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DRiEIPOIRT 
 
 The Prevention of Cholera, 
 
 J. H. RAYMOND, M. D, 
 
 Commissioner of Health 
 OIF THE OIT-5T OF BROOKLTN", 
 
 — TO THE — 
 
 Conference of State and MuniciDal Boards of flealtli 
 
 WASHINGTON, D. O., 
 
 December i o, 1884. 
 
T . C3 
 
 ~Rz 
 
 A conference of State and JIunicipal (Boards of 
 Health, was held in Washington, (2). C, (X>eeember 
 10, to consider the subject of Cholera, with reference 
 to Us threatened appearance in this country in 188c. 
 and to adopt measures to prevent Us entrance, if 
 possible: or should these 'oe unsuccessful, to reduce 
 its ravages to the minimum. Health Officers were 
 requested to present reports stating what had 'ceo:: 
 done in their respective localities to prepare for its 
 probable advent. In response- thereto the following 
 report was prepared ana read at the Conference. 
 
 JT. (B. — In an Addendum, numbered pages 10a 
 and 10':. will be found He propositions adopted by 
 the Conference. 
 
Form 34, C. 
 
 DEPARTMENT OF HEALTH. 
 
 Brooklyn, Dec. 4tli, 1884. 
 
 To the lit i>r> s< //tali res of Slate and Municipal lion ids of 
 
 //< alth : 
 
 Gentlemen :— In accordance with your requesl I beg 
 herewith to submit a report of the work of the Departmenl 
 of Eealth of the city of Brooklyn with reference to placing 
 the city in a proper condition to meet the probable advent 
 of cholera the coming summer. 
 
 WATER SUPPLY. 
 
 Two years ago there existed within the city of Brook- 
 lyn three hundred and sixteen pump-wells. These were 
 the ordinary surface wells dug to a sufficient distance in the 
 earth to reach water, this distance varying from fifteen to 
 one hundred feet. An analysis of the water of these wells 
 showed that of this whole number but seventeen furnished 
 water fit for human consumption ; of the entire number 
 three hundred and seven have, upon the recommendation 
 of this Department, been filled by order of the Common 
 Council, leaving but nine in the city^. And these it is to 
 be hoped the Common Council will close during the present 
 winter; if not, should cholera come, they will be closed 
 by this department. Having thus done away with a possi- 
 ble agent in the spread of cholera, namely, the impure 
 water furnished by surface wells, the attention of the De- 
 partment was next drawn to the sources of the Ridgewood 
 water supply, the only other water supply of the city, and 
 investigation is now being made by representatives of the 
 Departments of Health and City Works, which will show 
 to what extent, if any, this water supply is imperilled, and 
 immediate steps will be taken to remove all possible 
 sources of contamination. This being done it may be safely 
 assumed that Brooklyn need have no anxiety for the 
 spread of cholera through its water supply. 
 
 PONDS. 
 
 Cholera has appeared in Brooklyn as an epidemic 
 three times since the year 1848. The last epidemic oc- 
 curred in the year 1866, and resulted in the death of 517 
 inhabitants. The population of the city at that time was 
 three hundred and thirteen thousand, about one-half its 
 population at the present time. The disease appeared 
 most prevalently and most fatally in the Twelfth Ward. 
 This section of the city is one which is, to a great extent, 
 composed of tilled in ground, being originally covered by 
 salt. water, with marshes and islands interspersed. In the 
 improveraenl of this pari of the city, streets have been 
 constructed. Leaving between them ponds of water, which 
 being stagnant, became offensive. This was the condi- 
 tion of things in 1866. Why the disease attacked thispor- 
 
tion of the city more than any other it is difficult now to 
 say ; but I find in looking over the records that special 
 mention is made of a pump situated upon Van Brunt street, 
 which was looked upon by the health dfficials at that 
 time as being largely instrumental in the spread of the dis- 
 ease in that section of the city. There is no doubt about 
 one thing, whatever else may be said, and that is, that this 
 section of the city was at that time water-soaked, and thus 
 probably was adapted to the propagation of any germs that 
 found a lodgment there. Since that period very many of 
 these ponds have received from time to time a certain 
 amount of filling, but not enough to completely obliterate 
 them. Last summer (1884) special effort was made to fill 
 these ponds, and also all others in the city. Fifty-five 
 ponds have thus been filled at an expense of $26,721. It is 
 a source of gratification to me that all the filling of lots 
 during this past summer by the Department of Health, has 
 been with clean material entirely free from garbage, and 
 in every way unobjectionable. 
 
 At the present time there exists in this section of the city 
 but one pond, and measures have been taken which will 
 before the advent of spring, cause this one also to be com- 
 pletely filled. 
 
