No. 92. IN SENATE, MARCH 20, 1850. REPORT Of the majority of the committee on Medical Societies and Colleges on so much of the Governor's message as relates to the cholera. The majority of the standing committee on medical societies and colleges, to which was referred that portion of the Governor's message relating to cholera and other infectious diseases, REPORT: c Your committee not being practically acquainted with the disease known as J] static cholera, have not thought best to trouble the Senate with any speculations of their own on a subject so important in all its features to the interests of community, as the one under considera*tion ; but in order to meet the expectations of the public and to comply with the patriotic recommendation of his excellency, the Governor j have solicited communications from different eminent medical gentle*men, whose opportunities have been the most extensive for acquiring a knowledge of this disease, to which they refer the Senate as containing all that in the present state of medical science can be relied on in the treatment of this terrible scourge; together with many valuable suggestions in relation to the necessity for a more stringent system of sanitary and quarantine regulations, in order to protect the citizens of this great commonwealth, especially our large villages and cities, from the fatal consequences of another visitation of this (Senate, No. 92.] [u.n.&st.J 1 fearful malady, and to prevent the diffusion of all other diseases of a pestilential or malignant character. The nature and treatment of Asiatic Cholera are questions of much obscurity at presentj involving the vexed question of contagion or personal communicability, upon which your committee do not wish to express an opinion, but refer the Senate for a more complete solution of this very difficult problem in pathology to the very able papers on this subject by Doctors W. P. Buel, A. Vache, and Professors Reese and Clark, who have had ample opportunities for witnessing the various phases it assumes ; of watching its progress and of observing the laws by which it is governed, so far as they are within the reach of human comprehension, which are herewith presented for the consideration of the Senate, as a part of this report. The committee deem it to be their dnty, without intending to express any opinion on the mooted question of contagion, to recommend the propriety of adopting some measures, in connection with quarantine, to purify the persons and clothes of individuals arriving at our ports, sick with malignant cholera or other infectious diseases, while subject to quarantine, as necessary to prevent the spread of disease after such persons shall be permitted to mingle with our citizens. The committee deem it a duty they owe to the public welfare, to call the attention of the Legislature to the importance of a State Commission of competent persons, whose duty it shall be to make a limitary survey of the State, and to report to the Legislature at its iext annual session, feeling confident its utility will be apparent in furnishing accurate information, as to the many sources of disease and death to be found in almost every portion of the State, in the lowswamps and stagnant water pools, and in the vast amount of vegetable matter exposed to decomposition, filling the atmosphere with a poisonous malaria, and scattering the seeds of disease and death inevery direction, to say nothing of its importance to the agricultural interests of the State which would result from a thorough system of drainage. Whether the cholera is soon to revisit our country, is known only to the SUPREME RULER. That it has shown itself lately, at different points in our land, is a significant fact. It may be that the influences so fatally energetic, but a few months ago, now linger WC3 N534r Tss~O / JNo. 92.] only to strike here and there a mortal blow, as they prepare to pass away from us. It may be that these occurrences are monitors to warn us of ravages about to be renewed. To be prepared for the event is the course of wisdom. Millions for defence is our national boast. Why grudge the cost of protection against a destroyer more fearful than any mortal foe. With reference to that portion of the Governor's Message which suggests the propriety ,of securing " the benefit of the combined experience of scientific and learned men throughout the State with respect to the origin, the cause, the progress, and the treatment of all malignant and infectious diseases" two plans have bsen suggested to the minds of the committee ; the first, to establish a medical commission, either permanently, or for periods, during which the public health is unusually endangered, who shall consider and investigate such subjects as may from time to time be referred to them, in connection with the public health, and to report their views to the Legislature on all subjects which in their opinion require the interference of law; or, secondly, that the State look for medical advisers in the Stats Medical Society, or to the faculties of those medical colleges which receive pecuniary aid from its munificence. In making ihis last suggestion the committee would' not be understood to draw any comparison between the men associated in these bodies, and other members of the profession. But the State has less claim on the time and labors of private physicians, than would perhaps be recognized by those who hold offices created by its* choice. Recognizing the wisdom of the recommendation of the Governor, the committee are not prepared to say that they have fallen on the best plan to accomplish it. Finally, your committee have come to the following conclusions, to which they respectfully ask the attention of the Senate. Ist. In view of the facts before stated particularly, considering the unsettled state of professional and public opinion, regarding the contagiousness of cholera, and the moral effect of giving free admission into our ports to vessels having this or other pestilential or contagious diseases on board, they are not prepared to recommend any su«h alterations in existing quarantine laws or regulations as will exempt malignant or Asiatic cholera, typhus or ship fever, and small pox from the restraints now legally imposed by the State. NATIONAL LIBRARY OF MEDICINE BETHESDA 14, MD. 8 2d. They recommend that general provisions be made by law for the appointment of a board of health in every town, village and city in the State, whenever the health of such town, Tillage or city is invaded or threatened by any malignant or infectious disease. That in the towns, this board consist of the supervisor, the justice of the peace, and at least one physician, to be appointed by the st^ pervisor and the justices of the peace: that in every village where a board of health is not already provided for by law, they have power at their discretion to appoint such board, or a sanitary committee with the full power of a board of health, to consist of not more than yeven, nor less than five persons, of whom, one at least, shall be a physician; and that in every city, not now in like manner provided for by law> the common council may appoint such board, or a sanitary committee, with the full power of such board, to consist of not less than seven, nor more than nine persons, of whom the resident physician, if there be one, and at least two other physicians, shall be members: that these several boards shall have full power to establish quarantine against malignant or infectious diseases; to remove nuisances and filth of every sort; to establish hospitals for the sick; to appoint a health officer and physician to attend the sick poor at their own dwellings, or at their discretion to remove persons sick of * contagious disease, to some safe and proper place; to prohibit the sale of unwholesome articles of food, and to do all things, which, in their judgment^ the safety and health of community, may require. 3d. They recommend that it be enjoined on the officers and persons above named, to establish a board of heath, or sanitary committee for protection whenever there is any just ground to apprehend its approach, and to do all things necessary for a thorough cleansing of their towns, villages or cities, and all the dwellings therei n , and early to warn the inhabitants against such indiscretions as may expose them to danger; so far, if possible, to prevent the visitation of the disease, or at least, in case of its actual appearance, to diminish its r fatality ', by the timely removal of all accessory causes. 4th. They recommend that measures be adopted by, the Legislature to ascertain how far the State can judiciously extend its aid to the establishing of Fevkr Hospitals in our large cities. 4 sth. They regard it as among the legitimate duties of the public authorities to provide liberally wholesome food, suitable clothing, and as far as may be, proper dwellings for the suffering poor, from whose ranks the pestilence supplies daily its hecatombs of victims. C. D. ROBINSON, R. S. WILLIAMS. 5 Communication from D. M. Reese, M. D. EFhat portion of the message of His Excellency, the Governor, ich invokes the 'attention of the Legislature to the public health, i peculiar importance at the present time, in view of the recent calamitious visitation of various portions of our State by the epidemic denominated Asiatic cholera, and the subsidence of which is so justly referred to as cause of mutual gratulation and of thanksgiving to the sovereign Ruler of the Universe. But the past history of this formidable disease, its anomalous and erratic variations of access and decline, and especially the peculiarly exposed condition of the great metropolis of our State to its introduct on, by the increasing tide of immigration from trans- Atlantic countries, which the daily and almost hourly arrival of crowded ships admonish us is still destined to go on in an augmented ratio, all serve to render it possible, if not probable, that a recurrence of the malady in our midst may well be apprehended. And while waiving, as we do, any decision of the question of its communicabiliiy from the sick to the well, by the laws of contagion, the medical faculty of no country being absolutely agreed upon this point ; it must, nevertheless, be obvious to all, that the occurrence of a few fatal cases among any portion of the population, giving evidence that the dreaded cholera is again among us, would be the signal for a general consternation and panic among our fellow-citizens, which of itself would be most disastrous to the interests of commerce, and as experience has proved, would serve to increase immeasurably the liability to its spread and prevalence. Hence it becomes the imperative duty of the Legislature to provide against the introduction of persons sick, or supposed to be sick with cholera, by every possible guard which may be within their power. For although the history of cholera has amply shown that no absolute reliance can be placed upon quarantine restrictions, however strictly enforced, for entire exemption from the introduction of the pestilence, yet it has been equally proved, that without such restriction, the community would be thrown into needless and mischievous alarm by a few examples, or even a single case of cholera occurring in fheir midst, landing from ships, on board of which cases have occurred during the voyage. In view of these facts, then, it is due to the public health, that the Health Officer should be empowered and required, by additional legislation, if called for, to detain not merely the sick of cholera as now in the Quarantine Hospital, but to prohibit all the persons on