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PHILADELPHIA: KIXG & BALED, PRINTERS, 9 SANSOM STREET. 18 49. The following pages, embrace an account of the sanitary protective measures for the cleanliness and health of the City and Port of Phila- delphia, adopted by the Board of Health, prior to, and during the prevalence of the late Cholera Epidemic; together with a statistical history of the disease as it appeared among us. The whole subject of preparing a report, having been referred to the Sanitary Committee, they submitted the annexed document to the Board, on the 10th of October, 1849; when it was read and approved by them, and ordered to be published, as set forth in the following resolution : u Resolved, That the Report read be adopted, and referred to the Sanitary Committee to prepare for publication, and report to the Board the number of copies necessary to be published." At the meeting on the 17th of October, the Board resolved, "that fifteen hundred copies be published in pamphlet form." REPORT. The progressive advance of Cholera throughout continental Europe, during the years 1847 and 1848, and its appearance in England in the autumn of the latter year, claimed the serious attention of the Board of Health as early as November, 1848, and led them to the immediate adoption and rigid enforcement of a sys- tem of sanitary appliances, for the purpose of checking the progress and shortening the duration of this for- midable Epidemic, in the event of its arrival in the United States. To wi{ — by the careful removal of all those agents or accessory causes, which experience has proved, are abundantly fruitful, in favouring the promo- tion and spread of zymotic diseases. By a resolution of the Board, the Sanitary Committee had the whole subject of Asiatic Cholera under consi- deration, and after reviewing and investigating its his- tory and progress, from its appearance in the Spring of 1846, at Kurrachee, in the delta of the Ganges, down to its outbreak in Sunderland and London, a course of travel parallel to that of '30 and '32, and having every reason to apprehend its irruption among us at no very remote period, submitted to the Board on the 11th of November, 1848, a report, embracing the most important characteristics of the disease, and all that was necessary in a sanitary point of view, to be ob- served at that time. Among other recommendations in that report, the committee offered the following sani- tary resolutions for the action of the Board : — " Resolved, That the attention of the City Councils and the Municipal Authorities of the Districts of the County, be espe- cially called to the subject of sewerage ; and that said autho- rities be recommended to adopt measures, as early as practica- ble, to avoid surface drainage altogether ; also to attend to street paving, so as to avoid inequalities of surface, whereby water and refuse matters accumulate ; as a sanitary measure of paramount importance in the prevention and mitigation of Epidemic Cholera and other diseases. " Resolved, That the attention of the City Councils and the Municipal Authorities of the several Districts of the County, be called to a thorough and more frequent cleansing of the streets and gutters before 12 o'clock in the day; and to the cleansing of courts and alleys, and the prompt removal of filth and gar- bage therefrom ; and that they be respectfully requested, with citizens generally, to notify the Board of Health of any accu- mulation of filth or rubbish, of foul courts or alleys not within their jurisdiction— also of foul privies, pig-sties or piggeries, or any yards or cellars of houses where offensive matters exist ; so that by co-ordinate action we may establish a sanitary police, whereby the Epidemic influence may be in a great measure, if not entirely, counteracted. " Resolved, That the District Committees of this Board be requested to report to the Board of Health, all houses or places in their respective districts, suspected of being in an unhealthy condition, or likely to become so ; and diligently to inquire and report all causes or suspected causes of diseases in their neighborhoods, and particularly imperfect drainage of gutters in low situations, and the causes thereof — and that they be authorized to employ one or more agents to attend to or carry out the above important sanitary suggestions, when necessary." In offering these resolutions the committee were governed by the broad and well known principle, that all Epidemics are generally obedient to the same laws, gov- erned by like influences, and warmed into lively activity by certain atmospherical changes, yet modified by local circumstances, as filth, dampness, vitiated air, decom- posing animal and vegetable substances, crowded and illy-ventilated dwellings, bad drainage and sewerage, noxious gases, and other baneful agencies. These resolutions received the unanimous and hearty- co-operation of the Board, and prompt measures were immediately adopted, to carry out the spirit and intent of them without delay. Copies of the two first were for- warded to the City Councils and to each of the Muni- cipal Authorities of the districts in the county, while the third was referred to the several District Commit- tees of the Board, by whom it was executed with the utmost zeal and promptitude. So that by the thirteenth of December, there were five district sanitary agents at work in the field, to each of whom the following code of directions, approved by the Board, was presented, with strict orders to give it their faithful attention ; to wit : — " That they visit all houses, cellars, yards, school- houses, factories, slaughter-houses, streets, lanes, alle}^s, courts, and all other places within their respective dis- tricts, where nuisances may exist, for the purpose of examining if there are thereon, any nuisances tending to affect the health of the citizens, and to report to the Board, all hog pens, ponds of stagnant water, and such other nuisances as they may find." It is with the liveliest emotions that we acknowledge the zealous co-operation of the City Councils and the several Municipal Corporations, in the above measures, for the general good of the community. And it be- comes us to say, that a common sympathy for the pub- lic weal pervaded the above bodies, and that a marked disposition to put in force, from month to month, during 6 the past season of calamity, the various recommenda- tions of our Board, as far as they were compatible with other interests and claims upon their official position. While it is flattering to the Board, it must be grati- fying to their fellow-citizens to know, that the adoption and enforcement of the above preparatory sanitary measures for the promotion of cleanliness and the pre- servation of the health of our city, were neither esteemed unnecessary nor premature. Scarcely had the work of purification commenced, ere the fearful tidings reached us that the Cholera was on Staten Island, at the New York quarantine ground, and, a very few days after, the intelligence was conveyed to our city on lightning speed, that this desolating Epidemic had made its appearance in New Orleans. On the 20th of December, the Board appointed a committee to visit the quarantine station on Staten Island, for the purpose of obtaining official information as to the character of the disease, (it having been ques- tioned,) and all the facts connected with its appearance on the Island. This committee was received by the Health Officer at the quarantine station, with demon- strations of kindness, and every facility was afforded them through his politeness, and that of his medical staff, for acquiring all such information on the subject of the disease then prevalent among the inmates of that institution, as their mission contemplated ; nor can less be said, for the courtesy and manifestation of kindness on the part of the City Authorities of New York and the Sanitary Committee of their Board of Health, with whom the Committee took counsel in an official inter- view, at the Mayor's office in the City Hall. The report of this Committee, drawn up with much care, was presented and adopted by the Board on the 30th of December, and embraced a wide field of inquiry and information, the result of which was, that Cholera, in all its undisguised integrity, had reached our shores, and that nothing now remained for the Board of Health, but to prepare to meet and combat this strange and mysterious enemy — an enemy which disregards all es- tablished laws of Epidemics, sets at nought all precon- ceived theories, leaps over sanitary cordons, flies with the speed of the locomotive, or the ship, over land and ocean, destroying one in every three upon whom it fastens its pestiferous poison. The appearance of the Cholera at Staten Island, and its almost simultaneous outbreak at New Orleans, is one of those peculiar coincidences which will forever be shrouded in obscurity. Carried into both ports by emigrant ships from Havre, where, when they sailed, there was no Cholera known to exist — the one leaving on the 3d of November, and the other on the 9th, fol- lowing nearly the same track, the disease appearing at sea on the 25th of November, in one, and in the other on the 28th, when most probably in the vicinity of each other, crowded with emigrants, uncleanly and badly ventilated — the inference is, that they must have passed through a stratum of atmosphere, loaded with some peculiar influence, which, under favorable circumstances, produced in both cases the cholera poison. Indeed, all the facts connected therewith, possess intrinsic value, both to the medical profession and the advocates of sanitary reform. The advent of Cholera into the United States having 8 been fully confirmed and established, the Board of Health resolved, so to exercise the prerogative of their position between the disease and the community, that they might be competent to discover the first impression from a tainted atmosphere and arrest the inroads of a pestilen- tial habitude. On the 3d of January, 1849, the Board passed the following resolution, persuaded that the accumulation of filth, arising from the deposit of refuse meat and vegetables with other extraneous matter in the streets, involves a nuisance injurious to the public health, and should be corrected. " Resolved, That it be recommended to the Municipal Autho- rities, holding markets for the sale of meats and vegetables in their respective districts, to have the streets, in which the mar- ket-houses are located, cleansed within such market squares as early as possible after holding such markets." The continuance and increase of the Epidemic at New Orleans, becoming a subject of apprehension, owing to the frequent communication between the two ports, the Board issued a proclamation on the 6th of January, requiring all vessels from New Orleans, or from any other port in the United States, where Cho- lera prevailed at the time of their sailing, to be detained in the stream, in order to receive a visit from the Port Physician, in the same manner and form, and subject to like penalties, as prescribed by law, in case of vessels from foreign ports. While the adoption of this mea- sure, and its enforcement, seems to involve the propo- sition of the contagiousness of Cholera, the Board would express no opinion for or against the doctrine of con- tagion, a question which has puzzled medical philoso- phers in every age, and which aided by the lights of 9 science and experience, is now undergoing an altera- tion which may eventually merge the strict contagious theory into a higher generalization. The object of the proclamation was strictly a sani- tary one, a public safeguard, to allay undue solicitude in the community, to cleanse the ship, dilute the poison, and take proper care of the sick. At the same meeting, January 6th, 1849, the Sanitary Committee were directed to report as early as practica- ble, what arrangements were necessary in regard to the location of Dispensaries and Hospitals, and the employ- ment of physicians, and nurses, &c, in the event of the appearance of Cholera in our City. On the 7th of March, the Sanitary Committee reported a plan of Cholera Dispensary and Hospital arrange- ments. By the 1st of April, the Sanitary agents had com- pleted their work of visitation. It would be impossible for the Board to enumerate the cases and causes of insalubrity discovered by them, and the numerous locali- ties which, by their exact investigations, were found to be fruitful sources of filth and disease. Their labours involved the Board in an amount of duty unparalleled in all former years, and heaped upon its officers an accumulation of multifarious business, of sufficient magnitude for twice the number then engaged. Every nuisance was reported by them to their District Committees, who were intermediate between them and the Board. The Committees examined their reports, and if satisfactory presented them to the Board, who, upon sufficient cause, declared the same to be nuisances preju- dicial to health ; whereupon a notice was served upon the 10 owner, agent, or occupant of the premises complained of, requiring the removal of the same within a specified time, according to the 27th Section of the Act of Assem- bly, passed January 29, 1818, and if not then done, to be done by the Health officer at their expense, and they prosecuted for the penalty. It was made a part of the duty of the agents to follow up these notices, and when not complied with, according to the act of the Board, to give the same into the hands of the Health Officer, who would have the nuisance removed, and forthwith commence a prosecution for the penalty. This explanation is made, in order to exhibit some con- siderable portion of the vast burden imposed upon the Board and its various officers, after the nuisances have been ferreted out.