Assistant Messenger. — Thomas Bedford, No. 412 Tammany street. Runner. — David Brown, No. 02 (iaskill street. STANDING COMMITTEES. No. I.— SANITARY. Elkinton, Weer, Eldridge, Carpenter, B. Martin, Jewell, Wood. No. 2.— LAZARETTO. Duff, J. C. Martin, Evans, Delany, Logan, Christy, Simpson. No. 3.— ACCOUNTS. Wood, Duff, Delany, J. C. Martin, Goodwin. No. t— OFFICE. Wccr, Eldridge, Carpenter. No. 6.— POUDEBTTB. Jewell, 15. Martin, Klkinton, Simpson, Christy, Markley, Pleasants. No. 6.— BURIAL GROUNDS. Pleasants, Evans, B. Martin, Goodwin, Markley. No. 7.— BILLS OP SIORTALITY. Logan, Goodwin. NUISANCES. No. 8. — N. W. District, S. Garden and Perm. Jewell, Carpenter, Wood, Logan. >Jo. D, — N.E. District, Kensington, Northern Liberties and Richmond. Eldridgc, Evans, Delany, OooUwin. No. 10.— Xnrth City Dittrict. Duff, Weer, Elkmton. No. 11.— South City District. J. C. Martin, Lindsay, Markley. No. 12. — Suuthwark and Moyamensiny B. Martin, Simpson, Christy. No. 13.— West Philadelphia. Pleacants.