< • - ** 1865-6. CITY DOCUMENT. No. 5. A REPORT UPON SUNDRY DOCUMENTS RELATING TO ASIATIC CHOLERA, TRANSMITTED BY THE GOVERNOR OF RHODE ISLAND, . TO THE BOARD OF HEALTH OF THE CITY OF PROVIDENCE. --< "t EDWIN M. SNOW, M. D SUPERINTENDENT OF HEALTH. P R O V I D 5 : N C E : THOMAS & CO., CITY PRINTERS H. H ISCI. CITY OF PROVIDENCE, In Board of Aldermen, Oct. 9. 1865. Read, whereupon it is — Ordered, that the same be received and printed in book form for the use of the City Council. SAMUEL W. BROWN, City Clerk. NrtiiuNAL Library of muii^hc --v BETHESDA 14, MD. ASIATIC CHOLERA To the Hon. the Board of Aldermen of the City of Providence : Gentlemen : — Certain documents* relating to the Cholera, and the measures necessary for its prevention, have been referred to me by your Board, concerning which I beg leave to report. These documents are, — First. A communication from the United States Legation at Constantinople to the Secretary of State of the United States, urging the authorities of this country to guard against the Cholera, immediately, by " the most rigid quarantine regulations." This communication encloses and endorses a newspaper article, in which the doctrine is stated and enforced, that cholera is contagious, and can be prevented by quarantine regulations, though it acknowledges that the quarantines of the East, (well known to be of the most rigid character,) have had no influence in preventing the spread of the disease. Second. A communication from the Acting Surgeon General of the United States, to the United States Secretary of State, recommending that the attention of the Governors of States be invited to the subject, " with a view to the prompt establishment of rigid quarantine regulations." Third. A communication from the United States Secretary of State to the Governor of Rhode Island, in which it is said that the " expediency of adopting quarantine measures, for the purpose of preventing the introduction of Asiatic Cholera into this country, seems well worthy of consideration." *S«« Appendix. fourth. A communication to your Board, from His Excellency the Governor of Rhode Island, enclosing the above named documents, and recommending " the adoption of every possible sanitary precaution to give our citizens every protection which prompt action can afford, agnnst this fatal epidemic. " All the documents referred to, except that of the Governor of Rhode Island, recommend the adoption of quarantine regulations to prevent the disease, and they recommend no other measures. The Governor of Rhode Island does not mention quarantine, but recommends all necessary sanitary measures. So far as the City of Providence is concerned, if quarantine regulations were of any value, they would be useless here while we have communication a dozen times daily with New York and other cities ; but there is no principle more certainly established in the minds of all intelligent observers of this disease, than that quarantine regulations are absolutely and utterly useless to prevent the introduction and spread of Asiatic Cholera. The cholera cannot prevail as an epidemic without the presence of a certain mysterious condition of the atmosphere. Of this atmospheric condition little is known ; but it is known that its presence or absence is not affected or regulated in the slightest possible degree by quarantine measures. Vessels may have the cholera on board, and may land the sick on our shores ; but the disease will never become epidemic, nor spread among the people until that mysterious atmospheric condition is present. But that atmospheric cause may come and may be present, and the disease may spread epidemically, without any connection with the arrival of vessels from ports where the disease exists. If not a single vessel should arrive in our ports during the next five years, it would not make a single day's difference in the presence or absence of the cholera as an epidemic. The city of Providence has had some peculiar and instructive experience in relation to quarantine measures for the prevention of cholera. On the appearance of the disease in this country, in 1832, a most rigid quarantine was established in Providence, not only for vessels from foreign ports, but also for steamboats and vessels from New York, and even for passengers by stage coaches. No person was permitted to come into the city within 4 ten clays after leaving any place where cholera existed. The quarantine was so rigidly enforced as to stop all direct communication with New York, and to excite the indignation of the country generally. Nothing of the kind would he possible, if desired, at the present day. But, at the same time, a most thorough sanitary examination and purification of the city was made. What was the result ? The cholera appeared here, and the first victims were four persons, in one house on Eddy's Point, who all died within two days. A most thorough investigation was made in relation to these cases, and the fact was established, that those persons had had no communication, directly or indirectly, with any person or thing, from any place where cholera existed. So much for the rigid quarantine. But the internal sanitary measures were so effectual that the cholera did not become epidemic here in that season, and but a few cases occurred ; and except in the first house where it appeared, there were not two cases in any one locality in the city. The doctrine stated so positively in the document from the United States Legation, at Constantinople, that cholera is contagious, is