* A careless observer of the actual condition of our City as regards its cleanliness, would not fail to over- look the serious number of concealed nuisances, which are continually acting as the foci of an unhealthful atmosphere and disease, to be found within and adjoin- ing the premises, not only of the poor, but of those whose condition in society would place them far above suspicion. And whilst our City may enjoy, and well deserves the credit of being the cleanest in the Union, it must not be denied, that there do exist localities, and there may be found spots, hidden from the public eye, * The passage of a supplementary law, April 5 th, 1849, and which was read before the Board on the 18th of the same month, has greatly facilitated the sanitary operations of the Board of Health, by enabling them not only to destroy hog pens, but to seize upon the hogs, and deliver them as forfeited to the Guardians of the Poor, and has con- ferred upon them the same power also to remove the cause of nuisances, as they before possessed to remove nuisances. 11 where nuisances of the worst kind abound, generating and entailing disease, and sowing the seeds of physical death upon all around. It is to these nuisances that we desire to advert, in order to furnish the public with some feeble idea, not only of the investigations of a sanitary character, which have received the attention and occupied the time of the Board and its -officers, but to place before our fellow citizens, the amount of remediable evils, which have existed at their own doors as it were, and which have been removed during the past year. TABLE OP NUISANCES REMOVED, FROM OCTOBER 1848, TO OCTOBER 1849. Districts. -d a> '.E a o c a -a* o 73 0) 0. c3 gd o m § 03 O a ft .2 ■a 1 TS Fh O -a a o -r o 3 00 PI O 73 Si pi ci 3 5 19 9 18 4 4 5 50 'd = c 1 27 22 9 9 3 11 81 73 PI 03 oa "3 >> S 138 29 10 7 8 2 104 o > o 1 1 ID A 3 d 15 IS 4 6 11 5 50 73 1 s 00 1 "3 S"g 00 P -£ * O m O r-5 f-l O 59 9 13 2 12 19 114 d -a d of S a 24 4 4 32 TS d _£ s O t 53 9 12 7 10 11 40 o3 s. oa '£ 23 4 27 73 = Is '5 10 2 2 14 d y O — « Pi o ,a a ir. 16 10 -d a _c CO -a s a £ i.C s pq 3 3 i © EH 2621 1455 691 417 681 676 19 4 9 6573 City Proper, Spring Garden, Moyamensing, Southwark, Northern Liberties, Kensington, Richmond, Penn District, West Philadelphia, Total, 1122 894 115 119 457 257 6 2970 35 1 15 2 10 03 173 20 80 19 15 33 340 90 65 70 49 47 61 2 384 265 99 44 39 37 70 1 561 251 70 45 30 48 40 2 501 42 52 13 11 3 60 5 2 188 328 150 220 102 24 SO 8 4 2 01s The foregoing table furnishes at a single glance, the number and character of the local nuisances, which, having undergone the most rigid and personal inspection by the Board and its officers, have been abated, since 12 the 1st of October, 1848, in the City and several districts under their jurisdiction. Full privies, constitute one of the most prevalent nuisances which demand the attention of the Board of Health— nuisances of the most disgusting character, and rendered more so from their being made, in frequent instances, a deposit for all kinds of kitchen garbage, yard refuse, and other offal. The number of privies cleaned, 2,970, is unparalleled in the history of any former year of the operations of the Board. Nor will it be overlooked by the sanitary observer, that the con- tents of nearly 3000 privies, removed from the immediate vicinity of our dwellings, must have been at once a source of great benefit, as well to the comfort as to the health of the citizens, by purifying the atmosphere around. Foul privies, 501 of which have been corrected,* are not behind full ones, as a prolific agent of a deteri- orated air, and alike destructive to health and offensive to every feeling of delicacy. The numerous ponds of stagnant waters, 198 of which have been filled or drained, found principally in the suburbs and on the borders of the new districts, and in the midst of improvements, are another effectual means for producing disease. Sending forth their stinking and morbific matter, or loaded with the minute and invisible sporules of cryptogamous production, and carried by the prevailing winds, may settle down on some near or more remote and favourable location, spending their venom in disease and death. It would fill a volume if we undertook to carry the reader through the thousand ' plague spots' in the list of * Chloride of Lime was the agent employed. 13 houses closed, and houses, yards and cellars cleaned, &c. &c, that have infested our city, and have undergone personal inspection by the Board and its officers, and which, as far as their ability and power extends, they have wiped away with the sanitary besom. Day after day in their personal visits, did they breathe the pes- tiferous atmosphere of some degraded or illy-ventilated purlieus, where extremes of filth and misery and loath- some disease met the eye; where horrid heaps of manure from hog and cow pens; putrefying garbage and refuse of every kind; carcases in disgusting de- composition ; filthy rooms and damp, dirty and mouldy cellars, full and foul privies in close and illy-ventilated locations gave off their noxious gases. Many of these localities were in close proximity to contracted and badly contrived houses, crowded by occupants, filthy and poor, without ventilation or drainage, or receptacles for refuse, or supply of water, or the common com- forts of life. We cannot, however, omit a brief allusion to the rag and bone establishments in the immediate vicinity of the wretched neighbourhoods of Baker, Bedford and Spaf- ford streets, Moyamensing, where moral debasement and physical disorder, set at defiance all law, and shame civilization ; the very hot-beds of everything offensive and disgusting. In these bone establishments, 16 of which were re- moved, we found heaps of assorted refuse of every variety, gathered by the numerous poor and degraded blacks who infest that vicinity, from the filth of streets and gutters, and vacant lots, and other receptacles for offal, consisting of old rags, bones, iron, shoe leather, paper, 14 glass, and dog manure, which sent forth a most horrid odour. The whole of these disgusting premises, were immediately declared to be, in the most positive terms, nuisances of the worst kind, and every one of them were emptied, cleansed, and closed up. A single visit to these " store-houses of refuse" was enough to con- vince the Board, that they must be highly injurious to public health, and productive of diseases of the lowest type. Besides these, there were other premises of a less objectionable character, but perhaps equally productive of an unhealthy and foul atmosphere, vacated and closed up. The condition of the block of buildings on the east of Front street, between Race and Vine streets, called loudly for the purifying hand of the Board of Health, and received their special attention. The crowded and foul state of these houses, and their entire unfitness for comfort and convenience, having neither yards nor privies, induced the Board to close up the worst of them for the season, and to have the remainder thoroughly cleansed and the population diminished in numbers. Slaughter-houses and butchers' yards required and received the special notice of the Board ; many were visited, the foulest of them shut up and vacated, while others were thoroughly cleaned by their orders. It will scarcely be thought out of place, to glance at the numerous hog pens which have infested many neigh- borhoods w 7 ith their noisome exhalations. Hitherto, there has been great difficulty in reaching effectually, these most disgusting and sickly receptacles of filth, but a late law of the Legislature, has enabled the Board of 15 Health to remove in a summary and by a very certain method, all hogs and pens within their jurisdiction.* Dur- ing the year past, 918 hog pens have been rooted out, and thus our city freed from their pestiferous effluvia. The character of the nuisances removed were 19 in number, and are classified under the following heads : privies cleaned, houses cleaned, houses closed, yards cleaned, cellars cleaned, privies purified, ponds filled or drained, hog pens removed, stables cleaned, filthy lots cleaned, filthy alleys cleaned, manure heaps removed, streets and gutters ordered cleaned, courts ordered cleaned, slaughter-houses cleaned, sinks cleaned, vaults cleaned, rag and bone shops closed, burial grounds closed. The whole number ofmuisances removed within one year, has amounted to the enormous sum of 6573, of which, with the exception of 146, were on private pro- perty, and hundreds of them were entirely concealed from the public eye. The table exhibits what may be thought a very unequal division of nuisances as charged to the several districts ; and the question may very properly be asked — why Spring Garden, one of the newest sections of our city, should contain so many nuisances, while Southwark shows comparatively few ? — the answer is, that in those districts where the most nuisances are reported, the most active agents were found. While we have not attempted to show up the condition in which we found the inlets to the public sewers and the street gutters, we may be excused by the public authorities for venturing an opinion, that, collectively, they possess the materials for creating the worst form * See note on page 10. 16 of nuisance. It is admitted by all sanitary observers that the foetid emanations from foul sewers and gutters are highly dangerous to health. The constant exposure of the contents of these gutters, consisting in a great measure of decomposing vegetable and animal refuse, to the sun at mid-day, and the action of the rain and refuse water from houses, hastens decomposition and putrefaction, producing exhalations both pestiferous and intolerable. The attention of the public authorities were directed to these nuisances, and we are happy to say, that to them we are indebted for their improved condition ; rendered so by the free use of the broom and water to the gutters, and the frequent distribution of chloride of lime for the inlets to the sewers. On the 11th of April, the Lazaretto Committee offered the following report, which was adopted by the board : Whereas Cholera is now said to exist at the Port of New Orleans, and in all probability may extend to other ports of this continent, and whereas passenger vessels arriving at this Port during the months of March, April, and May, frequently have on board cases of sickness of a contagious character, and inas- much as this Board is frequently compelled to remove such cases to the City Hospital, which practice, although under the circumstances dictated by the motives of humanity, is mani- festly improper, therefore, Resolved, That all ships or vessels arriving at this Port on and after the 20th day of this month, from any Port in Europe (having passengers on board) or from any Port where Cholera was known to exist at the time of her departure, together with any vessel having had, during her voyage, a case of Small-pox or infectious or contagious disease on board, shall stop at the Lazaretto, and there receive a visit, and be treated the same as 17 though such ship or vessel had arrived between the first day of June and the first day of October. Resolved, That the Health Officer be directed to issue a Pro- clamation addressed to the Captains and Owners of vessels and Pilots, in accordance with the above. In accordance with these resolutions, the Lazaretto Committee made the necessary arrangements to enforce the orders of the Board ; and on the 20th of April, a pro- clamation was issued by the Health Officer, giving notice to merchants, mariners and pilots, that the quarantine was in force, as to all vessels arriving from ports where the Cholera was prevalent at the time of their sailing. By the middle of May, rumors were in circulation, that the Cholera existed in our city. This impression, gaining credence in the community, and pervading the timid and those accessible to fear, with a gloom and terror, almost as alarming as the effect of the scourge itself, made it necessary for the Board of Health, in order to allay excitement and arrive at the truth, to ad- dress itself to a careful investigation of some of the causes through which the report may have originated. They were enabled to calm the anxiety which prevailed, by the publication in the daily papers of the following preamble and resolutions, which passed the Board, on the 23d of May. "Health Office, May 23d, 1849. " Whereas, reports are in circulation to the effect, that malig- nant Cholera exists at the present time in the City and County of Philadelphia, which are unfounded in fact, the Board of Health deem it a duty to disabuse the public mind, in regard to said rumors, at the earliest possible moment ; therefore, "Resolved, That having received no information officially, that malignant Cholera prevails in our City and County, the 2 18 Board entertain the belief that there is nothing in the general state of health, within the bounds of its jurisdiction, calculated, in the least degree, to cause alarm, or excite apprehension of present or immediate danger to our citizens, and that our city- enjoys in every respect its usual exemption from disease." At the same meeting of 23rd May, the subjoined re- solutions were adopted. " May 23rd. "Resolved, That the Municipal Authorities of the City and County be requested to cause the gutters of the streets and alleys to be thoroughly washed and brushed every day, either before sunrise or after sunset during the present season ; also, to collect daily the kitchen garbage, &c, and likewise recom- mend to families to have their houses, cellars, and yards cleansed and whitewashed." "Resolved, That the President and Secretary be directed to confer with the proprietors and editors of the several