board such vessels from mingling with the lealthy population of the State, until be shall be satisfied that they are free from the predisposition to the disease, which is inseparable rom them on their first arrival in a vessel, on board of which the >estilence has appeared. But while the sick are forthwith removed from such vessel to the hospital, the well should not be condemned to remain on board, but be immediately removed to the shore ; and accommodations should be provided for them within the quarantine, until the health officer shall satisfy himself that, by proper regimen, they are free from any predisposition contracted during the voyage. Their own safety, not less than the public interest, demands this course of temporary subjection to quarantine. And for this purpose, buildings sufficiently remote from those occupied by the sick are indispensable ; and to these last, any who may be attacked should be instantly transferred. The hospital for cholera patients should be sufficiently isolated from all the other hospitals as to allay apprehension on the part of those sick with other diseases, and non-intercourse with such hospital should be rigidly enforced. The necessity of more extensive grounds and buildings than those at present occupied at Staten Island would seem to be imperative. Such precautions and prudential measures, in connection with our quarantine establishment, would seem to include all the preventive measures within the reach of legislation, and would secure us from any semblance of foreign importation of cholera, so far as human foresight can furnish such security. Be subject of the powers granted to municipal authorities, and local Legislatures within this State, for the prevention and rel of nuisances, and the prohibition of offensive and deleterious 7 8 [SXNATI occupations within thickly inhabited districts, has been very properly commended to the attention of the State Legislature ; these powersbeing regarded as at present inadequate in extent, and contingent ia some cases, instead of being perpetual and permanent. This aspect of the question, in view of another visitation of the cholera as an epidemic, is one upon which there is but little diversity of opinion among enlightened men, whether in or out of the medical profession. All will concede that impure air, illy ventilated houses, filthy and crowded apartments, and especially those varieties of manufacture which generate offensive and noxious effluvia, are pernicious to health, but signally so during the prevalence of cholera or any other pestilential disease. These sources of mischief to the public health abound most in large and populous cities, or where there is a dense population. And that under such circumstances the municipal authorities should have the power to remove such nuisances and suppress such occupations, and that in a summary way, if emergencies occur endangering the health and lives of the masses of population found in large cities, would seem to be apparnt. " Salus populi suprema est /ex," is a maxim as sound as it is venerable, commending itself to the intelligence of the public mind, and constraining the conviction which is everywhere felt to be public sentiment in times of general calamity, that private interests must be sacrificed to the public good, at any expense. It is the dictate, therefore, alike of policy and duty, that all necessary powers should be extended to local authorities throughout the State, to meet and provide for the emergencies which may occur in the event of a recurrence of cholera, or other similar pestilence, within their limits. The revision and reenactment of the law of 1832, entitled " An act for the preservation of the public health," with suitable amendments, will probably meet the views of his Excellency the Governor in calling attention to this subject. The experience of the last year would suggest, however, that some further legislation is called for, in reorganizing, or investing with new powers the several boards of health in our large cities, and particularly in the city of New- York. The recent report of the sanitary committee of the board of health of the latter city having admitted and deplored the absence of any sufficient sanitary or medical police, at all adequate to such an exigency as that of 1849. Ought there not to be, especially in so large and exposed a city, some specific and permanent provision by a board of medical officers, who should have in their special charge the sanitary regulations of the city, for the prevention and removal of the causes of all pestilential and malignant diseases ; and whose duty it should be to guard against the accumulation or concentration in any section of the city, of such conditions of the population as may engender disease, and by promtly reporting to the respective departments all the causes which they may judge endanger the public health, render it possible to effect their removal in time, without waiting until the development of a deadly pestilence in the neighborhood shall disclose the sources of poison to the atmosphere, after the commerce and trade of the city has been ruined, and scores or hundreds of lives have been sacrificed. Whatever may be doubtful or inscrutable in regard to the cholera all experience has proved that the spots in our cities which are pre eminently the nuclei whence its fearful ravages spread with the greatest rapidity and mortality, are those in which are found the mos filthy, degraded and vicious of our population, who are congregate! in dense masses, amid squalid poverty, and in apartments not onl; without ventilation or cleanliness, but in which neither of these ne cessaries of human life can by possibility exist under the circumstan ces surrounding them. From these localities and other kindrec nuisances found as they are in different sections of a large city, the atmospheric poison here engendered radiates and spreads in conformit; to the known laws of pestilence, infecting the air of otherwise health; localities, until a general epidemic overspreads the entire population with disease and death. Violation of the laws of health and life are now well understood to be among the most prolific sources of pestilential diseases j am while many such are admitted to be incidental to large cities, am inseparable from a dense population, yet the mischiefs resulting therefrom, may be mitigated and confined within very narrow limits if a skillful and scientific board of intelligent physicians were officially charged with their discovery, and with the duty of timely applying the remedy. Instead of a city inspector who may or may not be a physician, and often, as now, is not a physician, the medical police of a large 9 10 [Senatb city is quite as important as any other department of its government, and calls for a commission for its adequate management, composed of medical men, and this as imperatively as does the cause of popular education, or any other subject of great public interest ; and should be entrusted to a board of judicious and qualified citizens, whose public spirit, education and pursuits fit them to direct and conduct the sanitary measures called for by the public safety. The developments of the past year have demonstrably shown, that had such a medical board been organized with suitable powers, in connection with the boaid of health in the city of New-York, in anticipation oi" the appearance of the pestilence, it might have been shorn of its terrors, if not wholly prevented. The wisdom of such a measure, instead of waiting until the epidemic was raging, and then summoning a medical council, after the mischiefs of neglect were irreparable, would seem to be too obvious to require argument. And the identity of interests on this important subject between the state and city would seem to furnish paramount reasons for legislative action, lest another year shall find us again the sufferers by a repetition of the calamitous visitation of epidemic cholera. Eifou will see that by the new city charter, the whole subject of the )lic health in the city of New- York, is committed to a department which the city inspector is the head, and what provision is made the resident physician and commissioner heretofore associated with the health officer and appointed by the Governor and Senate, seems to be obscure, and the continuance of these officers seems to be doubted by the present city inspector, who, as the executive head of the sanitary department, is understood to claim the power of appointing these two officers, under the new charter. Is it not clt/ar, then, that the health of this great city, and correlatively the health of the entire State, ought to be better guarded, and ought there not to be a commission of medical men permanently associated with this department by State authority I It is certain that with the increase of our dense population, the sources of disease are multiplying in our midst, and without constant and rigid police, the hitherto proverbial healthfulness of New- York, will be forfeited by local causes. Houses are constantly going up, constructed by speculators, without the least regard to the health and No. 92.] 11 lives of the families who are to occupy every room, from the garret to the cellar, all being separate tenements, and the buildings covering the entire area of the lots on which they are built, so that in many instances there are no provisions for ventilation ; the light and air of heaven being shut out to a great degree, and a healthful cleanliness or purification of the atmosphere being rendered impossible. Old >reweries, factories and other dilapidated buildings, are refitted and crowded with poor families in like manner, without any regard to the aws of health or life, and ky these and the like means sickness and mortality are generated in such premises to an appalling extent, while the whole neighborhood surrounding such plague-spots, are visited with the like calamities ; and fearful epidemics are thus either created or aggravated when arising from other causes. New-York, Jan. 14, 1850. To the Hon. C. D. Robinson, Chairman Committee on Medical Societies and Colleges, JV. Y. Senate : Sir, — The undersigned in compliance with a request from your honorable committee, will proceed to offer some remarksfand suggestions in relation to Asiatic cholera, under the several heads named, viz, " its nature, origin, progress, causes, treatment, and what alterations may be necessary in existing laws, what new regulations, precautionary or sanative, to prevent its diffusion." tThe field opened for discussion is wide and extensive. To do it iinary justice, would require a large amount of time, and extensive quiry and research. It is evidently the design of your honorable committee to make the investigation a practical one, and to obtain more especially from different individual observers, such suggestions as may have been the result of their own practical experience rather than of speculative opinions or hypothetical deductions. The undersigned has had the opportunity of witnessing and personally observing the three epidemics of Asiatic cholera which have visited the city of New-York, viz, in 1832-34 and '49. In the first and the last, his opportunities were perhaps as extensive as those of any other practitioner, from being connected with the largest hospitals open during the epidemics, viz. with the Park Cholera Hospital, (present Hall of Records) in 1832, as assistant physician, and with the Centre and 35th street Hospitals, in 1849, as Principal. 