equally opposed to the opinions of physicians and others who have seen the most of the disease, and is calculated to work most serious injury, if fully believed, in any community where the disease exists. If the cholera was actually contagious, in the ordinary acceptation of the term, a panic would exist, and it would be difficult to obtain nurses, or medical attendance for the sick. But no intelligent medical observer of the disease in this country, at the present day, believes that cholera is contagious. I have, myself, in two epidemics of cholera in this country, seen a great number of cases of the disease, and have carefully observed and studied its causes and progress, and I may say, in common with many others who have made similar observations, that ive know that cholera is not contagious. So far then as relates to the documents, enclosed in the communication from the Governor, I cannot concur in their recommendations. On the contrary, I cannot but consider it unfortunate, and greatly to be regretted, that doctrines so injurious in their effects upon the community, should be given to the public 5 ASIATIC CHOLERA. aided by the natural and unavoidable influence of the high official stations from which the}' emanate. But the communication to your Board from the Governor of Rhode Island, recommends every possible sanitary precaution against the disease. With this we can all heartily concur, and if the cholera is coming to this country, there is much to be done. The cholera is preventible to a very great extent : much more so than most diseases which visit our cities. The causes of cholera are, first, the mysterious atmospheric condition of which we have spoken ; and second, local conditions of filth and impure air. The disease cannot prevail without the combined presence of these two causes. The first cause is beyond human control ; it advances and recedes in obedience to laws of which we know nothing : it crosses continents and oceans as freely as the winds of heaven, and it would be as reasonable to attempt to control the movements of the east wind, as to attempt to control the movements of this cause of cholera, by quarantine restrictions. But the second cause of cholera, and without which the first would be comparatively powerless for evil, is, to a very great extent, within our control, and here is where our duty lies. Looking to the city of Providence alone, the measures necessary for the prevention of cholera, may be divided into two classes ; first, those which, under the existing laws the State, and ordinances of the City, are within the control of the Board of Health or of the Superintendent of Health ; and second, those measures which require further action on the part of the Board of Health or of the City Council. The first class includes a thorough examination of certain localities in the city, the removal of filth from yards, and cellars ; the cleansing of tenement houses, the removal of families from over-crowded and unhealthy tenements ; the repair and cleansing of vaults, cesspools, and sink-spouts, and other measures of this description. The greater portion of the work necessary under this class of measures, can be as well done in the spring as now, and if done now, would be necessarily repeated in the spring. 6 The powers of the Board of Health, and of the Superintendent of Health, under the existing laws, are amply sufficient to do all that can be done under this head. Some additional assistance and expense may be necessary to carry out the laws effectually, and if so, I shall ask for such assistance at the proper time. I can assure your Board that I am fully awake to the importance of the subject, and that nothing will be left undone which it is possible to do. There is more of personal responsibility in this matter, than most of our citizens suppose. I can point out the precise localities in the city where the cholera would prevail if it visits us again ; can show the houses in which it would do its worst work ; can name the families and almost the individuals who would have the disease ; can show what there is in those localities, houses, families, and individuals, which would cause the disease ; and can show that these causes might be removed, and the disease prevented, by the proper action of the authorities, of the owners of the houses, and of individuals. If then, the authorities, the owners of houses, or individuals neglect their duty, on them must rest the responsibility for the consequences which may result. It is my intention to call the attention of the owners of these houses, individually, to this subject, in season for all necessary action. The second class of measures necessary in the city of Providence, includes those which require further action on the part of the City Council, or of the Board of Aldermen. There are certain nuisances and causes of disease which, on account of their magnitude, require more authority and expense for their removal than are within the control of any city officer. I may mention — First. The Cove basin and the Canal below Mill street. Of these the canal is the most dangerous, because the water is wholly fresh water, and it not changed by the action of the tides. There seemed to be, in 1854, abundant reason for believing that the condition of the canal, in the locality named, was one of the most efficient aids of the cholera, and was the cause of a large amount of sickness and mortality. The character of the contents of the canal has somewhat improved since that