newspa- pers, in respect to publications of rumors as to the existence of Cholera in our City and County, and suggest to them the pro- priety of suspending any publication of reports on the subject, unless officially from this Board." The first of these enactments, met the entire approval of the municipal authorities, who sustained the board in the excellency and in the exigency of the proposition, and without a moment's delay practically carried it out, to the great improvement of public cleanliness and the health of the citizens. The latter resolution was received by the editorial department with the same spirit which dictated its adoption, viz : the public good; and from that time forward, they embraced every suitable oppor- tunity to allay the cholera excitement, and to commend and favour the sanitary measures presented to the public by the Board of Health. The preceding were the principal sanitary police regulations instituted by the Board of Health, in advance 19 of the appearance of Cholera in Philadelphia. In all which administrative measures, they were influenced solely, by an ardent desire to place the city in the most favourable condition, in a sanitary point of view, to meet the scourge— adopting the great and ac- knowledged principle, that "prevention is better than cure," and that the removal and abatement of all those causes, which are calculated to feed and foster Epide- mics, are of far more importance to the vital and health- ful condition of the community, than can be, the most rigidlv enforced and best regulated medical treatment of the pestilence, when in our midst. The announcement, that three cases of Cholera were in the city, was made to the Board of Health on Wed- nesday, the 30th of May. Upon inquiry, it was ascer- tained that two of these cases were on board of a canal boat at Richmond, which had arrived the night before from Bridesburg, having on board three persons, two men and a woman, neither of whom had been to New York. One of the men had labored under diarrhoea for several days, and on the 29th was seized with Cholera, and died about 12 M. on the 30th ; the other, (both of whom were intemperate,) was attacked with Cholera after breakfast on the 30th, without any premonitory symp- toms, and died about 3 P. M. the same day. The boat was extremely filthy, confined, and damp. After the death of these men, the woman, who was not sick, being refused admittance into any of the houses at Richmond, owing to the panic, was taken care of by the Board of Health, conveyed to the City Hospital, and in a few days left the city for her residence, at Trenton, N. J. . 20 The boat was hauled to a sand-bar opposite the city, and sunk. The third case, was in Fourth street above Shippen, Southwark, that of an Irish emigrant, who had been in the country but a short time, and had, within a few days prior to his attack, arrived in the city from New York. He died within ten hours from the commence- ment of the disease. On the 31st, one case was reported in Barclay street, City, a man who worked at Market-street Ferry, on the Delaware. On the 2d of June, two cases were reported in the City, one on the eastern and the other on the western section, near the Schuylkill. From this date, the cases gradually increased. It was now evident that the Epidemic influence was being felt in the community. Three cases had simultaneously occurred at two extremes of the eastern section of our city, while others were traced to inter- mediate points. There was a very general excitement and anxiety manifested among the citizens to learn the extent and the location of the disease, while rumour was actively engaged in multiplying cases. The people looked to the Board of Health for correct information, they being the only official organ of communication. The board, on the other hand, felt their responsibility ; they looked abroad, and beheld Cholera as the all-absorb- ing subject. They saw mingled fear and distress depicted in the countenances of the people. Their position was embarrassing. But their minds were soon made up to give the truth — to conceal nothing — as the best and most certain course to tranquilize the public mind, and 21 thus effectually guard against the influence of exagger- ated and unfounded statements of the Epidemic. At the meeting on the 30th of May, the Board re- solved to publish in the daily papers, the cases of Cholera that had been already reported ; to meet -daily there- after, and to issue a daily bulletin of all Cholera cases that should be reported to them. They also passed a resolution, requiring practising physicians in the city and several districts, to report daily, in writing, at the Health Office, by 12 m. their cases and deaths from Cholera, and the districts in which they were located. At the same meeting, they considered the propriety of making timely arrangements for furnishing medical aid to the necessitous and labouring classes; and, having satisfied themselves, that the most judicious relief would be obtained, by the establishment of local dispensaries throughout the city and districts, adopted the following resolutions : " Resolved, That local Dispensaries be immediately selected and established by this Board in the city and several districts, for the purpose of affording aid, and furnishing whatever medi- cines or other remedies that may be prescribed for cholera pa- tients, by any regular physician, either during the premonitory or more violent symptoms of the disease." "Resolved, That the several District Committees of the Board, be requested to report at 12 M., of to-morrow, or as early as practicable, the names and localities of such persons in their respective districts, as may be proper to select, in accordance with the above resolution, and the terms upon which such medi- cines or other remedies as are required, may be furnished." As a further sanitary regulation, the following was adopted for general and special application. " Resolved, That when any case of malignant or contagious disease may be reported to this Board, the messenger, or such 22 officer as the Sanitary Committee may direct, shall forthwith visit the premises, and report to this Board what action, if any, may be necessary in reference to the removal of the patient, or the cleansing of the premises." The frequent applications made to the Board, from week to week, during the summer months, for permits to remove dead bodies from one church-yard to another, led them to inquire into the evils that might follow such disinterments, especially during the prevalence of an Epidemic, from the inhalation of the noxious gases, ema- nating from the decomposing bodies, by those who are compelled to reside in the neighbourhood of grave-yards. This inquiry, resulted in the adoption of the following resolution, on the 5th of June. " Resolved, That no further permits be granted for the re- moval of dead bodies from one burial ground to another, until otherwise ordered by the Board." On the 3rd of June, a committee of the Board had an interesting conference with a sub-committee of Coun- cils, " relative to the best means of securing the health and cleanliness of the city." In this joint committee there was a free interchange of sentiment, which resulted in the determination to co-operate with each other in the faithful performance of those high functional duties devolving upon them, for promoting the health and pre- serving the cleanliness of the city, during the prevalence of the Epidemic. At this juncture, the question of watering the streets, during the heat of the day, absorbed the mind of the Board, which resulted in the adoption of the following resolutions : " Resolved, That the City Councils, and the municipal au- 23 thorities of the several districts, have their attention directed to the improper and constant practice pursued by many of the citizens at all hours of the day, of scattering the filthy and muddy water from the gutters, and otherwise wetting the streets, as a nuisance productive of humidity, and dangerous to health at this season of the year.*' " Resolved, That they be earnestly requested to pass forth- with an ordinance, prohibiting this unhealthy and indiscrimi- nate application of mud and water, believing that a faithful compliance on their part with the recommendation of this Board for washing the gutters and collecting kitchen offal, is required to preserve cleanliness and health." Copies of these resolutions were forwarded to Coun- cils and to the several municipal authorities in the districts; and the Board not only take pleasure in ex- pressing their sense of the prompt manner in which these recommendations were complied with by the dif- ferent authorities, but that their judgment, as regards watering the streets during the hot days of summer, is borne out by the most respectable medical and scien- tific evidence that our city can produce.* The overwhelming accumulation of business (brought into the office,) occasioned by the co-operative labours of the Councils, and the City Police, the District Com- mittees and the agents of the municipal authorities, together with the fears and apprehensions of an excited people, rendered it highly expedient for the Board to engage the services of several assistants, in order to carry out promptly and efficiently their orders in the timely removal of nuisances — accordingly, by the 4th of June, there were five additional assistant messengers actively employed in pursuing reported nuisances. The * See Report of Sub-Committee of Councils on Cleansing the City, 1849. 24 services of these men were invaluable ; and the best evidence we can furnish of the arduous labours of all our out-door agents is, the number and variety of nuisances removed, as recorded in this Report, (p. 11.) On the 11th of June, the Board passed the following resolution. " Resolved, That application be made to the County Board, for the sum of $1 0,000, to assist in defraying the expenses in- curred in our plan of sanitary operations throughout the city and county, and other measures necessary to be adopted, with the view of preventing the spread of Asiatic Cholera in our community." The 5th Section of a Supplement to an Act, relating to the Board of Health, passed February 10th, 1832, authorizes the Board to call upon the County Commis- sioners, by consent of the County Board, for funds to defray all necessary expenses incurred by them, in the execution of their duties, — whenever the fees paid into the office are inadequate to the same. The time had now arrived, for the Board to make a demand upon the County Treasurer — in consequence of the numerous Sanitary measures, necessarily devolving upon them at this crisis, to be enforced, for the preservation of the health of the City. The sum asked for, would appear to be large, and no doubt many will be disposed to question, both the propriety of the requirement on the part of the Board, and the need of abstracting an amount so great from the County funds. In answer, we would only reply, that the Board of Health are obliged to account publicly for every dollar expended by them, and that, in the language of another, " It is only the purblind or the ignorant, who cannot see, that the largest sum that could possibly be required to carry out every 25 necessary improvement, is actually exceeded by the in- exorable tax, levied upon the community, as the con- sequence of bad Sanitary arrangements." As early as the 4th of June, when the several com- mittees of the Board had reported the names and loca- tions of the Druggists whose stores they had selected as Dispensaries, the Board directed the Clerk to have the following resolution published, in connection with the names and residences of the District Committees and the locations of the Dispensaries, for the benefit of the public. Resolved, That the several District Committees be directed to make the following arrangements with the Druggists and Apo- thecaries, whose places of business they shall select as local Dispensaries during the prevalence of cholera, or until other- wise ordered by the Board. 1st. That the said proprietors of the Dispensaries shall afford aid, and furnish medicines, or other remedies, (at the usual rate of prescription charges,) as may be prescribed by the practising physicians for cholera patients, whenever in the judgment of the physician such patients are not able to pay for their own medicines, provided, these prescriptions are endorsed with the date, the residence, and wherever practicable, the name of the patients, accompanied with the letters B. H., signifying, " charge to the Board of Hearth," which they shall preserve as their vouchers. 2d. That the Dispensaries shall be kept open all hours of the day, and be accessible at all hours of the night, for the accommodation of the sick. 3d. That in the event of persons being suddenly attacked in the streets, and who are without homes or friends, they shall be received into the nearest Dispensary, and the proprietor of such Dispensary shall give information, as soon as possible, to the Chairman, or any one of the members of the Committee of the District, in which the case has occurred, who shall take such action as may be necessary. 4th. That bills, accompanied with the prescribed vouchers, shall be presented to the Board monthly, by the several pro- prietors of the respective local Dispensaries. 26 The District Committees of the Board of Health are as follows : N. W. DISTRICT.