1. Origin and progress of Asiatic Cholera. The main facts on this part of the subject are too well known to your honorable committee to need repetition. Commencing in the Indian peninsula, about the delta of the Ganges, it numbered its victims by tens and hundreds of thousands. In these regions Asiatic cholera is endemic. It is never absent. The feeble Hindoo, dwell- mg amid the stamps and jungles of the Ganges, inhaling always a miasmatic atmosphere, scantily fed upon rice, has no stamina to resist disease of any kind. Before this giant malady he perishes like the moth. At three different epochs, leaving its original seat and centre, Asiatic cholera has extended itself westward over western Asia, Continental Europe, the British islands, and lastly, crossing the Atlantic, over a large portion of the western continent. Confining itself to no particular localities, it has on both the eastern and western continents affected mostly the banks of large rivers, the alluvial and diluvial regions of the earth. Mountainous and hilly regions, arid and sandy plains have been comparatively exempt. Its law or ratio of progresfm has never been accurately ascertained. During its recent inva>n about a year was occupied in spreading from the Persian Gulf the Caspian Sea, about 20 degrees of longitude. At other times has leaped at a single bound over twice or thrice that number of degrees. During the winter of '48-9, it prevailed extensively in the Mississippi valley, .crawling slowly up the large rivers. It did not cross the Alleganies. During the same period it was prevailing in England and France. Emigrant vessels arriving at the quarantine, New- York,, during the early spring of '49 had constantly cholera on board. On the 11th of May it broke out on the « Five Points," N. V., but entirely without any traceable connection with cholera at any other 2. Causes of Asiatic Cholera. The question of contagion is by far the most important in reference to the causation of cholera. Admitting the existence of contagion, or personal communicability, the absolute necessity of quarantines and cordon sanitaires is at once conceded. Repudiating that doctrine, all such cumbrous machinery is at once dispensed with. More than that the pestilence is robbed of half its terrors. The victim of chok era will not be forsaken by his nearest relative, and left to perish, without a friendly hand to close his eyes or assuage his dying agonies. These considerations, however, are of no moment, and entitled to no consideration, if the theory of contagion or personal communicability can be fairly established. The undersigned will proceed to examine briefly some of the evidence which is inainlv relied unon to 13 14 [SI*AT« establish the theory of contagion and also to state the arguments which it is believed show conclusively that cholera is never, in the proper sense of the word, a contagious disease. 1 . The argument in favor of contagion There is a class of facts on which great stress is laid in establishing the doctrine of contagion. These are principally the circumstance that cholera very frequently makes its first appearance in seaport towns and cities, simultaneously or nearly so, with the arrival X vessels with cholera on board, and appears to extend as from a mm on centre. This was the case in New-Orleans, at the commencement of the recent epidemic. This was also the case in the celebrated instance of the outbreak of cholera at Folly Island, near Charleston, S. C, in 1832. There are very numerous instances of a similar description. It must be admitted that they wear a certain degree of plausibility in favor of contagion; yet, on the other hand, we must recollect that such instances do not occur except when the agency which produces cholera is abroad in the earth, extending over entire continents. It is confidently believed that in such cases there are always facts which prove that the epidemic influence had been previously at work. There is existing over the entire population an unusual tendency to bowel complaints. The train is already prepared: it needs but a spark to ignite it. The terror and excitement occasioned in any community by the announcement of the arrival of that fearful pestilence, before which " all faces gather paleness," and which has strewed the world with corpses, has no small agency in developing the disease. The ghastly appearance of its victims, the nausea and disgust produced in those who witness the alvine discharges and the different symptoms in a case of cholera co-operate strongly in this result. It may be objected that cholera and no other disease is reproduced. True, because the cholera influence was there and everywhere. Likp an invading army, it had sent outposts in advance in the shape of diarrheas and bowel complaints. In like manner, as in New-Orleans, a vessel arrived at New- York almost simultaneously, in December, 1848, with cholera on board. There was no quarantine established that could at all interfere with its extension, yet it did not extend itself. Why 1 Because the epidemic influence was not there. When the cholera did really show itself in New-York epidemically in May, 1849, it was entirely distinct from any foreign importation. Again, it is said that cholera follows large rivers, and the great channels of intercommunication ; it follows also the march of armies, as in the Black Hawk war in 1832. Undoubtedly, cholera goes where it finds material to feed upon j where masses of men are congregated j in crowded cities and great marts ; in camps and armies. And here it is worthy of remark, that when cholera does leave the great lines of communication, and show itself in secluded towns and villages, it seldom extends itself. Those in immediate attendance upon the sick, and frequently panic stricken, may suffer, but it seldom occurs that the physicians in attendance are attacked with cholera, for the reason that they are seldom as much alarmed as others. Time would fail us to examine all the facts supposed to favor the idea of contagion. It is believed that all of them can be explained. One or the other of two suppositions. Either they have been merely accidental coincidences, or the instances of supposed contagion have been the result of terror and apprehension and other moral influences, or physically of the nausea and disgust produced from witnessing the symptoms and progress of the disease. f . The reasons why cholera is believed not to be contagious. It pervades almost simultaneously entire continents and great portions of the earth's surface. It does not spread progressively from point to point, but appears at the same time in many different and remote places. This is not the case with small pox, and other confessedly contagious diseases. It is true they prevail more in some seasons than in others, owing, as is supposed, to an epidemic influence, but we never hear of their spreading over entire continents. Cholera requires for its germination and development, certain cooperating causes, such as a malarious atmosphere,' a certain degree of heat, filth, dampness, intemperance, bad nourishment, &c. Even ia communities where it is most rife, the great majority who pay strict attention to Hygienic rules, escape an attack, though they may be constantly in contact with the disease. Is this true of any other disease admitted to be contagious 1 15 In five cholera hospitals opened in New- York during the recent epidemic, there was not, among all the physicians employed, a solitary death by cholera j though in each one there were several medical attendants, day and night, in the hospital. Of the nurses, and other non-medical attendants, a number sickened and died. It is believed in every instance they were intemperate persons, or had committed gross errors in diet. Among the hundreds of physicians in the city, not connected with hospitals, many of whom were engaged day and night in attending cholera cases, the sickness and mortality were very small, probably quite as much so as in any class in society. The strongest advocates of contagion will, it is supposed, admit the existence of a certain epidemic influence, be its nature and essence what they may. But they contend that under certain circumstances, the disease becomes contagious. This is what is by some termed " contingent contagion." But upon what rules of philosophising, it must be asked, when we have one cause abundantly sufficient to produce a certain phenomenon or result, why resort to another and second cause 1 Another and very strong argument against contagion is the fact, that no quarantine, however severe, no cordon sanitaires, however strong, have ever been able to interrupt or impede the march of cholera. It Liughs to scorn all such machinery, even when backed, as they have been, by millions of bayonets. " Sedet atra mors," still remain true. Pf it were deemed necessary to enter more at length upon the'cfission, many other reasons might be cited. It is believed that the facts and arguments already adduced, fully establish the position that cholera is not a disease communicable by contagion or personal communicability. With regard to the real and essential cause of cholera, its true nature and mode of existence, we are profoundly ignorant. To say that it is atmospheric, is but a cloak to our ignorance. Whether the? inscrutable agency that produces it be atmospheric or telluric, electric or magnetic, solar, lunar or sidereal, whether emanating from bodies celestial or bodies terrestrial, we know absolutely nothing. 16 No human chemistry has yet been able to detect the cause of cholera, except in the existence of certain results, which presuppose, the necessity of an adequate cause, we know nothing of the agency which produces cholera. It is one of those mysteries which compel us to bow in silent submission before the decrees of an inscrutable but all-wise Providence. But while compelled to acknowledge our ignorance of the true and essential cause of cholera, all experience and observation demonstrate that in the temperate regions of the earth, certain predisposing and exciting causes, certain co-operating influences are indispensable to the germination and development of cholera poison, without which the primary and essential cause is almost inoperative. These predisposing and exciting causes are well known to exist in every agency, moral or physical, which tends to depress the powers of life and produce a debilitated and atonic condition of the system. Among the most active are the depressing passions, fear, anxiety, and despondency. Intemperance and excess of every kind in eating and drinking, improper and indigestible food. Impure air arising from personal, domestic, and public filth, or from neglect of ventilation. Low, damp, and unhealthy situations, in fine all those causes which are peculiarly operative upon the lower strata of society, and which, especially in large cities, are the unavoidable concomitants of ignorance, poverty, and destitution. If, during the recent epidemic in the city of New-York, there could have been any agency, human or superhuman, which could have taken up and transported far away from the haunts and purlieus of poverty, destitution and crime, the thousands and tens of thousands of our miserable and degraded poor, cholera would all but have disappeared. The upper and middling classes of society furnished but a small and insignificant quota towards the , hecatombs which the cholera numbered among its victims. From the foregoing remarks it is perfectly obvious, that all measures designed to check and control the extension and progress of Asiatic cholera, must have a primary reference to the improvement of the condition of the poor, to their moral and physical elevation. General sanitary regulations m y have their influence, but so long as [Senate, No. 92. J 2 17 18 * poverty, vice, and intemperance continue to dwell in holes and bdvels, damp, filthy, and unventilated, so long must cholera in large r cities continue to number its victims by hundreds and thousands. 