 The same action which has been taken in the Twelfth 
 Ward has been followed throughout the city generally, so 
 that we have to-day in the city of Brooklyn but six ponds 
 which will be likely in any wa}' to serve as abettors in the 
 propagation of the disease, should it come, and action has 
 been taken in reference to these which will result in their 
 abatement during the present winter. 
 
 PRIVY VAULTS. 
 
 The first census, so far as I am aware, that was ever made 
 of the privjf vaults of Brooklyn was made at the request of 
 the Department of Health by the Police of the city in the 
 year 1878. At that time there were twenty-five thousand 
 privy vaults in the city. Of this number fourteen thou- 
 sand were known as not water tight; that is built with stone 
 as a rule loosely placed together, without cement, and with 
 no attempt to prevent soil saturation. In addition to these 
 there were eleven thousand vaults which were nominally 
 water tight, and were constructed in accordance with the 
 Ordinances; that is, they were built of brick and cement 
 and were connected with the sewer. For several years 
 this department has been earnestly striving to eradicate 
 from the city every privy vault which could be eradicated, 
 and to-day every one which is upon a sewered street 
 which is not legally constructed, is under orders for its aboli- 
 tion. During the past six years several thousand have been 
 abolished, just how many it is impossible to say at 
 the present time as the figures are now being 
 made up. We have up to this time been un- 
 able to proceed against the legally constructed 
 privy vaults, eleven thousand in number. Attempt have 
 been made by the department to have the Ordinances so 
 
altered as to entirely do away with all privy vaults, when 
 located upon Lots adjacent to existing sewers. These efforts 
 
 have thus far been unsuccessful. A communication is now 
 before the Common Council of this city, calling their alien 
 lion to the danger connected with vaults of this kind, per- 
 mitting, as they do, human excrement to accumulate and 
 decompose, and to serve as a.nidus for the germs of disease, 
 and requesting the repeal of the existing Ordinance and its 
 substitution by one which will not only prevent the farther 
 construction of these vaults, but will require the abolition 
 of those now existing ; and also requiring that where privy 
 vaults are built upon lots in streets where sewers do not 
 exist, such vaults shall be built so as to prevent all possi- 
 bility either of the contamination of the soil or of the 
 porous material of which the vault is built. It may be 
 said, in passing, that in new houses no privy vaults of any 
 kind are permitted where sewers exist, only water closets 
 are allowed.* 
 
 The communication to the Common Council in reference 
 to this matter is hereto appended, and in this will be found 
 in detail the reasons for this recommendation. Special 
 arrangements have already been made with the Police De- 
 partment by which all the privy vaults of the city will be 
 inspected at least once a month, and immediate steps taken 
 by the Health Department to abate any nuisances that may 
 be found. If the desired change above referred to is made 
 in the Ordinances, and all vaults abolished which will thus 
 be rendered illegal, the number remaining will be so small 
 as to permit an examination as - often as twice or even three 
 times each month. These reports of the condition of the 
 vaults will be followed up by disinfecting officers from the 
 department, who will attend to the disinfecting of the con- 
 tents of these vaults. The officers of the department will 
 thus be enabled to disinfect and keep disinfected the con- 
 tents of all vaults. 
 
 NIGHT SOIL. 
 
 Under the present arrangements night soil is collected 
 from the vaults in a manner which is free from objection. 
 
 The removal is effected only during daylight, when any 
 nuisances connected therewith could easily be seen, and 
 after thorough disinfection of the material ; the apparatus 
 employed is that which is known as "Odorless," so that 
 there is no improvement which could be suggested in the 
 method by which night soil is now removed from the vaults 
 of this city. For the past few years, since the use of the 
 dock at the Wallabout was abandoned for the removal of 
 night-soil and dead animals, the night-soil which has been 
 collected in Brooklyn, has been removed to the country and 
 deposited upon farms, and utilized as a fertilizer. Before 
 permission was given to the scavengers to thus dispose of 
 
 *Rule 17. On Stkeetk that are Sewered. — All buildings that are 
 located upon a street in which a public sewer exists, must he provided with 
 water closets, either in the house or yard ; privy vaults will not he permitted 
 when a public sewer exists in the street. 
 
the night-soil, it was required of them that they produce 
 the permission of the owner of the farm, and also a permit 
 from the Board of Health of the town in whifch the farm was 
 situated. It was believed that these requirements would 
 prevent the establishment of any nuisances ux^on neighbor- 
 ing towns. This system has now been in vogue for three 
 years and the amount of night-soil which has been thus dis- 
 posed of is not far from five hundred thousand cubic feet. 
 Should cholera come it would probably be necessary to 
 otherwise dispose of this material, and arrangements would 
 have to be made to carry it to sea. 
 
 SEWERS. 
 