— SPRING GARDEN AND PENN. Chairman, Wilson Jewell, M. D., No. 238 North Sixth street. Benjamin E. Carpenter, No. 215 Coates street. Joseph Wood, No. 443 North Seventh street, above Poplar street. J. D. Logan, M. D., No. 27 Logan Square, Vine street, west of Schuylkill Fourth street. N. E. DISTRICT. — KENSINGTON, NORTHERN LIBERTIES AND RICHMOND. Chairman, Jeremiah E. Eldridge, Germantown Road, above Fifth street. Oliver Evans, William street, between Point-no-Point Road and Delaware. Charles Delany, No. 43 Queen street, Kensington. William Goodwin, No. 305 North Second street. NORTH CITY DISTRICT. Chairman, Edward Duff, No. 39 Race street, and No. 35 North Wharves. Samuel W. W T eer,No. 147 North Twelfth street, and No. 21 South Eighth street. John A. Elkinton,M. D. No. 102 North Fifth street. SOUTH CITY DISTRICT. Chairman, John C. Martin, No. 319 Spruce street. John Lindsay, No. S Belmont Place. Edward C. Markley, No. 19 Madison street, and No. 4 Minor street. SOUTHWARK AND M0YAMENSING. Chairman, Benjamin Martin, No. 463 South Second street. Robert G. Simpson, No. 123 Queen street. Robert F. Christy, No. 289 South Ninth street. WEST PHILADELPHIA. Henry Pleasants, M. D., Washington street, above Mary street, W. P. 27 The Druggists appointed under the above arrangement are as follows : RICHMOND. C. S. Peale, William and Richmond streets. KENSINGTON. George C. Bower, Third and Germantown Road. T. W. Vaughan, Queen and Hanover streets. R. Etris, Frankford Road, opposite Commissioners' Hall. E. Morris, Germantown Road, Cohocksink. NORTHERN LIBERTIES. John Horn, corner Third and Brown streets. Benj. H. Sleeper, Fifth opposite George street. S. P. Shoemaker, Second above Noble street. George Snowden, corner Fourth and Noble streets. FAIRMOUNT. Geo. S. Hammill, Callowhill and west Schuylkill Front. FRANCISVILLE. Dr. A. Leiper, Railroad and Schuylkill Seventh street. SPRING GARDEN AND PENN. Abraham R. Horter, corner Broad and Coates streets. John T. Farr, corner Twelfth and Callowhill streets. Thomas R. Hawkins, corner Twelfth and Coates streets. John Hocker, Jr., corner Eleventh and Poplar streets. Wm. B. Webb & Co., corner Tenth and Spring Garden streets George W. Manson, corner Tenth and Thompson streets. J. N. Moore, Spring Garden street, below Eighth. Lay & Co., comer Eighth and Coates street. Dr. Joseph W. Farley, corner Seventh and Poplar streets. Wm. F. Bender, 224 Callowhill street. Livermore & Co., corner Sixth and Buttonwood streets. CITY. H. Erben, corner Twelfth and Vine streets. George Glentworth, Chester and Race streets. John L. Lippincott, 104 North Fifth street. 28 Thompson & Son, south side of Race, between Second and Front streets. A. H. Yamall, corner Schuylkill Third and Lombard streets. John Goodyear, Schuylkill Sixth and Pine streets. Joseph H. McMaken, corner Broad and Spruce streets. J. W. Simes, Schuylkill Front and Market Streets. J. Turnpenny, corner Tenth and Spruce streets. Charles Shivers, corner Seventh and Spruce streets. Thomas J. Husbands, corner Third and Spruce streets. George Mellor, Walnut below Fourth. Henry Zollikoffer, corner Sixth and Pine streets. Robert. C. Davis, corner Vine and Schuylkill Seventh streets, W. J. Carter, Schuylkill Seventh and Chestnut streets. SOUTHWARK. Giles Boulton, cor. Second and Catherine streets. Geo. W. Chambers, cor. Plum and Fourth streets. Wm. M. Reilly, cor. Second and Wharton streets. MOYAMENSING. Charles Rizer, cor. Shippen and Fifth streets. George F. Allen, cor. South and Thirteenth streets. WEST PHILADELPHIA. Banks & Walton, S. E. cor. of Washington and Mary streets. By order of the Board of Health. SAMUEL P. MARKS, Clerk. This humane and wise regulation, by which the poor of the community, attacked with Cholera, or its pre- monitory symptoms, could obtain medicine without charge, on the order of any respectable physician, and thus be enabled to receive attention at their own homes, proved of great advantage in ameliorating the condition of many, who would otherwise have perished for the want of timely assistance. Hundreds of our citizens, poor, though worthy, embraced this privilege, and we 29 have reason to believe that valuable lives were saved, by this judicious and wholesome sanitary arrangement. The Board would be neglecting an important part of their duty, did they fail here, in noticing the benevolent zeal and the meritorious conduct of the members of the medical profession, during this trying period. With no expectation of pecuniary reward, they stood ready to lend their aid to the suffering poor. By night or by day they were found in the pent-up chambers of the sick and the afflicted, breathing a loathsome and pes- tiferous atmosphere, cheerfully and assiduously adminis- tering to their relief. Exposed to contagion, if any ex- isted, and at the hazard of health and life, with no other reward than the pleasure of doing good to suffering humanity in a god-like profession. The continued and alarming increase of the epidemic, determined the Board of Health to carry out and to complete their plan of hospital arrangements. Accord- ingly the following Report of the Sanitary Committee was adopted on the 27th of June. The Sanitary Committee have had under conside- ration the subject of Cholera Hospitals, referred to them by the Board, and respectfully submit the follow- ing Report : 1. Resolved, That temporary Cholera Hospitals shall he immediately established, and organized in suitable localities in the City and several Districts, viz. : for the northern and west- ern part of Spring Garden, and the western part of Penn Dis- trict, and north-west part of the City, the City Hospital at Bush Hill — for the eastern part of Spring Garden and Penn,* one — * There was no Cholera Hospital opened in this district. 30 for the Northern Liberties, one — for the eastern and western parts of Kensington, one each — for Richmond, one — for South- wark, one — for Moyamensing, one — for the City, three — for West Philadelphia, one — into which all Cholera patients, who cannot have attention at their own homes, shall be received upon the order of any practising Physician, or upon the order of the Clerk, or a Member of the Board of Health. 2. Resolved, That for each Cholera Hospital there shall be appointed one principal Physician, and one assistant Physician, and other assistants when deemed necessary, by the respective Committees, who may be either graduates or competent stu- dents of Medicine. The principal Physician shall have the en- tire control and oversight of the Hospital, as far as relates to the management of the sick ; he shall select his own male and female nurses, of whom there shall be one chief female nurse, or matron, and one male and female assistant nurse for every ten male or female patients, or for a fractional part thereof. The appointment, however, of these nurses, shall be reserved for the Board, if they approve of the same. The assistant Physician shall be under the direction of the Principal, and shall remain in the Hospital day and night. He shall keep an accurate register of all cases admitted, under the direction of the Principal, in a book provided for the purpose, who shall report to the Board of Health, every day at 12 o'clock, M., all cases occurring in his Hospital. 3. Resolved, That the salaries of the Hospital Physicians shall be $5 per day, and the salaries of the assistant Physicians to the Hospitals shall be $3 per day, without board. That the wages of the nurses in chief shall be $5 per week, and the as- sistant nurses $3 per week, including board. It is understood that the compensation will not commence at the time of their appointment, but when their services are required, and to con- tinue until otherwise ordered by the Board. 4. Resolved, That the location for the Hospitals, and the ap- pointment of Hospital Physicians shall be determined by the Board. 5. Resolved, That the appointment of Hospital Physicians and Nurses take place as soon as the necessary preparation can be made for the same, with the express understanding that the salaries of the Physicians and Nurses, and the rent of the Hos- pitals, shall not commence until they are called into requisition by an order from this Board. 31 6. Resolved, That the necessary furniture and requisitions for the Cholera Hospitals be procured by the District Commit- tees, an inventory of which shall be made and kept by said Committees. 7. Resolved, That the Sanitary Committee be instructed to have in readiness convenient litters for the sick, coffins and hearses for the dead, and a suitable number of bearers and drivers, whese services can be had at any moment, (night or day) whose compensation shall be fixed by the Committee, but who are not to be paid unless in actual service. 8. Resolved, That the several City and District Committees shall have charge of the Cholera Hospitals in their respective Districts, subject to the general superintendence and control of the Board. Impressed with the fact, that large gatherings, es- pecially in public and other buildings, during the pre- valence of an Epidemic, where there cannot be a suffi- cient ventilation, is a fruitful cause of debility and ex- haustion of the vital resources, the Board adopted the following sanitary recommendation. " Resolved, That it be respectfully recommended to the Con- trollers of the Public Schools to vacate, at as early a period as practicable, during the present prevailing epidemic, the schools under their supervision, and especially to close forthwith the primary schools that are located in the basements of churches, or in other confined or illy ventilated apartments." A copy of this resolution was addressed to the Con- trollers of the Public Schools. In view of the approaching National Anniversar) r , the too free indulgence in ardent spirits, and the many indiscretions that persons are guilty of, on occasions of public rejoicings and festival recreations, where thou- sands are collected together, the Board, on the 28th of June, passed the following recommendatory resolution : 32 " Resolved, That the Board of Health deem it advisable, and recommend to the various clubs and associations to dispense with the usual celebrations on the ensuing anniversary of the 4th of July." It is with sincere pleasure that the Board take this opportunity to state, that in compliance with this advice, many public gatherings were avoided, and numerous clubs and associations postponed their contemplated excursions. At the meeting on the 28th, a committee that had been previously appointed to confer with the Controllers of Public Schools, on the subject of granting the use of certain school-houses for Cholera Hospitals, submitted the following report, which was unanimously adopted. " Resolved, That the following proceedings be entered on the minutes of this Board, and a copy sent to the Board of Con- trollers before 3 o'clock, P. M., this day, with a copy of the resolution of June 2Sth, to hold a special meeting this evening, &c. Impressed with the propriety of the measure sanctioned by the College of Physicians, City Councils, and a very general expression of public opinion, the Board of Health unanimously agreed upon designating certain public school-houses as suitable places for Cholera Hospitals, agreeably to the plan pursued in 1S32, should the present epidemic render the establishment of temporary hospitals necessary. And whereas, it is important as a sanitary measure, to avoid congregating together in large assemblies, which has a tendency to impair the salubrity of the atmosphere ; this Board believed the Board of Controllers would see the propriety of vacating at once most of the public schools for the education of children, and consent to their use as hospi- tals for destitute cholera patients, and thus by co-operating with the Board of Health in the present emergency, they would be carrying out the spirit of the law, and be the wisest and best appropriation of public beneficence that could possibly be made at this time. And whereas, it becomes all public bodies to fra- ternise together and disregard all minor or technical considera- tions when the hand of God is upon the people, and chastening them by manifestations of His mighty power, and whereas but 33 three public school-houses have been designated in the city, viz., 5th and Cherry Street, 6th and Lombard Street. and Ash- ton and Lombard Street on the Schuylkill ; one in Spring Gar- den, on Buttonwood Street, one in Moyamensing, 11th below Carpenter Street, one in Southvvark, Carpenter Street above 6th, one in the Northern Liberties, 3rd and Brown, one in West Philadelphia, Chestnut near Margaretta street, with the proba- bility that all will not be required, and perhaps a less number than in 1832, it is " Resolved, That the controllers be respectfully requested to allow and appropriate such public school-houses for cholera hospitals, as were used for that purpose in 1832, and an addi- tional number as may be designated by the Board of Health." The Board have cause to regret the manifest unwil- lingness, on the part of these public functionaries, to co- operate with them in the cholera emergency, as they would neither grant the schools for hospitals, nor close them, in accordance with the united recommendation of the Board of Health, the City Councils, and the Col- lege of Physicians. On the 29th of June the following resolution passed the Board. " Resolved, That it be recommended to the City Councils, and the district municipal authorities, to have the contents of the carts collecting kitchen offal, intermixed with chloride of lime during their progress through the streets, and when en- gaged in gathering the offal." On the 29th of June the Cholera Department of the Bush Hill Hospital was opened for the reception of Cho- lera patients ; and, by the 5th of July, there were five Hospitals organized and in active operation, viz., Cherry street, (City,) Southwark, Moyamensing, Northern Li- berties, and Bush Hill. The energy and diligence displayed by the members 3 u of the several district committees, in securing suitable buildings for Hospitals, fitting them up and furnishing them with the necessary requisitions, after a notice so limited, deserves the highest commendation. On the 