3. Mature and treatment of Asiatic Cholera. The undersigned regards the serous or rice water diarrhoea, which is the result of the epidemic influence, whatever that may be, as the essential and characteristic symptom and feature of Asiatic Cholera. If that is permitted to continue the blood is speedily deprived of its fluidity and rendered incapable of circulation and secretion, and the patient falls by unavoidable necessity into collapse. Collapse is but a sequence of the real disease, which is the serous diarrhoea. This diarrhoea if timely taken in hand is very manageable. It requires nothing but rest, moderate doses of opium, and astringents, and bland nourishment. When cramps, asphyxia and collapse have supervened, it is another and very different affair. No specific for this phase of the disease has been or is likely to be discovered. The majority perish under any treatment. . Gentle stimulation, warmth, friction, sinapisms, &c, will in a proportion of cases, sudceed in rescuing the patient from his otherwise inevitable doom. Mercurials possess in this stage no curative power. By depressing, the energy of the system they do much harm. Were it possible to place the entire population under medical surveillance, with the power to enforce its prescriptions, the mortality by cholera would be almost annihilated. 4. What alterations in existing laws, and what new regulations, pre- X cautionary or sanative, are necessasy to prevent the diffusion of Cholera. Upon this branch of the subject, the undersigned must speak with extreme diffidence. His studies and investigations have not been in uch a direction as to make him minutely acquainted with the already xisting legislation on this subject, nor has he within his reach the means of prosecuting such an investigation. He has already expresed his opinion as to the futility and inefficiency of quarantine regulations. Perhaps the most important consideration Bearing on this part 6t the subject is that in relation )p the prevention and suppression of nuisances, 'the late sanitary committee oi the Board of Health have in their report on the recent epidemic, (pp. 36 and 37) fully and for- cibly expressed their opinion on this subject. Whether additional legislation is or is not necessary to carry out the views therein expressed, the undersigned does not feel competent to determine. Beyond question,- in the 16th ward, where the epidemic raged with intense malignity, hundreds of lives fell a sacrifice to the noxiotfc and putrid miasmas engendered by various local nuisances existing in that section. Bone-boiling and horse-killing establishments^ glue and Starch factories produce and disseminate effluvia, singularly disgusting and offensive to persons riding rapidly through the neighboring localities, how much worse for those compelled constantly to inhale them. How to protect the public health without infringing upon private thts,, is a nice question even for experienced legislation to decide, c undersigned does not feel competent to venture an opinion. That some farther legislation is necessary cannot be doubted. Perhaps the establishment of some such board as hinted at in the report as above cited, would conduce greatly to a happy result. tin conclusion, gentlemen of the committee, the undersigned begs state, that he has thrown together, hastily, such remarks and suggestions as presented themselves in answer to your inquiries. Should ifeey conduce, in the slightest degree to the object you have in view, he will feel himself amply rewarded. Very respectfully submitted. WM. J. BUEL, M. D., Late Physician to the Centre and 35th st. Cholera Hospitals. 19 Communication from A. Vache, M. D. Sir — To your letter in relation to the " origin, progress, cause and treatment of cholera, together with what alterations or revisions in existing laws, and what new sanitary regulations my experience in the late epidemic may have suggested to my mind as necessary to prevent its diffusion," I can only make a very limited reply. To do otherwise, with so comprehensive a subject, would occupy pages of manuscript, considerable time for research, and more labor than my professional duties will allow. The history of cholera, in which I shall include its progress, unequivocally traces its origin to Asia. It is noticed by Hippocrates, who lived several centuries before the Christian era, and by others, not many years subsequent to that event. It prevailed in London in 1669 and in 1676, and in Paris in 1630 and in 1780. In 1762, it is said to have destroyed in Upper Himlostan, thirty thousand native s and eight hundred Europeans, and from these dates to the present day, it has been with great fatality one of the endemical diseases of India, clearly described by talented and unimpeachable authors. It was not, however, until 1817, when with other ravages throughout Hindostan, it decimated the army under the command of the Marquis of Hastings, encamped on the banks of the Sinde, that it assumed a positive epidemical form, and commenced its fearful and irresistible migration to the east, the south, the west and the north. To trace it on the Eastern Continent, from place to place and from period to period, as recorded by different writers, would scarcely come within the space allotted to a communication like the present, and I therefore shall confine any further observations to the invasion by it of this hemisphere, with a short detail of the course it pursued as it occasionally travelled from district to district. » first appearance of cholera on this continent, was in Quebec, Canada, on the Bth of June, 1832; it reached Montreal on the 10th, New- York on the 24th, Albany on the 3d of July, Rochester 12th, Troy on the 16th, Flatbush and Gravesend, L. 1., on the 15th, State Prison, Sing Sing, on the 17th, Philadelphia on the sth, Baltimore on the 22d of August, and the city of Washington on the 28th, It also prevailed in the large towns on the river St. Lawrence, and its tributary streams. It exhibited itself at Kamarouska, La Prairie, Sti Johns, Buffalo,La Chine, Canghnawaga,Coteau de Lac, Chateaugay, Cornwell, St. Regis, Prescott, Ogdensburgh, Brookville, Kingston, York, Chambly, Pittsburgh, and Three Rivers. It visited Baltimore, Richmond, Norfolk, Edenton, Cincinnati, New-Orleans, and various portions of the Southern States. To the east, a limited number of cases occurred in New-Haven > Newport, Providence and Boston ; at Newport it was unquestionably brought from the city of New- York. During the time, thousands were attacked. The average mortality was about fifty per cent, and the general duration of the epidemic at the various localities, between two and four months. fin this connection it is important to note, that the brig Carricks arved from Europe on the 3d of June, at the quarantine ground, Grope Island, thirty-nine miles below Quebec, with the loss at sea of thirty-nine passengers out of one hundred and thirty-three, by a disease which subsequent events established to be the one under consideration. I The two first cases at Quebec and Montreal, were immigrant?, nded from the steamboat Voyageur, which plied between the two places, and which was employed to convey persons from emigrant vessels anchored in the river. I In 1833, the disease commenced in February, at Havana and Mannzas, and prevailed for several months with great severity : the deaths in the former place reached upwards of ten thousand in a population of about one hundred thousand, including in the melancholy catalogue, the American consul, William Shaler, Esqnire, and the acting bishop, Pedro Valeria V', Ximenes. In June and August it invaded Tampico, Campeachy, Vera Cruz and the city of Mexico. In Central America it attacked the army, and destroyed large numbeis of the officers and men. 21 < < In the United States, at the south, it appeared at Apalachicola, and at Amelia Island on the coast of Florida ; at Mobile, Wilcox county, Montgomery, Tuscalodsa, Williamsport, etc., in Alabama; it Vicksburgh, Natches, Claiborne, Jackson, Portage dcs Sioux, ect., itt 'Mississippi ; at New-Orleans, St. Martinsville, Thibodeauville Franklin, Baton Rouge, Alexandria, Contrells, etc., in Louisiana, and at Brazoria, etci, in Texas. In the Western States, it was at Helena, Little Rock, etc. y in Arkansas ; at Nashville, Pulaski, Memphis, Simsonville, Shelby ville, Effingham, Beach Grove, etc., in Tennessee; at Maysville, Flemingsburgh, Georgetown, Lawrenceburgh, Lexington, Lancaster, Paris, Blue Licks, Millersburg, Frankfort, Bardstown, Cynthiana, Greene cbiinty, Mt. Vernon, Danville, Jacksonville, etc, in Kentucky ; 'at Alton, Garrolton, Quincy, Rushville, Galena, etc., in Illinois ; at Williamsport, Salem, etc., in Indiana ; at Cincinnati, Steubenville, Bridgeport, Belmont county, Zanesville, Jackson, Gallipolis, Senecaville, Chilicothe, Richmond, Fulton, Dayton, Lebanon, Columbus, ect., in Ohio; at Allegany, Pittsburgh, Brownsville, Claysville, etc., in Pennsylvania, and at Hagerstown, etc. , in Maryland. It also appeared at Wheeling, Fredricksburgh, Charlestown,etc , in the northern parts of Virginia. ' in 1834, it again made its first visit at Quebec and Montreal, anil from thence spread to the country parishes throughout the whole course of the St. Lawrence. It prevailed severely at La Chine, Kingston, Prescott, Ogdensburgh in this State, opposite Prescott, at Toronto, and amongst the villages on the north side of Lake Ontario. The village of Gait, U. C, was nearly depopulated. In Nova Scotia, it was very violent at Halifax, and extended to St. Johns. In the State of New- York, it exhibited itself in the villages on the south side of Lake Erie, at Buffalo, Rochester, Salina, Albany, Poughkeepsie, city of New-York, Brooklyn (L. I.), Staten Island, &c. Kin New-Jersey, at Bergen hilt and at Newark. In Pennsylvania, WilliamSport,on the line of Schuylkill canal. Port Carbon, Beaver, and Washington county. In Maryland, there were a few cases at Baltimore; and three or four in the District of Columbia. In Virginia, at Wheeling, Richmond, and Petersburgh. In Ohio, at Cincinnati, Butler county, the Miami country, and the townships of Corwn- bia, Anderson, and Fulton, at Huron, Lower Sandusky, and Cleveland. In Michigan, at Detroit. In Kentucky, at MilPu point, the mouth of Sandy river, and Princeton. In, Mississippi, at Rushton. In Illinois, at Luzerne and Pekin. In Texas, at Austin's and Power?s colonies, in the towns of Labride and Willaugh, and as far as the river Lavacca. In Florida, it was at Amelia Island and at Pensacpla, at which place it was introduced by the United States ship Fahnouth. In Georgia, it was at several places on the Savannah and Ogeeebee rivers. It also made its appearance at Jago, Island of Cuba. In 1835, in Tennessee, there were cases at Nashville, Memfrees>orough, Franklin, north side of Duck river, in the neighborhood of efferson, Williamsport, Memphis, in the neighborhood of Jackson, nd at several towns, and on board of the boats, oh the Ohio and Mississippi rivers. It also continued on the Savannah and Ogeechee rivers, and prevailed to some extent on the Rio Grande. lln 1836, it for the first time appeared in Charleston, S. C. During c previous years it had not approached that city nearer than Edenn on the north, Savannah river on the south, and Folly Island, off c mouth of the harbor. At this last place, it was undeniably atibutable to the