time ; but it will be decidedly dangerous to the public health, and 7 especially dangerous if the cholera is here, so long as any portion o its mud is exposed to the action of the sun. It ought to be cleanec out so that the water will cover every portion of its surface at al times. Whatever is done in this matter, should be done certainly before the middle of May. After that time it would be useless to prevent sickness, while the removal itself would be an active cause of sickness. Second. The Sewers. The foul air, arising from the street openings of the sewers, has been too generally observed, and too obvious to the senses of the whole community, during the past summer, to need any description. That this foul air is dangerous to the health of the people, and would be especially dangerous in a cholera season, is obvious to all. The sewers are nuisances, and must remain so without a complete and general reconstruction, which we cannot hope for at present. The only practicable remedy at this time, is the construction of stench traps, at the street openings to prevent the escape of the foul air which is generated in them. The construction of these traps should be done at once, and particularly in a few localities which are more dangerous than others. Third. The Streets. The total failure of showers, during the past summer, upon which it seems we have depended in past years to clean our streets, has shown us what terrible nuisances they may become when neglected. In many of the sultry days of July and August, the filth of the streets, moistened by the street sprinklers, and fermenting in the vertical sun, filled many portions of our city with a most nauseating and depressing atmosphere. This cause of sickness did not exist when the cholera was here in 1854, and there can be no doubt that if it is permitted to remain when the cholera visits us again, it will greatly increase the mortality of the city. As it is certain that private individuals cannot be depended upon to clean our streets, and as it is shown that showers sometimes fail to do it, it is to be hoped that the city government will do what is obviously its duty, and see that the experience of the past summer is not repeated. Fourth. The Sivine. I have recently presented a Report to your Board upon the subject of keeping swine in the city, 8 and have given the general reasons why it should not be permitted ; but in connection with the subject of cholera the subject acquires new importance, and in my opinion calls for immediate and efficient action in one particular locality. I will be brief. In 1854, there were 47 deaths from cholera on and near Fox Point Hill, or 30 per cent, of all the deaths from the disease, in the city. It was positively proved, at least to the satisfaction of all who were acquainted with the subject, that the hogs were the chief cause of these deaths in that locality. No one ever doubted it, and the City Government acted in accordance with this belief, and removed the hogs. At the present time, the locality north of India street, and east of Ives street, is in a worse condition in respect to keeping hogs, than Fox Point Hill was, in 1854. The hogs are more numerous, and the natural location in regard to ventilation is far worse. I have recently ascertained that there are about 200 hogs in that locality, and 350 in the whole portion of the city on the east side of the river. There can be no possible doubt that if the cholera should visit us next year, and these hogs are permitted to remain, that locality will be one of the chief centres of its prevalence, and with the hogs there, no amount of sanitary labor will be of any avail to prevent the disease. It is near the season of the year when the hogs can be removed without loss to the owners, and it seems to me th^t the interests of the city imperatively demand, that every hog should be removed from that locality, and that the pens should be destroyed immediately, so as to allow the filth to be washed away, and absorbed in the ground during the winter. Fifth. Water. Investigations made in England, show that impurities in the water used by the inhabitants for drinking purposes, are one of the chief causes of cholera. In past years the cholera, in this city, has been almost wholly confined to a few localities ; but there is reason to fear that, in consequence of the rapid deterioration of the water in many of our wells sinc»the last visitation of the disease ; combined with the impure air from our sewers and filthy streets, if the cholera shall visit us again, its ravages will be more generally spread through the city. ¦i 9 It is too late to remedy the want of pure water before another season ; but should the cholera reach us, I have no doubt that it will furnish our city most powerful reasons for the introduction of pure water as speedily as possible. Respectfully, EDWIN M. SNOW, Superintendent of Health. Providence, October Oth, 1865. Note. It may be proper to observe, that we have, as yet, no positive evidence that the cholera will be in this country next year. The disease has visited this country epidemically, three times ; in 1832, 1849, and 1854. It has, every time followed nearly the same course from India to the south-eastern part of Russia in Europe, thence through Russia, thence to Germany, thence to England. It has always reached England very soon after its appearance at Hamburg, and has always appeared in England in the fall of the year preceding its appearance in this country. This year, its course has been entirely different. It has not extended into Russia ; but has been confined to the shores of the Mediterranean sea, and we have no certain evidence that the disease has yet appeared in England. Judging solely from the experience of the past, we have then, as yet, no positive evidence that the cholera will be in this country next year. But we should not place too much reliance upon our very limited experience with a disease of this character, and we may, within a few days, have evidence of its progress which is wanting at present. We may rest assured that we sjiall have certain evidence in season for preventive sanitary measures ; and that, whether the cholera comes or not, such measures are always needed, and never fail in their beneficial effects upon the health of the people. 