12th, the Richmond Hospital was opened; on the 14th, the Kensington and the Pine street, (City); on the 18th, the South street, (City); and on the 23d, the West Philadelphia ; in all, ten, including the Bush Hill Hospital. On the 9th of July, the Board adopted the following resolutions, and ordered them to be published for one week in all the daily papers, also in hand-bills to be posted at the corners of the streets, together with a list of the several Hospitals, and the names and residences of the several physicians attached thereto. " 1st. Resolved, That it be earnestly recommended to all per- sons affected with any derangement of the stomach or bowels, who cannot be properly provided for at home, immediately to avail themselves of the hospitals prepared for cholera patients, or the advice of hospital physicians, who will prescribe and fur- nish medicines at all hours, gratis." {l 2nd. Resolved, That to prevent collapse and save life during the epidemic influence, it is of primary importance promptly to arrest the diarrhoea or first stage of cholera, which can only be done by rest and appropriate medicine" Anxious to meet every contingency, and overcome all the moral, as well as the physical exciting causes in the community, that might predispose the system to an attack of the Epidemic, the Board on the 10th of July adopted the following resolution, which, they are gratified to say, met the decided approbation of the fire department. " Resolved, That it be respectfully recommended to the Pre- 35 sidents and members of the different Fire Companies of the City and County of Philadelphia, not to ring their bells, and not to run unless it is certain that fire exists, and their servi- ces are actually required, as excitement and violent exercise impair the vital energies, and thereby increase the suscepti- bility, and predispose the system to an attack of cholera." On the 13th of July, the Board received the following resolution, in a communication from the Sanitary Com- mittee of Councils. " Resolved, That the Board of Health be respectfully inform- ed, that this committee have heard a rumor that the number of cases and deaths by cholera, reported at the Blockley Alms House is incorrect, and that the same should be inquired into, which was referred to Messrs. Boswell, Snowden and Christian, to confer with the Board of Health, and obtain information on the subject." Warned of the unfavourable reports floating in the community, prejudicial to the interests and character of a great public corporation, and the officers in their em- ploy, the Board, without hesitation, in order to allay the anxiety occasioned thereby, referred the whole subject to the Sanitary Committee. This led to a searching investigation, and resulted in the adoption of the follow- ing report from the said Committee. (See Appendix, No. 1.) It is needless, here, to multiply remarks upon the cir- cumstances involved in the examination made of the Blockley Alms House, by the Joint Committee of Coun- cils and the Board of Health. The report tells the whole story; and while we have ventured to place the Board in a disagreeable position with the conductors of that institution, by making ourselves and the public cognizant of its then existing evils, we take pride in announcing, that after our visit and report, they were assiduous 36 in their efforts, to correct everything which could pos- sibly affect the health or the lives of the inmates. Nor did they spare expense, to make every necessary pro- vision for the trying emergency in which they found themselves placed, during those terrible scenes of ex- citement, disease and death, into which they were sur- prised by a fearful onset of the Cholera. By the 8th of August, it was apparent to the Board, from the daily reports of cases in private practice, the few cases admitted into the Hospitals, and other con- trolling circumstances, that the Epidemic was gradually declining. With this view they passed the following resolution : " Resolved, That all the Cholera Hospitals except the Cherry street, Moyamensing and Richmond, be closed for the reception of patients by the different Committees, on and after the ninth inst." So that after the 9th of August, there were only three hospitals open to receive patients, which were also dis- continued by a resolution of the Board on the 28th of August, there being no longer any need for them, as the Epidemic seemed to be passing rapidly away. This favourable change in the course of the Disease, led the Board to discontinue the Dispensary arrange- ments, by the adoption and publication of the following resolution : " Resolved, That the Clerk be directed to give notice in the several newspapers publishing for the Board, and in the Public Ledger, that the furnishing of medicines to poor Cholera pa- tients, from the several Dispensaries established by this Board, will be discontinued on and after Saturday, the 11th inst." The cheering indications presented to the Board of Health of the subsidence of the Epidemic, and their 37 desire to enhance the welfare and comfort of their fellow- citizens, as well as to subserve the interests of the business community, and draw back again those streams of wealth which had been directed into other channels of commerce, led them, on the 18th of August^ to adopt the following preamble and resolution, which were published in the daily papers : "Whereas, In the opinion of this Board, Cholera no longer exists in our community as an epidemic, therefore, "Resolved, That daily bulletins will be no longer issued by this Board, unless our City and County should be visited by a return of Epidemic Cholera." This announcement gave general satisfaction, and had its desired effect, both at home and abroad, by allay- ing all excitement, and restoring to our commerce its accustomed amount of trade. Fearful that the wholesome sanitary regulations for cleansing the streets, which had been so timely and wisely approved of by the several municipal authorities, through our recommendation, should be withdrawn, the Board, on the 24th of August, passed the following reso- lution, and had it forwarded to those concerned : " Resolved, That it be recommended to the municipal authori- ties of the City and the several Districts of the County, to con- tinue their Sanitary operations, so far as respects the prompt collection and removal of kitchen offal, and the cleansing of the gutters during the remainder of the present and the suc- ceeding month of September." One of the most important sanitary acts of the Board during the prevalence of the Epidemic, was to visit the place of interment for the dead from the Alms House and the out-door patients. These premises had been reported to the Board, as requiring their immediate 38 and careful inspection, believing them to be a prolific agent in the concentration of the Cholera poison in a certain locality in West Philadelphia, where the disease had been rife. The Sanitary Committee, by direction of the Board, visited the ground, and made the follow- ing report, which was adopted, and a copy ordered to be forwarded to the Guardians of the Poor. (See Ap- pendix, No. 2.) As on a former occasion, the Board of Guardians, desirous to remove every suspected cause for the pro- motion of a scourge from which they had so recently and most painfully suffered, followed the recommenda- tion of the Board of Health, and at once set at rest the apprehensions of their fellow-citizens in West Phi- ladelphia, by abating this most disgusting and revolting nuisance. CHOLERA HOSPITALS. The organization of temporary Cholera Hospitals, located in various sections of the city and districts, was a measure of precaution actually demanded in a city like Philadelphia, when menaced with a fierce outbreak of Cholera. No provision for the poor and destitute, who could not be attended at their own homes, met with more general satisfaction, or conferred greater benefits upon those for whom they were intended, and who shared their advantages; without them, many would have perished who were otherwise rescued from a cholera grave. These hospitals were well furnished, and as well con- ducted as the nature of circumstances would allow. They shared the services and skill of some of our most 39 respectable physicians, and were supplied with the best nurses. The Committees who had them in charge, spared no expense to make them convenient, with an eye single to the comfort of the patients, while the rules of economy were not entirely overlooked. In short, they were well provided for. The table in Appendix, marked (No. 3,) exhibits the number and location of the hospitals, the names of the physicians attached, and their statistics. It would have been gratifying to have presented a more full and de- tailed statistical account, but from the imperfection in statistics of many of the reports handed in from several of the hospitals, this must necessarily be defective in its details. The ten temporary hospitals were kept open in the aggregate, 408 days, a period of time equivalent to the services of one hospital for one year, one month and thirteen days. The whole number of patients re- ceived into them, amounted to 463, of these, 344 were cases of epidemic cholera. The remainder were af- fected with cholera morbus, dysentery, diarrhoea, cramp, intoxication, fever, and other diseases, sent in by physicians and others, supposed to have been la- bouring under cholera. Of the cholera cases, 278 were whites, viz : 186 males, and 92 females — and 66 were blacks, viz: 33 males, and 33 females. Among them were 84 Americans, and 106 Foreigners. As far as the reports showed, there was an excess of patients of intemperate habits of nearly 50 per cent., and of the intemperate, almost all the cases proved fatal. 40 Of the 344 cholera cases, 111 died, or about 32 per cent, of the whole — equal to one in every three, being a fraction greater than the deaths to cases in private practice. The fatality of the blacks and whites compared to cases, was about the same, viz. one in three. The Moyamensing Hospital received almost twice the number of cholera patients to any other, owing to its favourable location to that class of the population who would be most likely to need assistance. The mor- tality to cases in this hospital was as 1 to 4. In the Southwark, 1 to 9.14. In the Cherry street, 1 to 1.92. In the Northern Liberties, 1 to 2.13. In Richmond, 1 to 4. In Kensington, 1 to 3.40. In Pine street, 1 to 1.75. Bush Hill, 1 to 1.90. South street, 1 to 3. West Philadelphia, 1 to 2. The Medical Reports of the physicians-in-chief to the several hospitals, are in many respects highly in- teresting, and creditable to the gentlemen from whose pens they emanate. They contain much that is useful, abounding in facts and observations that must be of intrinsic value to the profession, while they tell of their assiduity and devotion to the duties of their hospitals, and the claims of their profession. As these reports are of some length and strictly of a medical character, and will in all probability appear in the medical journals of the day, and as we have embraced their statistics in the form of a table in the Appendix, we have thought it unnecessary to publish them with this Report. The medical treatment of cholera, did not come within the wide range of duties belonging to the Board of Health. To provide for that treatment was alone 41 required from us, which we endeavoured to do; the results, some of which we have undertaken to furnish, speak for themselves. DAILY BULLETINS AND STATISTICS OF CHOLEKA. The Board issued their first official bulletin, May 30th, and continued them up to August 18th, inclusive, a period of 81 days. At their meeting on the 18th of August, they resolved, that Cholera no longer existing as an epidemic, the daily bulletin of cases should be discontinued. From this period a few scattering cases were handed in to the Board for several days, and the weekly bills of mortality reported deaths from cholera up to Sept. 8th. (See Table, Appendix No. 4.) During the 81 days, there were reported to the Board 2141 cases, and 747 deaths. The largest number of cases and deaths reported were on the 14th of July, viz : 84 cases, and 32 deaths. On the 12th of July the highest number of cases and deaths were reported from the Alms House, viz: 24 cases, and 14 deaths. From the 11th to the 14th of July, inclusive, there were 328 cases, and 120 deaths reported, averaging 82 cases and 30 deaths daily, for four days in succession. The cases reported in June, including the two days in May, numbered 278, and the deaths 97; being 1 death in 2.86 cases. In July, 1579 cases and 578 deaths, as 1 death in 2.73. From the 1st to the 18th of Au- gust, a period of 18 days, 284 cases and 72 deaths, as 1 in 3.94 cases. In summing up the statistics of cholera in private 42 practice, affecting the population of those districts, making returns to the Board of Health, and in esti- mating the changes that have taken place in the popu- lation since the census of 1840, embracing a period of nine years, we have based our calculation upon the usual estimate of increase, which is supposed to be 3{ per cent, per annum, adding thereto, an allowance for the increase by emigration. While we do not claim perfect accuracy for this calculation, we believe, all things considered, there is a sufficient approximation to the truth to serve the purpose of statistical investigation. According to this estimate, the present population of the city and the several municipal branches, amounts to about 350,000, embracing in all, ten districts. The following Table will exhibit the cases and deaths in private practice, as reported to the Board of Health, from May 30th to August 18th, inclusive, with the ratios of cases and deaths to population and to each other. It is proper to