stranding and loss of the brig Amelia, the 31st ctober, 1832, bound from New- York to New-Orleans, and on board which were cases of the disease. From the wreck, and the passengers and crew, and their effects landed from that vessel, it immediately extended to the few negroes inhabiting the island, to the men employed in saving the cargo, to the physicians and nurses, sent to attend to, the sick, and to the city guard, detailed to enforce the quarantine. The mortality was extreme. [With the epidemics of 1848 and 1849, every person is familiar, 'o continue, however, in chronological order the recurrence of this estructive disease, it becomes necessary to devote a page or more to le sad reminiscences of those years. On that occasion, the first introduction of the malady was in the ;port of New York, at the quarantine ground,. Staten Island, by 'the packet ship New- York. She sailed from Havre, then healthy, on the 9th of November, with three hundred and eighty-five French and German steerage passengers, twenty-one cabin, and a crew of thirty men. According to the statement of the commander, Captain Lines, 23 24 [Senate Rhanda remained well until the sixteenth day out, and the vessel s in lat. 42°, long. 61°, Sable Island bearing about 140 miles S. S. W., when, owing to the coldness of the weather, there was a general overhauling of chests in search of warmer clothing, and the first cases occurred. At the time of her arrival, on Friday night, December Ist, seven of the steerage passengers had been buried at sea ; and on the 2d and 3d, eleven were landed sick at the lazaretto, and put in the hospitals on the hill. Seven of them died. The remainder, in apparent health, were ordered on shore, and were lodged in the " public stores," belonging to the United States. From these buildings the disease spread to the hospitals, and prevailed in both until the 28th of the month. In this time, upwards of one hundred were attacked. The mortality was about one-half. It is alleged, and probably with truth, that several of the passengers were indirectly from Bremen, where cholera prevailed. In April, the disease reappeared in the stores ; and in May, in the lospitals. From the 18th of April to the 15th of August, there were ne hundred and ten deaths. During the period, forty-one persons with cholera were received from the shipping. Several fatal cases occurred on different parts of the island. tin the early part of December, two cases exhibited themselves in s city. The first was an individual from quarantine ; the other was a person who had occupied the same room in the boarding house. Both were fatal. With these exceptions, the first persons attacked in New- York was on the 11th of May, 1849. It occurred in Orange street, and was soon followed by six others who resided in the same premises. From that point, the disease gradually spread from ward to ward, and continued with more or less intensity until the last of September. The number of deaths was 5,017. The nearest vicinity of the pestilence was the quarantine, between which and the city there was constant intercourse by the residents of each place ; and, in most instances, the passengers from sickly vessels were permitted to disembark at the Eharves with their unventilated baggage. If the infection was not icribable to these causes, it could not be traced to any other. In Brooklyn, L. 1., it manifested itself about the 26th of May, In Williamsburgh, L. 1., on the 29th. In Jamaica, L. 1., on the4tb of June, and about the same period at Bergen and Newark, N. J. It prevailed at Albany, Troy, on the line of the Erie canal, in Chicago, and Buffalo. In Montreal, the deaths were 499 ; in Quebec, to the 23d of August, 943 j and in Toronto, to the 9th of the same month, 380. At Boston, Mass., the bark Argyle arrived on the 4th of June, from Scotland, with cholera on board ; and cases are said to have occurred in that city from that time. From the 29th of June to the 13th of October, however, the deaths were 602. In several other cities and villages of New England, the disease prevailed. In Philadelphia, eight cases were announced on the 22d of May. The number of deaths accurately reported from the 2d of June to the 22d of September, was 3,022. In Baltimore, it was reported on the 22d ; in Norfolk, Va., on the 29th, and in Richmond, Va., on the 30th of May, the Legislature of which adjourned to Fairquer Springs. At New Orleans, like at Staten Island, the cholera appeared in December, and under similar circumstances. The two first cases sent to the charity hospital were from the ship Swanton, from Havre, on board of which the disease manifested itself when about two weeks from port. Thirteen bodies had been thrown overboard. Her passengers were also composed of French an J Germans, and the latter were recently from their own country. From that source it spread to the shipping, to the river boats, and over the city. The number of deaths from the 11th of December to the 7th of February, was nearly reive hundred, when the boards of health pronouced the epidemic an end, and ceased to report. The disease visited Vicksburg, Cincinnati and several other places. On the Btb of January it was at Memphis, and on the 17th at St. Louis v It also appeared at Mobile, and in a severe form in Texas. At Fort Lawson, forty deaths occurred in one night among the troop,. Subsequently, the malady resumed its fearful strides in New-Orleans, and in Cincinnati, and continued several months. It prevailed throughout the valley of the Mississippi with sad havoc on the plantations, and extended itself to Indiana and Illinois. At St. Louis its duration and violence was unsurpassed on this continent, and in Texas it raged with unabated and dtstiuctive fury. 25 Amongst the victims, was the chivalrous Worth, the brave Duncan, the gallant Yates, and the veteran Games. Invulnerable to the balls of an enemy while leading their victorious columns on the field of battle, they were suddenly and remorselessly stricken to the earth by that unrelenting and desolating foe to the human race. A nation's tears bedewed their graves. Peace to their ashes ! fAt present it is on "Ward's Island — the home for destitute, invalid and sick immigrants. The proximity of that institution to the city of New- York ; the recurrence of cholera in this country, with the. return of it to Europe, and the probability of the spread of it from these sources, demands the prompt adoption of every available means o prevent so serious a catastrophe. It has also commenced its march in Louisiana, and will doubtless again overrun the valley of he Mississippi and the shores of the Ohio. The cause that produces cholera is not known. By some, it is said to be atmospheric ; by others, meteoric, telluric, electric, animalculae. To reiterate the speculations on the subject, would be more curious than useful. Each writer has imagined the premise from which the fact is assumed, and the supposed fact has invariably been made to conform to the fancied premise. That it is a specific poison, would be difficult to confute. Its effects on the human system, unlike every thing else ever beheld, seems conclusive evidence of the correctness of the problem. I The treatment of cholera, has been as various as the opinions of ledical men on the nature of the disease. More obscure than any ther malady presented to the consideration of the profession, each lember of it seems to have framed his ideas agreeably to the hyothesis derived from his opportunity to investigate, and his ability to ldge. As one of the number, I have pursued the same course, and rhile I avoid any reference to the views of others, I do not decline 3 furnish you with the conclusions I have reached, based on experience at the bed-side, during the epidemics in this city of 1832, 1834, and 1849. In my opinion many of the phenomena, and the immediate cause of death in cholera, are to be attributed to the disintegrated condition of the blood, from the direct loss of serum poured out of the capillary vessels into the alimentary canal, and subsequently ejected, in most instances, from the body. Chemical analysis of the discharges 26 has abundantly established the feet, and venous saline injection by its instantaneous effects on the circulation, has synthetically confirmed the truth of the proposition. The first indication, therefore, is to suppress the loss of that fluid, in order to retain, as long as possible, sufficient vital energy for the action of other remedies oa-the system. For this purpose astringents are the only agents. Various have been recommended, and I have fairly tested the efficacy of each. To the vegetable combinations I gave a decided preference, and from tannin, in five grain doses, diffused in half a wine glass. of water, I derived the most satisfactory results. Ice, so generally used, produces similar effects. Independent of alleviating the intolerable thirst, its temperature contracts the muscular tissue of the prima vise, and closes in proportionate degrees, the mouths of the secerning vessels. Next, and equal in importance, is the necessity to incite the liver to action, as speedily as it can be accomplished by the administration of cathartic medicines. With me, twenty grains of calomel, blended with one grain of powdered opium and a grain of powdered camphor, succeeded the best. t After a satisfactory trial of many others, in these remedies I placed c utmost reliance. If rejected they were repeated, for when retained by the stomach, and bilious evacuations were obtained from te bowels, little else remained to be achieved, in most instances, but guard against relapse by cautious diet during the period of convalescence. When other diseases supervened, they were treated in accordance with the type, the condition, and the habits of the patient. External applications, I have looked upon as mere auxiliaries. As such, they are of some importance ; but in themselves, of very little value. For profuse perspiration, no agents have equalled the free application, in Indiarubber bags, of very cold water to the skin j and for cramps, none have exceeded the use of tourniquets, without the strap pad, sufficiently tight to interrupt the superficial venous circulation in the limbs. Iced, " Congress spring " water was a grateful drink, and valuable for its saline and alkaline properties. B above remarks, it must be understood, are alone applicable to i when it presents unmistafceable evidence of its existence, by re or less alteration of the countenance ; tne clammy moistness skin ; the slowness and feebleness of the pulse ; the huskiness 27 • of the voice ; the coldness of the tongue ; the corrugation and lividness of the hands and feet ; the spasmodic action of the muscles of the abdomen and extremities, and the " rice water" discharges from the stomach or bowels. In the earlier stage, with simple diarrhoea and excessive lassitude, diffusible stimuli composed of laudanum, spirits of hartshorn, essence of cloves and peppermint, tinctare of Cayenne pepper, and spirits of camphor, followed by calomel, if necessary, are all, in most instances, that is requisite to put a speedy termination to the attack. ELt the several times the " health laws" of the State underwent reon by the Legislature, no reference was had to cholera unless in 2, when a special act was passed to meet the occasion, and which expired, if I understand section 10 correctly, by its own limitation with the year 1833. tin reading over, however, the law as it appears to stand, for it is ry difficult to say what portions have been repealed by subsequent ts transferring the " marine hospital" to the Commissioners of Emigration, it