 The condition of the sewers of Brooklyn as to cleanliness 
 was probably never better than it is at the present time. 
 The Commissioner of City Works, through his competent 
 Superintendent of Sewers, has given this matter great at- 
 tention, and I am persuaded that the reduction in zymotic 
 diseases which has occurred in Brooklyn during recent 
 years is in no slight degree due to this condition of the 
 sewers. Special attention will be given to the sewers of 
 those localities in which cholera may appear to see that 
 they are kept cleansed and well flushed. 
 
 MEDICAL INSPECTION". 
 
 The residences of the Medical Inspectors of the Health 
 Department, twelve in number, will be connected by tele- 
 phone with the Health Office, so that all reports of cases 
 which are received can be at once communicated to them 
 and receive prompt attention. In addition to the regular 
 corps of Medical Inspectors, arrangements have been made 
 by which a special corps of physicians will be appointed, 
 whose duty it shall be to visit regularly all tenement houses, 
 a list of which is on file in this office, and all localities where 
 people are likely to be without medical assistance, with the 
 object in view of administering remedies for the premoni- 
 tory diarrhoea, and disinfecting infected clothing and fumi- 
 gating infected premises. The methods of disinfection 
 and fumigation at present practiced are those adopted by 
 the National Board of Health in 1879, and recommended by 
 our State Board of Health. Sulphur, sulphate of zinc, com- 
 mon salt and copperas are the principal agents employed ; 
 in the present aspect of sanitary science the bichloride of 
 mercury might with advantage be added to this list, as has 
 already been done by some Boards of Health, notably that 
 of Boston. The necessity for a thorough reexamination of 
 disinfection and disinfectants was duly appreciated by the 
 American Public Health Association at its recent meeting 
 in St. Louis, and a committee which was then appointed, is 
 now at work upon this important subject. 
 
HOSPITALS. 
 
 It is difficult, previous to the advent of the disease, to 
 Incite hospitals, inasmuch as such buildings should be situ- 
 ated in the immediate locality affected, it having been 
 abundantly proved thai the removal of persons sick with 
 cholera to a longdistance from their homes is very injuri- 
 ous and has, in no small number of cases, contributed to a 
 fatal termination. It may also be questioned whether a 
 better plan than a general establishment of hospitals would 
 not be to vacate the infected houses; that is, to leave 
 within them only the sick, and to require those that are 
 well to seek refuge elsewhere,* for a house which becomes 
 infected by the sick person is, as is well known, a house 
 that will infect those that are well. It will of course be 
 necessary to have some hospital provision made for persons 
 who are unable, through poverty or other cause, to obtain 
 the necessary nursing and care at their own homes ; but I 
 question very much whether a general removal of infected 
 persons from their homes to hospitals is a wise measure. 
 
 In this connection permit me to call attention to the re- 
 markable results reported by Edwin Chadwick, Esq., C.B., 
 in his address entitled, " Precaution against Cholera," and 
 reproduced in the Appendix to this report. In the last 
 epidemic of cholera which fell upon Limehouse, he says 
 that the children of the pauper half-time school were dis- 
 tinguished by their entire exemption from any choleraic 
 attack, and attributes this exemption to careful head-to- 
 foot washing with tepid water. He gives also other strik- 
 ing instances of the comparative immunity which personal 
 cleanliness confers on individuals, not only in times of epi- 
 demics but under ordinary circumstances. His observa- 
 tions are well worthy of careful perusal, and of adoption, 
 not only by the managers of public institutions but also by 
 individuals. 
 
 ITALIAN QUARTERS. 
 
 Special attention has been o-iven to the quarters occupied 
 by Italians, of which people there are in Brooklyn, upon the 
 lowest estimate, ten thousand. Few of these can speak Eng- 
 lish, and to accomplish anything in the way of sanitary 
 improvement among them requires the constant efforts of 
 one of their own nation. Such an inspector has been en- 
 gaged in this duty for several months, and will be contin- 
 ued in the work. The nature of the employment of this 
 portion of our population is such as to bring them con- 
 stantly in contact with rags, bones, and all manner of tilth 
 which, unless watched, they bring to their homes and accu- 
 mulate in large quant it ies. 
 
 The accumulation of rags is one which should be kept 
 under the surveillance of health departments and an ordi- 
 
 *In this connection see " Precautions against Cholera," an address delivered 
 in August, 1884, by Edwin Chadwick, Esq. C. B., and especially the extracts 
 given in the appendix to this report. 
 
nance lias been asked for in Brooklyn to prohibit the storing 
 of them except in such localities as are approved. 
 
 LODGING HOUSES. 
 