observe here, that for the same period of time the weekly bills of mortality, published by the Board, exhibit the total number of deaths from Cholera to have been 1012. If from these we deduct the 362 cases occurring in the Hospitals, Alms House, and County Prison, we have left 650 cases, which will show an additional number of 264 cases more than the ag- gregate of reports of deaths in private practice made by the Board in their daily bulletins. This discrepancy can be accounted for from the fact, that many physicians did not report daily the deaths occurring in their practice, and also, that numerous cases came under the notice of the Coroner, but one of 43 which was reported to the Board of Health and included in their bulletin. In addition to these, some persons who died in the country were interred within the county limits, and were necessarily included in the weekly bills of mortality, while no reports were made severally of their deaths to the Board of Health. Nor have we any hesitation in believing, that all the cases of Cholera which actually occurred in private practice, were not reported to the Board. A number of practitioners declined reporting altogether, while others only reported those of their cases which col- lapsed, and others again, only those that proved fatal. The inference, therefore, is, that the results of the Table we herewith present, would have been in like propor- tions, had all the cases that were regarded as Cholera, as well as the deaths therefrom, been reported. District. Popula. Cases. CD Ratio of Cases to Population. Eatio of Deaths to Cases. Eatio of Deaths td Population. City, - - - - 118,491 388 127 1 to 305.39 1 to 3.05 1 in 933 South ^ark, - 36,458 276 50 1 to 132.09 1 to 5.52 1 in 729.16 Kensington, - 47,697 218 54 1 to 218.79 1 to 4.03 1 in 883.27 Spring Garden, - 54,532 108 33 1 to 504.92 1 to 3.27 1 in 1652.48 Moyamensing, 25,705 191 52 1 to 134.58 1 to 3.67 1 in 496.25 Northern Liberties, 49,321 147 38 1 to 335.51 1 to 3.86 1 in 1297.92 Penn District, 7325 14 4 1 to 523.21 1 to 3.50 1 in 1831.25 Richmond, - 5529 39 13 1 to 141.77 1 to 3. 1 in 435.30 West Philadelphia, 3413 21 11 1 to 162.52 1 to 1.90 1 in 310.27 Passyunk, - 1529 10 3 1 to 152.90 1 to 3.33 1 in 509.66 Unknown, - 6 1 Total, 350,000 1418 386 ! 1 to 246.82 1 to 3.66 1 in 906.73 From a dissection of this Table, we derive some in- 44 formation of a sanitary character, which not only pos- sesses interest, but may prove useful in the event of a recurrence of Cholera, or some other equally alarming epidemic. That the Epidemic was not confined to anyone por- tion of Philadelphia, but that all suffered a share of its malign influence. That Southwark, Moyamensing and Richmond, in the order they stand, show the most unfavourable ra- tios of cases to population, the mean ratio being about one in every 136 inhabitants; while Penn and Spring Garden present the most favourable,— one in every 514. West Philadelphia shows one in every 162. The North- ern Liberties gives one in every 335 1. The City one in every 305.39 and Kensington one in every 218.79. The increased ratio of cases to population in Southwark must be attributed to its want of cleanliness, its locality, to the character of a portion of its inhabitants that reside in the more densely populated neighbourhoods, and to its numerous, confined, and illy ventilated courts and alleys. That of Moyamensing, to the depraved condi- tion of hundreds of its inhabitants, to the filthy and crowded condition of many of its small houses, inha- bited cellars, and their vitiated atmosphere, to the nox- ious exhalations from their persons and clothing, and the numerous collections of offensive bones and rags, and other offal, heaped up and arrayed for sale in many of their small streets. In Richmond, to its locality along the river front, its want of proper drainage and sewerage, and also to the character, habits, and occupa- tion of a large portion of its population, viz : canal and river boatmen, coal-heavers and labourers- 45 In Kensington, the chief cause lies in the unpaved, ungraded and undrained condition of many of its streets. Penn, almost a rural district, elevated and dry, and to the N. W. of the city, with a population of 7325, reported only 14 cases and 4 deaths, whilst West Phi- ladelphia, situated along the western border of the Schuylkill river, with a population of only 3413, gave 21 cases and 11 deaths — locality in these two instances must explain the comparative exemption of the former from the Epidemic, and its increased prevalence in the latter. Spring Garden, next in point of healthfulness to Penn, exhibiting only 1 case to every 504.92 of its in- habitants, is situated high above the two rivers bound- ing the city, is well improved, its streets wide, well paved, graded, its under-ground sewerage many miles in extent, free from a population degraded and depraved, and exempt from an excess of crowded and illy-venti- lated courts and alleys that exist elsewhere. The mean number of cases reported to the Board in private practice was 1418, and the deaths 386. The population being 350,000 — the ratio of cases to popula- tion was 1 in every 246.82 — the ratio of deaths to population was 1 in every 906.73, and that of deaths to cases as 1 in every 3.66. The table of mortality, (see Appendix No. 4,) which is taken from the weekly bills of mortalily issued by the Board, and differing from the daily bulletins, exhi- bits the average ratio of deaths from Cholera during the season of its prevalence, at thirteen periods of life. The sum total is 1012; of these, the males amounted to 540, and the females to 472, showing an excess of 46 deaths of one-eighth males over females. But during the three weeks from June 30th to July 21st, when the disease raged to the greatest extent, the proportion was reversed, so that the mortality among females was one- sixteenth more than among males. The period of life between 30 and 40, presents the greatest mortality, and this ratio is exhibited in all medical statistics, showing a less resistance to disease at this age than at any other decimal period. Of the whole number who died, 386 were attended at their own houses; 111 at the several hospitals, under charge of the Board of Health ; 229 at the Blockley Alms-house, 20 at the County Prison, and 1 unknown. We have not been able to gather the statistics of the Epidemic, as it occurred among the coloured population, separate and distinct from the mass. This, however, is no fault of the Board of Health, the censure must fall upon the practising members of that profession, who should be most interested in such tables, but who, we regret to say, are far too neglectful in making their re- turns, both of deaths and births, with that accuracy which is desirable. All we have accomplished under this head has been to ascertain that 106 people of colour died of Cholera, and were interred in grounds within the districts mak- ing returns to the Board of Health, between the 1st of June and the 8th of September, a period of 100 days. Estimating the coloured population at 25,000, would give us about one death for every 337, which it will be discovered shows a greater mortality from Cholera among the coloured than the white population. 47 By a reference to the weekly bills of mortality issued by the Board of Health for the last four consecutive years, embracing a period of the summer months, from the 1st June to the 1st of September in each year, it will be seen that since 1846, there has been an annual aggregate increase of mortality from the four bowel diseases — Dysentery, Diarrhoea, Cholera Morbus, and Years, jiumiJtuin, Dysentery. Diarrhoea. a Choi. Morb. Choi. Infant. Total 1846, 37 55 12 272 376 1847, 87 83 15 367 552 1848, 163 63 25 388 639 1S49, 337 137 62 512 1048 The great increase in the deaths from the four bowel affections, for the past season, and during the prevalence of the Epidemic, affords a striking contrast to those reported for the three former years, constituting nearly 50 per cent, more than either of those years — to which, add the mortality from Asiatic Cholera, amounting to 1012 deaths, and we have an increase over former rates of more than 100 per cent. An evidence, not only that while an Epidemic is prevalent, other dis- eases may prevail with undiminished force; but that diseases of the same class, or partaking of the same congeneric character, are augumented almost 50 per cent. And further, that Epidemics do not always swal- low up, in their mighty grasp, other diseases. CHOLERA OF 1832. According to the Statistics in Hazard's Register, Vol. 10, 1832, the Cholera appeared in this City, July 11th, when there was one case reported in the City proper, which terminated fatally. No others occurred 48 until the 16th, when there were five* cases reported, four in the Northern Liberties, and one in Southwark, three of which proved fatal. On the 17th there was one in Southwark ; on the 24th, one in Kensington ; on the 27th, one in Southwark ; on the 28th, one in Southwark; on the 29th there were four:, two in the City, one in the Northern Liberties, and one in Moya- mensing ; on the 30th there were eight cases, and from this date they rapidly increased, up to August the 6th, when it reached its maximum, 176 cases and 71 deaths. Although the proportion of deaths to cases was greater on the 7th, when the deaths reported w r ere 73, and the cases fell below the maximum of 176. From this date, August 6th, the cases ranged above 100, until the 14th, when they gradually declined until September 25th, when there were no cases in private practice reported ; but it lingered in the Hospitals up to the 4th of October, making a period of 86 days from its commencement, on the 11th of July. The following table, will exhibit a summary of cases and deaths, in private and Hospital practice, for the 86 days of its prevalence in 1832. City, 411 Southwark, - - - - 251 Kensington, - - - - 112 Northern Liberties, - - 147 total. Penn Township, 56 Moyamensing, - - - 198 CASES - deaths. West Philadephia, - - - 6 1181 271 Hospitals, 888 345 Alms House, 174 92 Arch Street Prison, .... 86 46 GRAND TOTAL, 2329 754 49 COMPARATIVE RESULTS BETWEEN CHOLERA OF 1832 AND 1849. The recent visitation of Cholera as an Epidemic in our City, according to the bulletins of the Board of Health, continued for 81 days, or eleven weeks and four days. In 1832, according to the same standard of calcula- tion, it prevailed for 86 days, or twelve weeks and two days. From its first appearance, May 30th, '49, it continued to increase up to the 14th of July, when it reached its acme, showing an augmentation of 46 days — -when, oscillating for three or four days, it began to decline, and 35 days elapsed before its disappearance. In 1832, it appeared July 11th, and its augmentation was 27 days, while its decline was 59 days, — showing that in 1832, during its first invasion, it reached its maximum in almost half the time that it did the past season, while the period of its decline was one-third longer than the decline of the late Epidemic. During the whole period of its existence the past season, there was reported to the Board of Health, 2141 cases, and 747 deaths, that is for 81 days, averag- ing 26j cases, and 9} deaths, daily. In 1832, the cases reported for 86 days, amounted to 2329, and the deaths, 754, exhibiting an average of 27 cases and 9| deaths, daily. The following tabular view, gives the comparative results between the two Epidemics, in the ratio of their cases and deaths to populations, and their ratios to each other. 4 50 Ratio Katio Ratio of cases of deaths of deaths Population. Cases. Deaths, to population. to cases. to population. 1832, 160,000 2329 754 1 in 69.1 1 in 3.06 1 in 212.2. 1849, 350,000 2141 747 1 in 164.24 1 in 2.86 1 in 470.4. Thus it will be seen that while the population has doubled itself since 1832, the whole number of cases and deaths as reported for 1849, stand numerically, about as they did in 1832, but when compared with the difference in the population, they are in reality less by almost one-half than they were in 1832. While the mortality to cases, during both Epidemics, stands about alike. As in other places, the deaths in both Epidemics, in proportion to the cases, were greater during the onset, than the decline. The following tables show the number of cases and their locality in private practice, also in the Hospitals, Almshouse and County Prison, the past season, as com- pared with those of 1832. PRIVATE PRACTICE FOR THE YEARS 1849 AND 1832. 1849. 1832. City, 388 Southwark, ... 276 - 411 251 Kensington, - - - - 218 . 112 Spring Garden, - - - 108 Penn District, - 14 - | 56 Moyamensing, - - - 191 Northern Liberties, - - 147 - 198 147 Richmond, - 39 . West Philadelphia, - - 22 Passyunk, - 10 Residence unknown, - 6 - 6 " T S Cases, 1419 T0TA M Deaths, 389 m ™ 1T S Cases, T0TAL > \ Deaths, 1181 271 51 HOSPITALS, ALMS HOUSE AND COUNTY PRISON. 1849. Cherry street, - - - 27 Pine street, - 14 1832. South street, - 3 Southwark, - 64 Kensington, -.-..- 17 Moyamensing, - Northern Liberties, 116 47 Richmond, - 16 West Philadelphia, Bush Hill, 2 38 Alms House, - 314 .... 174 County Prison, - Coroner, - 63* ... 1 - 86 Stations 1,-3, 4, 5, 15, 17, 19, and 10 City Hospitals, - - 888 mAT f Cases, T0TAL > { Deaths, 722 '■ - , T i Cases, 358 T0TAL > \ Deaths, 1148 483 From the above we learn, that in the late Epidemic there were only ten Cholera Hospitals in requisition, and the number of cases treated in them amounted to 344, while the deaths were 111, or 1 to 3. In 1832 there were 17 Hospitals in service, viz., ten organized by the Sanitary Committee of Councils, and seven by the Board of Health. In these Hospitals there were 888 cases of Cholera treated, out of which 345 died y or 1 in 2.57. , The average number of patients in each of the ten Hospitals, in 1849, was 34 4-10ths, and the deaths, 11 l-10th. In the 17 Hospitals, in 1832, the average to each was, cases, 52 2-10ths, deaths, 20 2-10ths. Therefore, it appears, that while the average of cases * In 1832, it was known as the Arch Street Prison. 