seems to me that the alteration of a few words and the addition of a few sections are all that are required to render it more protective without being additionally oppressive. With this view, I have marked in the annexed copy of the law, as published by the commissioners of health in 1846, the amendments I suggest. I also advise the separation of the quarantine from the institution provided for the protection of the immigrant. Between an establishment for the care of individuals in health, and with ailments harmless to others, and a lazaretto for the reception and detention of persons with pestilential and contagious maladies that endanger the lives of a community, it is difficult to discover any affinity, or to adopt any rational idea why the connection should exist. As it is, singular as it may appear, the board of health have control over the local sanitary laws of the county, with the exception of the important appointment of health wardens, who are selected by the chief of police, while the Commissioners of Emigration hav^e possession of the hospitals and grounds on Staten Island, from whence the safety of the city of New- 28 ordinary admixture of departments, and divisions of powers and responsibilities, the results, it seems to me, cannot fail to be disastrous in its consequences to the public. In my judgment the " marine hospital and its fund," in order to fulfil the intentions of their creation, should be as the wise heads and pure hearts, governed by the experience of years, originally made them — a direct unencumbered branch of the medical police of the ttate, and immediately under the jurisdiction of the authorities of the ty and the commissioners of health, who are alone competent, from >osition, to meet the exigencies that momentarily arise. How to acomplish that object, in full, in accordance with the decisions of the Supreme Court of the United States, is the province of a lawyer, not f a physician, to explain. The mountain heretofore raised in relation to economy, or rather whether epsom salts can be purchased for one or two cents a dose, nevr can be worth the notice of enlightened men, especially when the >rosperity and health of a population comprising millions, are under onsideration. Before leaving this branch of the subject, I deem it a duty to recommend the removal of the quarantine from its present location to a more distant site, if one can be procured that shall afford a harbor for the anchorage of vessels, and sufficient accommodation for the safe detention, and purification of passengers and their baggage, when circumstances demand it. With any other disease than cholera this IBrhaps would not be immediately necessary ; but when the populaon of Staten Island — its proximity to the city — the constant unaridable commingling of the inhabitants with each other, and the fality and rapidity with which the virus is conveyed, are taken into jnsideration, the conclusion is self evident that much greater secuty must'arise from a more isolated and better ventilated position. When this is done, and the law as amended in 1846, with trifling alterations is restored to the statute book, and published in one act that it may be understood, all, probably, will have been practically obtained by the authorities of the State, that is within the power of the wisest legislation to devise, short of non- intercourse with infected countries, divided by seas of thousands of miles in extent. 29 E prophylactic measures adopted against the accession of chole- Qust be admitted, have hitherto been futile. Military and civic s of the strongest kinds have been instituted, and quarantines of the most rigid character have been established without avail. Governed by special, though inscrutable laws of its own, its independent march over vallies and mountains and oceans, regardless of climate, has defied the most energetic efforts of human wisdom to control. That the disease, however, is indigenous to India, no one can dispute, and that it radiated from that point over the habitable globe, few will deny. Be the cause that produces, therefore, what it may, there cannot be a doubt that it is transmittible from hamlet to Clage — from town to city — from country to country — and from conent to continent. Take for example, the invasion of Quebec and Folly Island in 1832, and who will question that the poison did not emanate from the brigs Carricks and Amelia, and the baggage of their infected passengers and crews 1 Look at the ship New- York, at Staten Island in 1848, and who will see^ any other source t6 explain from whence the pest was derived 1 Remember the ship Swanton, in the same month and year, at New-Orleans — the bark Argyle at Boston in 1849 — and the myriads of steamboats on the northern and western rivers, and what greater proof can be required to establish, that from these nuclei the malaria was disseminated in North America, dealing misfortune and death from one extremity of it to the other. It has been observed, that cholera primarily selected the vitiated and? depraved members of society, and sought its victims to a greater extent in low grounds and filthy localities. However true that may be, it is very questionable if the result arose from any other cause than the greater susceptibility of that class to receive the impression q{ a poison. If impaired health, personal degradation crowded dwellings, abject penury, and an atmosphere loaded with animal and vegetable putrefaction, were the only pre-requisites for an attack of the disease, the lapse of time between the years 1834 and 1849, could not have occurred in the city of New-York, especially in the " Five Points." An interval of fifteen years, under precisely the same local circumstances, surely requires some other explanation to account for the presence or absence of the epidemic. That the malignancy of the disease, however, may be mitigated by judicious local regulations, and due observance of personal habits, 30 cannot be contradicted. To accomplish that object, the most reliable means are the purification of the streets, yards, privies, gutters and sewers, by the removal of all offensive matter, and the free use of ¦water and other agents ; cleanliness of person ; strict precaution against transitions from heat to cold; regularity in the mode of living; avoidance of indigestible food, and excess in the use of malt or alcoholic drinks ; due regard to change of clothing with alterations of weather ; pecuniary and other aid to the indigent ; the organization of hospitals for the speedy reception of the sick ; and of dispensaries for prompt advice, and gratuitous distribution of medicines ; the timely appointment of capable ward physicians, to visit those who are unable to pay for professional services, and an admonition to the public to discard all nostrums, and reject all preventive remedies. With proper attention to these recommendations, the predisposition to the disease may, at least, be allayed, and the violence of its assaults greatly subdued ; but in the practice of them, it is equally necessary to avoid sudden and decided changes in the habits of individuals, for no fact can. be better established than the injurious teidency of immediate revolutions in the nervous system during the prevalence of an epidemic, and no greater exciting cause can be induced for the attack of thousands with the malady who otherwise might escape. The burial of the dead in deep dug graves is preferable to vaults. The decomposition of the body under ground, is far less objectionable than in tombs, — the air of which, when opened from time to time, I diffused through the atmosphere, and cannot fail to have a delete•us effect on those within its influence. I Whether cholera is contagious or non-contagious, is difficult to termine, if personal communicability alone be understood by the words, the evidence presented by the advocates of either side is so evenly balanced, that time alone can distinguish the right from the wrong. My own observation has been confined to localities where it prevailed in an epidemic form, and where all persons were alike subjected to the impression of the general cause, in a greater or less degree, independent of any connection with the sick. For me, therefore, to express an opinion on so doubtful a point, under circumstances where it was impossible to distinguish from which source the 31 disease was derived, would be to place myself in the conjectural school, with about equal claim to the correctness of my views. In closing these remarks, sir, I avail myself of the opportunity to say, that I sincerely hope that others with far greater knowledge, may point out more positive and effective measures to protect the (itizens of this otherwise healthy and prosperous country, from the evastations of a scourge, the terrific offspring of a far distant land. I have the honor to remain, sir, Your obed't serv't, / ALEX'R F. VACHE, JVb. 75 Lexington Avenue. To the Hon. C. D. Robinson, Chairman Stand. Com. Med. Soc. and Col in Senate, Albany. 32 New-York, March 14, 3850. To. Hon. C. D. Robinson, Chairman of Com. on Medical Societies and Colleges : Dear Sir — The diseases which occur in this State, properly denominated " malignant or infectious," are eight in number, viz : typhus fever, scarlet fever, small pox and measles, which are commonly believed to be communicable by contagion j an epidemic form of dysentery, and epidemic erysipelas, which often merit the epithet " maignant," though they are not usually regarded as contagious ; Asiaic cholera, which in its triple visitation, has among us, as elsewhere, caused a wide-spread mortality, entitling it to be considered the most errible of all the plagues the world has ever seen ; and yellow fever, which, however, has appeared among us but once, (and then hardly as an epidemic) for more than a quarter of a century A contagious or infectious property has sometimes been claimed for all these, but t is in favor of the first four only that claim is generally conceded, although the malignancy of the remaining four is fully attested by the severity of their symptoms, and their too often rapidly fatal termination. There are other diseases which, either from their fatal tendency, or their contagious character, are not far removed from those here named ; but it is believed that they are not strictly entitled to a place among the diseases referred to the consideration of your committee. Among these, however, is one which I am not willing to pass without a brief notice. I refer to the malarious remittent fever, which, although it is not usually called malignant, (and is certainly not contagious) destroys annually, in different sections of the State, many valuable lives. The agent which produces miasmatic fevers, is universally believed to be some emanation, during the warm seasons, from marshes and from alluvial soil, newly brought under cultivation. 'he remedy is found in tillage and drainage, and it is gratifying to [Senate, No. 92.J 3 [Senat. 