10 APPENDIX STATE OF RHODE ISLAND. Executive Department, Providence, Sept. 8, 1865. J To THE BOAHD OV HEALTH, of the City of Providence, R. I. Gentlemen : — I beg to call your immediate and earnest attention to the enclosed copies of communications just received from the Department of State at Washington, touching the necessity of adopting prompt and stringent measures to prevent the introduction of Asiatic Cholera into our State. I respectfully request and recommend that your Council give this subject their most careful attention without delay, which might be dangerous, and by adopting every possible sanitary precaution, give our citizens every protection which our prompt action can afford, against this fatal epidemic, which has spread such terror through Eastern Europe, and which is evidently rapidly travelling toward the "West. It will be considered a favor if the action taken by your Council is reported to this Department, so that I may make a report to the Hon. Secretary of State at an early date. JAMES Y. SMITH, Governor of Rhode Island. DEPAETMENT OF STATE. Washington, Ist September, 1865. To His Excellency the Governor of the State of Rhode Island, Providence. Sir: — Your Excellency's serious attention is invited to the accompanying letter of the Acting Surgeon General of the Army, to whom the despatch from the United States Minister at Constantinople, which it mentions, was referred. The expediency of adopting quarantine measures, for the purpose of preventing the introduction of Asiatic Cholera into this country, seems well worthy of consideration. I have the honor to be Your Excellency's obedient servant, WILLIAM H. SEWARD. SURGEON GENERAL'S OFFICE, Washington City, D. C, ) August 29, 1865. ( Hon. William H. Seward, Secretary of State : Sir :—ln: — In the absence of the Surgeon General, I have the honor to acknowledge the receipt of your communication of the 24th instant, enclosing despatch from Mr. Morris, Minister Resident of the United States at Constantinople, relative to the ravages of the Cholera in that quarter, &c, and would most respectfully recommend that the attention of the Governors of States be invited to the facts contained therein, with a view to the prompt establishment of rigid quarantine regulations, to prevent, if possible, the introduction of Cholera into this country. The despatch from Mr. Morris, and enclosed paper, are herewith respectfully returned. Very respectfully, your obedient servant, C. H. CRANE, Acting Surgeon General. 12 LEGATION OF U. S. OF AMERICA, Constantinople. Hon. William H. Seward, Secretary of State Sir : — I have the honor to acknowledge the receipt of despatch No. 90. I regret to be obliged to state that the Cholera continues to extend its ravages, otwithstanding the efforts making by the Government to arrest its progress. Vhatever may be the opinion of medical men, it is evident that it is propagated >y contagion, as it fixed itself in the locality where the first deaths from an Egyptian man-of-war took place, and has thence gradually extended itself over le Christian quarter of Pera, and through Stamboul, (Constantinople proper.) n the most infected region, Cassim Pacha, where it originally broke out — a uarter inhabited chiefly by workmen connected witli the navy yard, and situaed in a low valley, encompassed by high hills, with imperfect drainage — it has >een very fatal, having attacked almost the entire population. Such have been s ravages there that the Government has ordered all the large khans and •uildings, occupied by many persons together, to be vacated, and has provided ents for them on the heights surrounding the city. I Had proper quarantine measures been taken at first, the introduction of the holera from Egypt might have been prevented. It seems to me, from our :perience here, that it will be advisable in the United States to guard against by the most rigid quarantine regulations. Otherwise, if it once enters the mntry, it will be very fatal, in consequence of the great destitution prevailing Virginia and other of the Southern States, and of the diseases which always How in the train of war. The published number of deaths per day now is about one hundred and sixty but they are known to largely exceed that number. The whole number of deaths from the origin of the disease to the present time is about two thousand. A great panic prevails among the population, particularly the Christian portion of it, and people are fleeing by thousands in every direction from the city. It is hoped, however, that the sanitary measures adopted by the Government, and pursued with great energy, will have the effect sooner or later to arrest the epidemic. With great respect, your obedient servant, E. JOY MORRIS. 13