52 in each Hospital, in 1832, was only l-3rd more than in 1849, the average deaths in 1832 were two to one, compared with 1849, showing that the success of treat- ment in Hospital practice was in favour of that pursued in 1849. CHOLEKA EXPENSES OF 1849. Whether our climatical condition the past year, found us better prepared to meet and repel the scourge, or whether the Sanitary measures and the plan of Dispen- saries, Hospitals and other arrangements, as adopted by the Board, were the efficient agents — one thing must be evident to those who read this report, viz. that the cost of Cholera in 1849, is but a fraction over one-fifth the cost of the same Epidemic in 1832; or in other words — while it cost the City and Districts in 1832, with a population of 160,000, the sum of $105,285.91 for Cholera purposes — in 1849, the expenditures for the same object, with a population of 350,000, were only $22,635.37 — as per the following account. Am't Exp'd by the Pine Street Hospital, South Western, Northern Liberties, Kensington, Southwark, Cherry Street, Richmond, Moyamensing, West Philadelphia, $916 39 684 27 843 45 497 79 882 80 1382 03 979 14 1301 68 307 04 a North West District Committee, 25 86 (I North East, it a 132 38 it North City, a (t 26 69 a South City, cc it 46 08 (i South, a tt 102 89 $7784 59 $333 90 53 Am't Exp'd by the Office for salaries of Sanitary Agents in November and December, 1848, 61 65 u " " Office from January 1, to Octo- ber 3, 1849, for salaries of Sanitary Agents, Assistant Messengers, Assistant Clerk, Litter Carriers, Chloride of Lime, Printing, Advertising, Posting Proclamations, and for removing nuisances on lot east of Eastern Peniten- enses tiary, - of Committee to visit Staten Island, 1181 50 7127 $1252 77 Amount expended for salaries for Physicians and Nurses; board of Physician, Patients and Nurses; Medicines, conveying patients, bury- ing dead, repairing litters, blankets, muslins and calico for City Hospital, - - - 1202 61 $10,635 37 Amount expended by Councils and several of the Municipal authorities of the County, for Sanitary purposes, cleansing streets, &c, about 12 000 $22,635 37 CHOLERA EXPENSES IN 1832. In 1832, during the first visit of Cholera to our City as an Epidemic, there was expended for Cholera pur- poses alone, the enormous sum of $105,285 91. This amount was divided between the City proper, the Board of Health, and the several Municipal authorities, as follows : 54 By the Sanitary Committee, under the direction of the City Councils, for the City alone, - - - $40,414 70 By the Board of Health, 56 ; 934 86 By the Corporations of Northern Liberties, Kensington, South wark, Moyamensing and Penn, embracing Spring Garden, 7,936 35 $105,285 91 The two first items in the above table are official, while in the last, there may be a slight variation from the official expenditure of the several districts embraced therein, but not enough to make any great difference in the aggregate. In presenting this statement, and in order to do justice to those gentlemen who composed the several bodies enumerated, and who were very actively engaged during that memorable event, it may be necessary to make every proper allowance for the dreadful appre- hension and fear which then prevailed among all classes of our citizens. The disease was to them a new one, the most alarming accounts had reached the City of its dire effects abroad, and every one felt that the most ample provision ought to be made to arrest the ravages of the Epidemic, and as will be seen, no expense was spared by those in authority. CONCLUSION. In closing up this chronological and statistical ac- count of the Cholera, as it appeared in our City during the past summer, it would not be improper for the Board to allude, for a few moments, to the gratifying results of their sanitary efforts, as measures of palliation, and 55 to the favourable contrast in which Philadelphia stands to her sister city, New York, and other large cities, where the Epidemic has been felt. It was a matter of surprise to the Board, after they had instituted the plan of house to house visita- tion, and received the reports of their agents, that there existed such an accumulation of nuisances preju- dicial to health. It was a revelation, as unexpected as it was alarming, and for which they were not pre- pared. It presented an emergency under the circum- stances, that called for the most energetic application of their time and abilities, in order to remove the one and prepare for the other. Now that the danger is past, and we breathe once more an uncontaminated air, we look back upon the trying and laborious scenes through which we have passed, and congratulate our- selves, and the community at large, upon the results of our Hygienic efforts, in staying the hand of the pesti- lence. By calling attention to the mitigated form of the Cholera, as it appeared among us, and to the limited period of its duration, compared with other places where it prevailed, the conviction forces itself upon every intelligent mind, that the efficient organization of sani- tary measures for cleansing the city, and their practical application by the Board of Health, have been the active and efficient means for lessening the ravages of the Pestilence; by removing and abating those procuring causes and conditions in the community, which tended to depress the forces of life, thereby favouring the preva- lence of the Epidemic, and adding to its mortality. Nor can less be said for the very excellent provision 56 made by the Board in the plan of dispensary arrange- ments, by which medicines for the poor, could be had gratuitously as well by night as by day. Timely aid being afforded, the disease was arrested in its premoni- tory stage in hundreds of cases, which otherwise would have become fully developed or hopelessly lost. The Hospitals established by the Board, also per- formed their full share, in rendering prompt assistance and in saving life. In conclusion, the Board would add, that they have felt both the delicacy and the responsibility of the posi- tion they occupied before the community, during the trying emergency of the past season, and that in all their sanitary actions, they have been governed by a deliberate and humane spirit. They also embrace this opportunity to express their thanks to those of their fellow-citizens, who so gener- ously sustained and aided them in the sanitary mea- sures they deemed it proper to institute for the public good, and the preservation of the health of the Citizens at large. 57 APPENDIX No. 1. The Sanitary Committee, to whom was referred the reso- lution from the Sanitary Committee of City Councils, respecting rumors about the Blockley Almshouse, Report, That they visited that institution on Monday the 16th of July, accompanied by members of the City Sanitary Committee. Your committee was very kindly received by the Board of Guardians, and by the medical gentlemen connected with the Alms House. Every facility was offered for a thorough examination of the premises, and the condition of its inmates. So far as relates to the correctness of the reports of the num- ber who die from Cholera, the committee believe the report of the Alms House physicians to be essentially true, without any attempt at concealment or exaggeration one way or the other. If any mistakes have occurred, it is attributable to the fact, that they report no case as Cholera, until the patient exhibits one or more asphyxiated symptoms, when all remedies are un- availing. Entertaining this view, it changes the complexion of things in favour of the physicians. Diarrhoea in its worst form is recognized as a disease* contradistinguished from Cholera ; whereas, in the opinion of your committee, during the epidemic influence, it should be regarded as a different stage of the same disease. We hold this proposition to be correct and fair, as well to members of the medical profession as to the public generally, and as a basis on which sanitary measures can be established. If we can prevent or cure diarrhoea we need not fear cholera. What then is the cause of the mortality prevailing among the paupers at the Alms House, and what sanitary measures will arrest its progress ? Better ventilation is required throughout the building, but it cannot be brought to bear upon the present incumbents so as to save them from present danger. A change of air by a sys- tem of distribution and transposition, however temporary, would doubtless be beneficial. 58 The committee had an opportunity of inspecting the diet; the food given to the well, and saw preparations for supper in several rooms. A slice of fresh bread, and a large bowl of black tea constituted the ration for one person. In one room, we saw ship biscuit instead of bread, covered with rancid butter, which was very offensive, and sufficient, at this time, to disorder the stomach and bowels of the most robust. Mo- lasses was used for sweetening the tea ; and the committee can- not refrain from expressing their full conviction, that to this inattention or error of diet, may be traced one of the chief causes of the dreadful spread of cholera, and its fatality among the shattered constitutions of the pauper population at the Blockley Alms House. A change of nutrition is demanded immediately. Annexed is the recommendation of the medical staff to the Board of Guardians on that subject, in which we unanimously concur, and urge upon the Board its most prompt execution, as they value the preservation of human life. Let every pauper in the establishment be treated to a dinner of roast beef with porter or brandy, followed up by correspond- ing regimen, and other suitable appliances for a few days, and the cases of cholera will diminish, and its mortality be lessened in proportion as this recommendation is complied with. Where large masses of paupers or convicts are crowded to- gether, and confined within certain limits, a change of nutrition and better living is necessary, to enable them to resist the influ- ence of an epidemic poison. The committee, in conclusion, would respectfully offer the following suggestions : — Let the diet be instantly changed, agreeably to the recom- mendations of the medical staff at the Alms House. Let there be a periodical inspection of all the pauper inmates indiscriminately, (during the epidemic influence,) particularly those most liable to an attack of cholera, say once every three or four hours during the day, and on the first symptom of de- rangement of the stomach or bowels, enjoin rest andmedicine. Let there be a medical police instituted in all the wards, with directions to nurses to attend to this personal inspection and supervision during the night. Whitewash all the walls that will admit of it, where it can be done without injury to sick patients. Vacate immediately the present Cholera Hospital, and empty it of all its contents, and then thoroughly purify, whitewash, 59 ventilate, and cleanse the building, and shut it up for the pre- sent. Abandon the cells or cubbies in the recesses of certain walls, and allow the inmates to sleep on the floor, corridors, or in the middle of the rooms, where the cubbies are constructed. Separate the dead and dying from the living as quickly as practicable. Forbid the use of molasses and rancid butter, and let every eatable be fresh and wholesome. Remove all cholera patients on litters to a hospital outside the walls of the building. Free ventilation, free bathing, frictions to the skin, and good diet will preserve the living, and prove the best sanitary mea- sures against an attack of cholera. Early rest, early remedies, and prompt assistance, with pro- per system, will prove the best means of controlling the disease. That the patients be allowed to walk over the grounds. Besolved, That a copy of this report be furnished to the Guardians of the Poor, and the medical staff of the Alms House, &c. John A. Elkinton, M. D, Wilson Jewell, M. D. B. E. Carpenter, Benjamin Martin, p> Sanitary Committee. Joseph Wood, S. Week, J. E. Eldridge, Philadelphia, July 17, 1S49. 