34 Bthat certain places which, only a few years ago, were rendered st uninhabitable by the prevalence of miasm, are now, by the prise of our agriculturists, wholly relieved from the influence of this cause of mortality. So much of this remedy, then, as can be effected by the cultivation of the earth, will be slowly but surely accomplished by the farmer j but effectual drainage is often a work too great for him to achieve unaided. Many low and wet lands within the State now lie unproductive, and worse than useless, exhaling poison, creating diseases, and from their extent, and their unfavorable position as regards drainage, must long remain in this condition* How far the Legislature can judiciously extend its aid to reclaim these insalubrious wastes, I have not the means of forming an opinion. The absence of all sources, from which extensive and reliable information on this important topic can be obtained, seems to me one among the many strong reasons which might be urged for a sanitary survey of the State. With reference to the diseases especially submitted to the consideration of your committee, I would remark : first, regarding epidemic dysentery and epidemic erysipelas, as they are not generally considered contagious affections, and as their causes are in a great degree unknown, I am not able to suggest any plan by which legislation can materially mitigate their severity or limit their spread. Secondly, regarding scarlet fever and measles, although they are contagious diseases, and might in this view seem to require isolation no Jess than small pox, yet when it is remembered that the sufferers rom these diseases are mostly persons of tender years, dependant wholly on parental care, society has perhaps wisely preferred to trust o parents for such seclusion as can be secured in their own dwelling, and to leave every thing to the promptings of their love for their offspring. The time may come, when discoveries analogous to that which has rendered the name of Jenner immortal, will deprive these affections of their fatal power, but till then they will probably be regarded as among the unavoidable perils of childhood ; and those will be congratulated who have safely escaped through the perils, rather than those who have not yet been called to endure them. With regard to typhus fever, I would remark, (assuming that if yphus and typhoid fevers s if they are not substantially modifications No. 92. ] 35 of the same disease, at least are closely allied in their origin and progress,) that though it attacks all classes of persons, it is most prevalent and most malignant in large towns, among the poor. The total mortality from this disease, in every country where it prevails, through a term of years, far exceeds that produced in those countries by the occasional ravages of Asiatic cholera. Like cholera, it is most fatal in over-populated, ill-ventilated dwellings ; among those who are poorly fed and poorly clad ; where filth of any kind is allowed to accumulate. It is a disease, which in all temperate northern latitudes, follows the scarcity of food, and has occasioned the fearful collocation, " famine and pestilence." From these facts it will appear that legislation, if it aims at the removal of this cause of mortality, must first improve the social and domestic condition of the poor ; provide for them airy and comfortable dwellings, and abundance of wholesome food, and early remove the sick from among the healthy. But this is a great work, beyond the ordinary range of legislation. To educate the poor, to encourage industry of every kind, so tha* hey may procure for themselves commodious dwellings and the means of comfortable subsistence ; to offer asylums to the destitute, the helpess and sick, has thus far been considered the whole duty of good government. Whether more than this can now be done, lam not >repared to say. The hospitals provided for large towns have no appreciable influence in stopping the progress of fever. The infected are not invited to them. Indeed^ the project of diminishing the morality from this cause, by isolating the sick, seems not to have been earnestly proposed in this country, much less attempted. There is not proper fever hospital in the State. That such hospitals should be esablished, and on a basis so liberal, as that dispensary and other phyicians may be led to encourage the sick poor to resort to them, not ess to increase their own chances of recovery, than to relieve their riends from the danger of infection, I fully believe. Older governments than our own, have had this subject long under consideration. Eome of the most distinguished physicians of Europe have urged it s the only practicable means of moderating the ravages of this too tal disease, and the plan has been partially adopted in many of the ties of Europe^ with beneficial results ; but nowhere fully ; yet nohere has less Seen done than in our own country. lam aware that 36 [3«f» such a project as this would be impracticable in the midst of an epidemic, like that which d€cimated the poor of New- York city in 1837 and '38 ; but it remains to be shown that the plan of isolation here advocated, would not render such epidemics impossible. Yet these institutions should not rely entirely for support on the State treasury. Local authorities have a duty to perform in this matter, and at the same time, it may be well considered, whether the public good doe& not require that they should receive encouragement and liberal aid from the State. Regarding small-pox, permit me to suggest, that so great have beenthe benefits of vaccination, that that disease has almost ceased to attract public attention, or to excite alarm. Yet it is not extinct among us. In the year 1848, the deaths from variola and varioloid .in the city of New- York were 585, or lin2B or all the deaths, In,, this* city it is a constant visitor, and in all our large towns it is a frequent visitor, while it occasionally alarms the most secluded villages and towns in the State. The malignant and highly contagious character of this affection has, from time immemorial, in all civilized countries y been held to justify even the forcible removal of the infected to some safe and proper retreat. I do not discover, in the laws defining, the " rights and duties" of towns, any provision by which this important sanitary measure can be effected. PA. severe epidemic of this disease has not occurred within the limits the State for very many years, and it is believed, that with the idea of security that has grown out of this fact, the practice of vaccination has of late been alarmingly neglected. England, Germany, France, and indeed most European countries, since 1828, have been repeatedly and severely visited by it. Our mm may come when we least look for it. The disease is never absent from the State, and when the circumstances will occur which will render it epidemic, ncone can know. Recent investigations have shown, that while successful vaccination in infancy affords a seasonable protection till the age of puberty, re-vaccination is necessary after that period, either to test the value of the former vaccination, or in a large number ta renew the weakened influence of the vaccine virus. ¦ye reason to believe that while vast numbers of our population : without the security which a first vaccination affords, only a • 37 small proportion, and those chiefly inhabitants of cities, have availed themselves of the still higher protection furnished by re-vaccination. This is a > legitimate subject for legislation, as is also the isolation of those suffering from small-pox, by hospital or other provisions. But I am restrained from making specific suggestions, lacking that accurate information on which alone such suggestions can be safely based — information that can only be furnished by a sanitary survey, or by a census embracing some of the objects of a sanitary .surrey. Yellow fever and cholera remain to be noticed. Of the former I will only remark, that the experience of former years seems to have demonstrated that it may safely be left to the management of an intelligent board of health, in the town affected, fully empowered to act in all things as circumstances may seem to require ; and should that disease again visit our shores, I believe the Legislature will do all that the public good can require, if it provides, by general law, for the creation of such boards in places either threatened or attacked, empowering these boards both to enforce internal sanitary measures and quarantine, where quarantine is not already provided for. Regarding cholera, I believe it to be proper to extend my remarks to somewhat greater length. From the obscurity that rests on many important points in its hisory, the praiseworthy labors, thus far bestowed by medicine men, iave been but partially rewarded, for nature still holds secrets regarding the origin and spread of the cholera, which, if fully known, would reveal, not to the physician only, but to the legislator, his duty s guardian of the public health. But while indulging in this tone of remark, I do not forget that there are some reasons for supposing that the cause of epidemic diseases in general may have been hidden beyond the research of man. This, at least, is certain, that many diseases of this class have been known and carefully studied for many hundred years, and yet little more is known of their origin and diffusion, than is now known regarding this last and most terrific of the maladies entitled to this name. When, then, it is remembered that cholera, in its triple visitation, has scarcely been the subject of study, in the majority of towns attacked by it, in Europe and America, for a total period cf nine months, is it not rather a subject of 38 fS«NJI* congratulation that so much-Has been learned of its nature, progress and treatment, than of surprise that so much remains unknown? Cholera has been ascribed by different persons to animalcule floating in the air or living in the water of infected places ; to minute vegetable substances of the class "fungi ' pervading the air and water; to a substance called ozone, diffused through the atmosphere ; and to the withdrawal of a portion of the electricity naturally belonging to the human frame, by some telluric influence I have investigated the bases on which each of these opinions rest, and though tis beyond my province to assert regarding any one of them, that uture inquiry may not demonstrate its truth ; yet I confidently beieve that at present, neither of them is sustained by such a number of well observed and uncontradicted facts, as should entitle it to any consideration in searching for a foundation on which to construct wise sanitary laws. The two opinions which share the divided support of the great body of the medical profession, and of the public, are that it originates from atmospheric causes, or from contagion. The great question then, is, whether cholera is or is not contagious ? At first view it would seem that such a question ought to be satisfactorily answered by an appeal to facts. But if the atmospheric origin of the disease be admitted as possible, and if at the same time an accessary influ-ence from local causes be admitted, (and at this day such influence is nowhere denied,) it will be seen that almost all the cases which can favor the views of the contagionists, will at the same time, admit of an interpretation equally favorable to the opinions of those who reject this doctrine. Thousands of instances could be cited in which the disease has been carried from an infected to a healthy region, or has originated in a place previously healthy, and has not extended beyond the individual primarily attacked; so, that the contagionist is compelled to admit that the disease is not uniformly and equally contagious under all circumstances. Yet, on the other hand, its spread in many instances is so analogous to that of affections universally recognised as communicable, as to induce the non- contagionist to entertain respect for the views of his opponent, and even to excite in him temporary doubts of the correctness of his own opinion. A volume might easily be filled with recorded facts, which, viewed separately, would seem conclusive for the opinion of either party. This difference arises then, not so much from any want of