60 APPENDIX No. 2. The Sanitary Committee, in accordance with a Resolution of the Board passed on the 4th of August, Report, That they visited the place of interment for the dead from the Alms House, and the out-door patients of the Guardians of the Poor, where they are deposited in large trenches ; and which ground is located about one-eighth of a mile in a southwardly and eastwardly direction from West Philadelphia. Here your Committee found a nuisance which calls loudly for immediate abatement. In superficial trenches, about eight feet wide by eighteen feet long, and six feet deep, have been deposited, since July 1st, more than four hundred bodies, placed, it is true, in coffins, (but by no means air-tight,) and covered with earth, but so in- securely, that from the decomposing and putrid carcases, there was emitted through the loose gravelly soil, a most horrid ex- halation of an insufferable sickly and poisonous stench, while flies and other insects, were glutting themselves with the filthy food, found in this pauper charnel house — in these " lodgings for the dead." From this condition of things it must be, in the opinion of your Committee, that the atmosphere for some con- siderable distance around and beyond this cemetery, is highly charged with impure and unwholesome gases ; and from its near proximity to that portion of West Philadelphia where the Cholera was most rife, and the constantly prevailing southerly winds at this season, wafting this morbid atmosphere in that direction, your Committee believe that it may have been, one of the procuring causes for the concentration of disease in the above described neighbourhood. To what extent this has been the case, when combined with miasma from the borders of the river Schuylkill, and the noxious emanations from the crowded and illy ventilated wards of the Alms House, with other excit- ing causes, your Committee are not prepared "to determine. In adopting a proper remedy to remove this nuisance, your Com- 61 mittee have been greatly embarrassed. Several suggestions have been made, but the difficulty has been to propose one, combining practical utility with a certainty of removing the nuisance. Your Committee believe that the present method of constructing the trenches, and depositing the dead therein, where they, are suffered to lay from day to day, sprinkled over with a few inches of loose dirt, festering under a hot and mid-day sun, until such time as the trench shall become filled, and then covered with about three feet of porous earth, is in a sanitary point of view fearfully objectionable, and demands an imme- diate correction of the whole system. Had four hundred dogs been buried in a similar enclosure, in a similar manner, in the same period of time, and during the prevalence of the present epidemic, by the orders of the Board of Health, an outcry would have been raised against them, extending over the length and breadth of the land, which would have required herculean nerves to grapple with, and the most rigid application of the moral and physical sanitary shovel to remove ; and yet, in the opinion of your Committee, the partial burial of one dead human body, dying from the present or any other epidemic, is more to be dreaded than half a dozen carcases of dogs ; for besides the chemical poison from the decomposition of animal matter, we have other morbid poisons thrown off from bodies, having died of pestilential and loathsome diseases, which, dis- seminating themselves into the surrounding atmosphere, assist in doing a deadly work. Putrid exhalations from dead bodies have, in a concentrated form, caused immediate death, and hence, when diluted in the atmosphere, must be dangerous and unwholesome, in proportion to the relative quantity diffused, and the condition of the individual inhaling the same. In view, therefore, of an immediate removal of a nuisance prejudicial to the health of West Philadelphia, your Committee would re- commend the following resolutions : Resolved, That the present method of interments pursued by the Guardians of the Poor, is a nuisance prejudicial to health. Resolved, That the Guardians of the Poor be required to suspend until the 1st of October next, the present mode of bury- ing their dead in trenches, and that they be directed to dig graves, deep and wide enough to contain four coffins, two abreast and two deep, between which there shall be placed at least, twenty-four inches of dirt, and room enough left for four feet of earth from the surface. 62 Resolved, That they be required to fill the trenches now ex- posed, using fifty pounds of chloride of lime in each trench in doing so ; and that, until the 1st of October next, twenty five pounds of chloride of lime shall be used for each grave be fore it is filled. John A. Elkinton, M. D." Wilson Jewell, M. D. B. E. Carpenter, Benjamin Martin, )> Sanitary Committee. Joseph Wood, S. Weer, J. E. Eldridge, Philadelphia, August 4th, 1S49. APPENDIX No. 3. O CO 00 ^T OS cn t^ co to J-* CO 3^ w CO o 3 3 CD CO 2 5" CD CD 3 CO B* crq O CD CO o 3 5" 3 o Q 3" CD o p 3 w o CO p 3 w i -1 ^^ P Q o 3 I"" 1 pu CO CO O ' O 3* ^ ' a 1 CD ' Q 3 ffq fad Q 1 i . I CD GO . i • i-H O r 1 o « C-l CO CO «H CH 53 W hJ t-< O CD g CO *J Q ^ t- 1 2 ^ M CD o W 3 ■P o CM o Q o cs co p CO Q W o CD 3 o ' ^ CO El. H aq 3' > CO 1 CO o 1 1 1 • CD 1 p 3 JO CO id i— i .. „ O > " "* " " " "" 7* CO CO i P CO £ k 3 p CO CO H H o 1 T3 CD 3 1 a 8 Q ST CO CD 3 p- CD W o' CD 3 CO B 5 CO o 3 CO 3 CD o CO I-H o o £ CO 1 ' • ■ crq 1 3 1 ' 1 i ° 00 co to 00 co co OS CO o co CD Cn CO Cn cn OS No. of Days opened. >_* as CO 00 00 ^ OS to OS OS OS to o No, of Patients admitted. co 1—1 rf^ CO 00 co to rf>- ~T OS CS to as !iTo. of Cholera Cases. en OS to to to M co h^ CO CO co o OS ~T CO OS Males, 3 5! P CD to K M _ *- co os oo OO CO Females, » to Males, w CO to to -J t- 1 >— ' co to Females, I- 1 1-1 00 Cn to - co as to to Americans. o as co to CO Cn CO o to 00 rf»- Cn Foreigners. Cn to co cn os M Temperate. CO 00 to to cn 00 to OS Intemperate. OS M M Males, ^ to to M I— 1 en CO *«. CO as E b lO Females, CO l -> 5 i i I 1 1 s 1 -9 to a £3 tf P P OS J> !? So c. D. c. D. C. j D. C. D. C. D. C. D. c.l D . C.l D . C. D. C. D C.l D. May 30 • .22.. 31 ' 1 June 1 1 1 2 1 3 , 4 , 5 , 6 1 1 . . . 7 1 'l 8 1 1 . '. . . . . 9 10 11 . 12 1 1 . 13 2 '1 14 1 1 ! 1 . ! . 15 1 1 ! . 16 1 1 . 1 1 ! . . . 17 1 1 1 18 2 ! 1 1 . . 19 *2 '2 '2 1 20 2 1 , ! 11 '. '. 21 1 '5 1 1 . . . 2 2 . . 2 22 *3 1 1 . . . 1 . 23 2 1 11... 1 .' 1 24 . 1 1 . . . 1 . . . 1 . . . . 25 4 *2 8 2 *5 211.. 1 . . 11... . 26 3 3 2 1 9 4 21 1 4 11.. 2? 10 2 14 3 8 2 5 3 1. 4 2 . ....] 1 '. 28 12 3 11 3 8 4 2 1.. 5 . . ! 1 1 . . 11. . 29 11 2 17 2 2 . 5 1 6 3 4 1. . . . 1 . 1 . 30 15 7 13 1 4 2 2 11. 5 4 6 2 '. . 1 1 . . 1 . July 1 4 4 6 2 3 113 2 12.1 2 . 2 14 5 12 4 8 3 4 19 15 3 1 . 1 3 9 3 7 . 9 2 7 3 16 2 3 13 1 . 4 10 1 5 2 1 3 1 10! 3 111 5 7 4 3 2 11 2 3 13! 17 2 1 . 1 '. 3 .' '. '. '. '. 6 7 2 6 1 . . . . 2 . 3 . . 1 7 13 2 7 1 • . 3 . 3 . 2 . 1 8 7 4 . . . 1 • 5 1 . 9 4 3 10 2 '3 1 . 3! 2 3 1. 10 13 1 4 . 8 1 . . 3 2 11. I 1 1 '. 11 20 2 16 5 5 1 1 . 13 4 1.2 1 . 12 17 5 7 1 8 . 1 . 8 4 1.. 13 15 4 6 1 16 6 4 15- 5 1 1 . 3 . 1 14 8 2 9 7 . 3 1 7 3 9 6 3 15 11 2 4 2 . 2 2 3- 4 1 . 16 12 1 4 1 1 . 1 . 6 16 2 1 . . . 2 1. ! 17 16 10 1 1 13 2 5 1. 7.1 . 11... . 18 1 14 3 9 . 12 3 7.8 1 5 2 . 1 . APPENDIX No. 4. DEATHS IN PHILADELPHIA IN 1849. HOSPITALS. Cit y- i . d § Cherry Street. Pino Street. South Street. Southwark Moyamensi Northern Liberties. Kensingtoi Richmond. j West | Philadelph Bush Hill. Almshouse County Pri Coroner, TOTAI C. B. C. D. C. D C D. C. D. C. JD. C. D. C. D. C. D. C. D. C. D. C. D. c. D. C. 1 i>. 3 3 ■ 1 1. . . . 2 1 • • .-'... 1 1 1 .:.:::..:..::.: i . . : : i . . . i 1 :::::::: :::::::::::: : : 1: : : : ! 1 .'..'..'.'.. . . . '. . . ! . ! . .' . . '. '. . .' ! 2 1 . 3 1 2 1 . . . . • 2 2 2 2 1 3 1 2 3 2 . 10 4 5 1 5 2 3 3 20 8 21 10 ... 43 12 40 13 1 48 9 48 18 ....... 4 4 3 .... 23 20 1 3 10 5 .... 65 25 3 1 2 1 7 7 .... 66 21 24 3.- 11 8 72... 47 20 1 . 7 3 11 5 3 .... 53 19 5 1.1 2 . 8 7 1 ... 35 12 1 . . 2 1 9 4 .... 40 9 .1 1 . 4 . 8 4 .... 26 10 1 . 3 2.. 1 1 9 9 1 ... 39 20 11.... 1 . 111. 11 6 . . 1 1 46 15 2 2 .... 4 . 3421 1 . 13 11: .... S3 31 3 3 2 1 . 3 ... 1 ... 3 1 24 13 .... SO 26 3 2 . 3 1 . 1 ... 1 .... 17 14 .... 81 30 113 1. . 2 . 5 3 4 2 1 2 1 20 12 . . . . 84 32 . 1 1 1 . . 1 . 2 13 1- 1 . 21 7 .... 55 16 . . 1 . . . 1 2 1 . 1 2 1 20 14 • ... 59 23 1 . 1 ... 1 . 2 .. 1 1 1 1 ... 2 1 20 14 .... 73 32 . . . . 1 . . . 2 2 12 1 . 14 9 .... 75 21 65 APPENDIX No. 4.— Continued, PRIVATE PRACTICE. 1849. 5 * H bo .5 "Sa Pi a 1 t XII .s PI 1 O g m 1 % a 1 s Ph P "8 1 1 s ft s a ^ Ph West Philadelphia Residence not stated. c. D. c. D. c. D. 1 3 2 3 2 1 1 1 1 1 54 C. 5 3 *2 3 3 2 1 3 2 4 2 1 1 1 2 1 1 1 1 108 D. 1 1 1 1 ] 1 2 33 C. 8 5 2 4 4 8 6 2 3 1 6 1 3 1 4 1 *3 1 1 3 2 1 191 D. 1 1 3 2 4 1 2 52 c. 2 1 1 4 7 7 6 1 2 5 3 1 2 2 1 4 *3 1 1 2 147 D. < 1 1 1 2 1 1 2 38 3 3. D. C. 2 '. '. 1 ! '. 2 1 . 3 . . 1 1 . . . 2 1 '. '. 1 '. '. 9 13 10 D. C. . 1 '. 1 '. \ . 1 3 14 D. c. . 1 ! *2 . 2 '. 6 '. *2 . 1 ! 3 421 D. C. D. 1 . . 2 ". '. 1 . . 2 '. .' 1 ! .' 2 ! '. . 1 1 11 6 1 July 19 20 21 22 23 24 25 26 27 28 29 30 31 August 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 12 11 5 2 10 9 3 6 9 2 6 7 6 3 2 1 1 1 1 1 *3 1 1 6 2 1 1 2 4 3 2 2 *2 2 2 5 4 3 1 1 1 'l 1 1 3 2 1 7 4 10 1 1 3 2 4 4 4 2 5 1 2 1 4 4 3 3 5 4 4 1 1 2 2 1 3 1 3 6 8 6 1 *4 9 8 3 *3 2 2 1 4 2 2 • 1 2 1 Totals 388 127 276 50 218 APPENDIX No. 4.— Continued. HOSPITALS. u g a C. D. 11 1 City. tJ3 S3 ■a § 02 S 1 9°* 1 sT! 5 o-S « £►3 U i f § ! 1 § .a a 3 O H H CO CO a 3 c. 1 1 2 1 1 1 1 2 27 D. 1 1 1 14 c. d. c. r . 1 . . . 1 . 1 . . . 1 . . . 1 . . 11.. '. 1 1 1 2.1. ill. . 1 1 1 11.. 14 8 3 . C. D. C. 3 . 3 . . 1 3 . . . . 4 1 . 2 3 . 5 . . 3 2 . 4 4 . 2 3 . 1 12. 6 1 . 5 4 . 2 1 . 1 3 . 4 . . 5 2 . 1 3 . 1 2 1 4 4 . 3 3 . 1 1 . 4 . . 2 . . 3 . 1 2 . . 1 . . 1 1 1 '2 . . 1 1 64 7 116 D. 'l 2 1 1 1 'l 'l 1 1 29 c. 2 3 2 47 D. C. 1 . 1 '. 1 . 1 . 1 1 . 1 . 1 1 1 1 . 1 2 1 1 . 1 1 2 . 2 . 2 22 17 D. C D. . 1 . 1 1 1 1 2 . 1 1 1 • . . .' 1 .' 1.1. 1 1 'l . 2 'l 1 1 • 2 . . • 1 . 1 . . .ill 1 1 . 1 5 16 4 :. D. C. . 3 . 1 1 1 1 1 2 .' 3 1 1 . . 1 1 1 . 1 2 1 38 2 D. C. 5 1 10 1 6 1 12 . 5 . 12 1 5 4 . 3 5 5 1 4 1 . *3 2 2 'l 2 315 D. 14 11 5 5 9 6 6 5 2 6 3 2 1 *3 1 *1 229 c. 2 2 21 4 3 3 2 3 1 5 1 4 1 5 2 63 D. 4 3 4 1 2 1 2 1 1 1 20 C. 53 49 32 28 35 64 43 40 35 30 61 40 39 20 21 23 20 15 24 25 26 13 18 16 7 17 15 12 3 5 4 2141 D. 23 20 14 12 20 18 15 9 9 13 19 14 12 5 4 8 6 2 3 2 9 4 3 4 1 10 3 2 3 2 1 747| APPENDIX No. 4.— Continued. QO OS ^H rH b- OO CM Jt- •-IVXOJL dtfVHS CO CO •puouiqoi'd i—i CM CO 1—1 i— 1 os b- lr~ t^ b- ^ OO •saijiaqiT; CM o rH rJH CM CO UJ3t{lJ0>I rH r-i tO to rH r-i CD CO GO CM o H •Saisu9uiB^Co]/\[ »— 1 to 1— 1 CM OS H CO o CO CO OS CO o o CO CO E-i *uapaBf)8u]jds CM b- O rH T~i CM CO "* Jf~ b- OO CO ■*£ TjH TJH w 5 •uoi§uisu9}i Ttf r-i r-i r-i CM rH CO to t- OS O co CO o ^ o r> fr- UO ^H t^ 1— CO to 1—1 h rH CM Tjl OS tO CO o o a t- •A%\o b- OO CM CM OO CO CM QO CM rH aT aT V? • _c -a -a OS .o hs 6 o CO w m VI O .ft -+3 ^3 ■43 P OO rH O O 6 1" ;* 6 g o ^ 6 o 6 £3 73 ■"c3 73 Is 73 Is o o o o O o O o H EH H H H H H EH APPENDIX NO. 5 * <3 « O ffl Q O 3 o o H CD IS •tw»°I CO CO tO 1—i o o r-i C5 r-1 tO rH CO CO rH tO OS O CM co rH 00 rH CO r-i CM rH o rH l-S rH rH s-s§ • CM o rH rH CO r-i • t^ CM tO CM rH CO OO "3 • • rH rH CO C5 . CO rH CO CM 00 t^ tO CO rH CM tO >1 o pq * rH rH rH r-i * 1^ to rH rH CO tO CO tO CO tO CO H^ os CO CM CO CM i.2 CM r^ o OS CO ^ r-i rM rH h- a r-i H^ TO CO CM H^ 00 tO tH HH CM rH CM CO CO o CO o O rS to OS t- o W tO CM CM r-i r-i HH 1 r-i tO r^f -*3 £ •p 1 02 J? ^+3 a) tO rH -f-3 oi rri 00 CM 1 © •N. CO r-i © H3 CO CM © a ■+3 o CO © a PS -t-3 r-i o +2* xa r-i CM ha oo CM >> 1 i <1 rH rH 02 PJ IP O rH 02 1 < CM 02 g> o © O -*> -a © © © s 1-3 O CM O -1-9 o o £ o s o pd +3 ■^ -+3 02 o CO CO rH TS CO » !>> >^ PS & © © £ z £ ^ £ H g £ 5 < ^ ^ <1 * This table, referred to on page 45, is there incorrectly marked as No. 4. BOAKD OF HEALTH, 1849-50. City. — John Lindsay, No. 8 Belmont Place. Edward C. Markley, No. 13 S. Schuylkill Seventh st., and No. 4 Minor st. John A. Elkinton, M.D., No. 102 North Fifth street. Edward Duff, No. 39 Eace street, and No. 35 North Wharves. John C. Martin, No. 319 Spruce street. Samuel W. Weer, No. 147 North Twelfth street, and No. 21 South Eighth st. Northern Liberties. — Benjamin E. Carpenter, No. 215 Coates street. William Goodwin, No. 305 North Second street. Spring Garden. — Wilson Jewell, M.D., No. 238 North Sixth street J. D. Logan, M.D., No. 27 Logan Square. Southwark. — Benjamin Martin, No. 463 South Second street. Robert G. Simpson, No. 123 Queen street. Motamensing. — Robert F. Christy, No. 239 South Ninth street. Kensington. — Jeremiah E. Eldridge, Germantown Road above Fifth street. Charles Delany, No. 43 Queen street. Richmond. — Oliver Evans, William st., between Point no Point Road and Delaware. Penn. — Joseph Wood, No. 443 North Seventh street, above Poplar street. West Philadelphia.— Henry Pleasants M.D., Washington above Mary street, W. P, OFFICERS OF THE BOARD. President. — John Lindsay. Secretary. — Benjamin E. Carpenter. Treasurer — Samuel W. Weer. Clerk.— Samuel P. Marks, No. 376 South Fifth street. Solicitor. — J. A. Phillips, No. 56 South Sixth street. Steward of Lazaretto. — Martin Kochersperger, Lazaretto. Physician of City Hospital.— Wm. B. Wilson, M.D., No. 163 Arch street. Matron of City Hospital,— Lydia Tomlinson, Hospital. EXECUTIVE OFFICERS. Health Officer. — George P. Little, No. 126 Catharine street, above Third. Port Physician. — Willirm Henry, M.D., No. 321 South Second street. Lazaretto Physician. — James S. Rich, M.D., Lazaretto. Quarantine Master. — John H. Cheyney, Lazaretto. Messenger.— Charles P. Thiesen, Redwood street, Ibelow Fifth street. Assistant Messenger. — Thomas Bedford, No. 42 Tammany street. Runner. — David Brown, No. 62 Gaskill street. STANDING COMMITTEES. No. 1.— SANITARY. Elkinton, Weer, Eldridge, Carpenter, B. Martin. Jewell, Wood. No. 2.— LAZARETTO. Duff, J. C. Martin, Evans, Delany, Logan, Christy, Simpson. No. 3.— ACCOUNTS. Wood, Duff, Delany, J. C. Martin, Goodwin. No. 4.— OFFICE. Weer, Eldridge, Carpenter. No. 5.— POTJDRETTE. Jewell, B. Martin, Elkinton, Simpson, Christy, Markley, Pleasants. No. 6.— BURIAL GROUNDS. Pleasants, Evans, B. Martin, Goodwin, Markley. No. 7.— BILLS OF MORTALITY. Logan, Goodwin. NUISANCES. No. 8. — N. W. District, S. Garden and Penn. Jewell, Carpenter, Wood, Logan. No. 9. — N.E. District, Kensington, Northern Liberties and Richmond. Eldridge, Evans, Delany, Goodwin. No. 10.— North City District. Duff, Weer, Elkinton, No. 11.— South City District. J. C. Martin, Lindsay, Markley. No. 12. — Southwark and Moyamensing. B. Martin, Simpson, Christy. No. 13.— West Philadelphia. Pleasants. rffcHi^4tA»flfi2j i STATISTICS OF CHOLERA: wit ft th:-: SANITARY MEASURES ADOPTED r.Y THE BOARD OF HEALTH PRIOR TO, AND DURING THE PREVALENCE OF THE EPIDEMIC IN PHILADELPHIA, IN THE SUMMER OF 1849. CHRONOLOGICALLY ARRANGED. Prepared by the Satr.tary Committee, approved by the Board, and ordered for publication. October 10th, 1849. I I i I PHILADELPHIA: KING & BAIRD, PRINTERS, No. 9 SANSOM STREET. 18 49. 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