acJuteiness, or honest judgment in the minds of the observers, as 'from the intricate and apparently variable phenomena involved in the inquiry. lam ready td express the conviction that cholera is not contagious. I believe that in this conviction I am sustained by a large majority of the medical profession, both? in this country and in Europe. I believe that the: spread of the disease is essentially dependent on an agency of utiknown origin ; often widely diffused ; affecting frequently large communities—even whole countries, at nearly ttie same time ; producing however, only, in most instances, what has been called a " predisposition," which persists in some persons only a few days, in others for many weeks, awaiting in most the influence of some accessary cause, either local of personal, to produce the full development of its terrible -energies. On this opinion lam willing to act, in all that concerns my own personal interests and welfare; yet I entertain so profound a respect for the opinions of the many great and learned men who differ from me, and honestly and intelligently hold the doctrine of contagion, that I would hesitate to put. the interests and the welfare of the public at hazard, on what may possibly prove an erroneous inference, from facts which now appear to me conclusive. The question fortunately admits of definite settlement, and it will not be long before all will concur in one opinion, either for or against the doctrine of contagion. The State Medical Society at its last meeting, appointed a commission to investigate this subject, in the light of new facts to be collected in our own country. From their labors, results important alike to the physician and the legislator may be expected. I would give all encouragement to every inquiry that may tend to develope the specific cause of cholera, and ascertain the laws of its diffusion, and would advise appropriations of money to aid such investigations, whenever they are believed to be judiciously conducted and require such aid. I now turn from these debatable- topics, to facts regarding which, there is no dispute, and earnestly call your attention to the acknowledged accessary causes of malignant cholera. Whether the disease be contagious or not, all who have witnessed its progress agree that it expends its greatest violence in low, damp, and unclean places ; in ill- ventilated and crowded apartments ; among the poorly clothed and the badly fed j among the dissolute and miserable ; where filth of any 39 40 |Se»ax E kind is allowed to accumulate, whether within or near to dwellings ; where pools of foul and stagnant water are permittted to collect j where open drains or putrid city streams taint the air ; where the ebbing tide leaves the foetid accumulations of docks to putrify in the sun ; where marsh miasm has undermined the constitution of the inhabitants; among those who are exhausted by excessive and untimely labor j among those who are guilty of excess or imprudence in eating or drinking ; about unclean butcheries, filthy manufactories neglected stables for domestic animals, and among those who are compelled to drink hard or otherwise impure water. Here are acknowledged causes of mortality, many of which the law can control and remove. Here then is the proper sphere of legislation. Whatever is the essential cause of cholera, here are the superadded influences, which render it so terribly mortal. And I ask for these facts, although they have been many times stated, and are generally believed, the legislative sanction for the support of those municipal officers, throughout the State, who perform their duty on the one hand, and on the other rebuke those who neglect it. With this important object in view, I have no fear of being considered unnecessarily prolix, if I make a few citations and refer to a few facts, which sustain my opinions. v The British and Foreign Medico-Chirurgical Review," says, in July 1848, " the poison of cholera derives its terrible power, chiefly, if not wholly, from accessary circumstances." In January of the present year, the same journal alludes to the sentence just quoted, and adds, " Cholera has now passed over us, (again,) and we are more than ever convinced of the truth of this opinion." re man in all England, who has a position that enables him to the widest and most accurate views of the causes and progress of all forms of disease, is the registrar general. This officer, in summing up the ravages of cholera during the last summer, says, " chole- Eis a health inspector that speaks in language which nobody can sunderstand ; it visits the prisoner in the hulks, on the polluted river ; the neglected lunatic in his cell ; the crowded work house ; the establishments for pauper children ; the sides of stagnant sewers ; the undrained city j the uncleaned streets. The oversights, the errors, the crimes of persons who, in responsible offices, have charge of the health and life of men, are proclaimed aloud by its inexorable voiced These are words of heavy import, and should be written on the memory No. 92. 1 41 of every municipal officer, that he may perpetually feel the vast responsibility of his station, when the public health is threatened. Eatements of the same tenor as those just quoted, occur in every try, and every region that has been visited by the epidemic, y sanitary report that has fallen into my hands, if it records unusual fatality from cholera in any particular locality, has also found local causes which were believed to account for such unfortunate results. They recognize everywhere the fearful influence of the accessary causes. Thus the report of the New- York sanitary committee, for 1849, declares that " among the important facts which appear to be well established, is this, that the agency of various exciting causes is generally necessary to develope the disease (cholera.) Among these causes the principal are the existence of filth and imperfect ventilation, irregularities and imprudences of living, and mental disturbance." The Philadelphia report for the same year fully recognizes the influence of " local circumstances, as filth, dampness, vitiated air, decomposing animal and vegetable substances, crowded and illy ventilated dwellings, bad drainage and "sewerage, noxious gases, and other baneful agencies." Pages might easily be filled with extracts corroborating these statements, and nowhere has a doubt been hazarded of the fearful agency of these " local causes. 7 ' The voice of the affected world is unanimous. tin the city of Philadelphia, as early as December 13, 1848, orders ere given to proper officers, " That they visit all houses, cellars, yards, school-houses, factories, slaughter-houses, streets, lanes, alleys, courts, and all other places within their respective districts, for the purposes of examining thereon any nuisances tending to affect the health of the citizens, and to report thereon." By the first of April the sanitary agents had completed their visitation. "It would be impossible," says the report, " for the board to enumerate the causes of insalubrity discovered by them. Foci of unhealthy atmosphere and disease were found within and adjoining the premises, not only of the poor, but of those whose condition in society would place them far above suspicion." All these sources of disease were promptly removed. The city acted on " the principle that * prevention is better than cure.' 5) The result of all these precautionary measures was that when the plague actually appeared, (on the 30th May,) its duration was limited to 81 days, and its destruction to 747 deaths, in a [Senate 42 population estimated at 350,000: This is a mortality of lin 470 inhabitants. In New-York it does not appear that any extraordinary protective measures were adopted in expectation of the epidemic. The sanitary committee was not even appointed till the 16th of May, two days after the first case of cholera had appeared in that city. On the 21st of May the sanitary committee visited that section to which the disease was then confined, (the " Five Points,") and they say, " to be appreciated the place must be seen;" " to those of the committee who visited the place for the first time it seemed almost impossible that such a state of things could exist in any portion of our city. In addition to what had been previously done, orders were now given, arid efficient measures adopted to cleanse this place." New-York then, urilike Philadelphia, had not duly heeded the warnings it had received in December, nor yet the frightful devastation the disease was effecting in the west; but it awaited the actual visitation of the pestilence to undertake a work which should have been completed long before. The plague lingered for 143 days, and 4,017 deaths are ascribed to it, and nearly 1500 deaths more than in the preceding year, occurriftg from bowel complaints, are reported under other names. If the pop^ ulation of the city for 1849 be estimated at 420,000, this will show 1 death from acknowledged cholera in every 84 of the inhabitants, or adding the deaths which were in all probability produced by the same agency, nearly lin 64. Making every fair allowance for the great emigrant population of New- York, I am compelled to view this contrast as striking, and instructive. But if these facts stood alone, I would willingly believe that the inference deducible from them i» an unfair censure on the city of which the whole State is justly proud. But so far as facts are known, this is but a part of the history of cholera in every country which it has visited Were details necessary, I could refer to the city of Boston, which, in 1832, while cholera was gradually approaching through Canada, was energetic in removing all accessary influences, so that before it appeared in New- York, a newspaper announced that " if this enemy of man chose to visit the capital of New-England he was welcome, but that he would not find in the whole city filth enough for a single breakfast." The result was, that though several imported cases proved fatal there, Boston had to record less than a hundred that were indigenous; yet Boston did not escape in 1849. They might refer to towns unfavorably situated, that by timely sanitary measures have escaped without a death; and to others having every natural advantage, which, trusting to these alone, have been frightfully devastated. The appaling fact is recorded, that officers having charge of these measures have refused to undertake them on account of the expense; and were finally roused to their duty, not by a sense of the awful criminality of their neglect, but by finding that the cost of coffins already distributed to the poor had exceeded the amount necessary for the thorough purification of their town. It is to be hoped that Mammon's betrayal of his votaries has in no other instance been attended by such disastrous results. Yet it is notorious that in almost every town visited by the pestilence the last summer, sanitary measures were delayed too long; so long as to annul half their advantages, and it is necessary to add that in most instances, this delay was dictated by a false economy, in the delusive hope that no extraordinary outlay would be needed. In concluding my remarks on this topic, 1 cannot but express the fear that I have failed to present these statements in a manner to secure for them the grave cqnsideration yfissi they merit. It not easy to give the interest of novelty tofprinciples and facts so long, and so universally known. Yet trustingjn. their acknowledged truth and paramount importance, I leave them to plead their own cause. Respectfully, your ob't serv't, ALONZO CLARK. 43