 Brooklyn has, at the present time, nine cheap lodging 
 houses, containing in all five hundred and thirty two beds. 
 In these houses congregate a large portion of the poor float- 
 ing population of the city. Coming from vessels lying at 
 the dock, or from neighboring cities, some are quite regu- 
 lar in their attendance, while others come to-night and are 
 gone to-morrow. These houses have been thoroughly ex- 
 amined from cellar to attic, and where defects of sewerage 
 or ventilation have been found, they have been corrected. 
 The disinfecting officers are at work, disinfecting and fum- 
 igating them throughout, and the sanitary inspectors have 
 been directed to visit them frequently and keep close watch 
 upon them. The proprietors have been summoned to the 
 Health office, and instructions have been issued to them 
 which will result in keeping these buildings in good con- 
 dition, and in making us aware of the existence of any sus- 
 picious sickness. 
 
 LAUNDRIES. 
 
 The number of cases of cholera which have occurred from 
 washing infected clothing, suggests that precautions should 
 be taken in every public laundry. These establishments 
 receive clothing from unknown sources and are the means 
 of spreading the disease. The idea has occured to me that 
 if proper disinfecting solutions should be kept upon these 
 premises, and the proprietors be required to soak all cloth- 
 ing that was received .in this solution, immediately upon 
 its receipt, before washing, the danger of the spread of in- 
 fection from this source might be avoided. Or some method 
 of applying dry heat of sufficient intensity might be deemed 
 more efficacious, or both combined. 
 
 FOOD SUPPLY. 
 
 It is conceded that the food supply during the times of a 
 cholera epidemic is an important agent in the predisposition 
 of individuals to attacks of the disease. Koch, if I mistake 
 not, calls attention to the greater liability of contracting the 
 disease, when from any cause the alimentary canal is in an 
 abnormal condition. Whether this is true or not we know 
 that when the body is properly nourished, individuals are 
 more able to withstand attacks of disease and even to 
 escape them, than when, from any cause, they are in a de- 
 bilitated condition. With this in mind, special attention 
 has been given to the food supply of Brooklyn during the 
 past summer. My experience leads me to the conclusion 
 that a very much greater proportion of diseased animals 
 is slaughtered and the meat of the same put upon the 
 market than is commonly believed. During the past Sum- 
 mer inspectors have been stationed at the slaughter houses 
 
with reference to this detection of impure meat, and 
 fchey have thus been enabled to discover and condemn 
 meat which would otherwise have found its way into 
 the market. In one of our large cities, at a nol very distant 
 date, scores of carcasses of immature veal were exposed for 
 sale in the public market, and it was the opinion of men 
 competent to decide that some of I hese calves had come into 
 the world only a day or two before, and that others had 
 been born dead. The effect of such meat upon the health 
 of those unfortunate enough to eat it can readily be sur- 
 mised. And here let me say that, in my judgment, no in- 
 spection of meat can be of much value unless it occur at 
 the slaughter-house, and before the viscera have been re- 
 moved. Many cases of tuberculosis and of contagious 
 pleuro-pneumonia have been detected by the inspectors who 
 were able to interrogate the lungs before they were removed 
 from the animal, which would have passed a most rigid in- 
 spection had an examination of the carcass alone been 
 relied upon. No statistics, so far as I am aware, have ever 
 been collected in this country of the amount of tuberculosis 
 in our cattle. In the abbatoir of Munich in 1875, out of 
 55,882 head of cattle, 704 were tuberculous. It has been 
 estimated that nearly six per thousand of the cattle of 
 Bavaria are thus affected ; and Fleming assumes that rive 
 per cent, of the cattle of Great Britain are affected with 
 tuberculosis. The milk supply of large cities is also one to 
 be specially kept under observation during epidemics ; and 
 this not only because there is danger of milk from diseased 
 cows finding its way into the market, but because a large 
 amount of milk furnished in our cities is adulterated with 
 more or less water. 
 
 This water is, as a rule, from the ordinary water supply 
 of the farm or of the stable, and is liable to be impure, and, 
 just as infected water may communicate disease to those 
 who drink it, just so may milk, adulterated with infected 
 water, be the means of conveying disease. The adultera- 
 tion of milk with water, therefore, is to be looked upon as 
 something more than an ordinary adulteration affecting the 
 pocket of the consumer, and something more even than 
 one depriving the growing child, depending upon it for its 
 support, of a large portion of its nutrition ; it may be a 
 means of conveying cholera as it has time and again com- 
 municated typhoid fever. Courts, therefore, when com- 
 plaints are made before them of selling milk adulterated 
 with water, should have their attention specially directed 
 to this danger, and asked to impose the heaviest penalties 
 which the law allows. 
 
 Attention to the sanitary condition of cow stables is also 
 very important. If the urine and excremenl are permitted to 
 accumulate and putrefy, either within the stable or its im- 
 mediate vicinity, the milk will almost certainly be affected. 
 Everyone is familiar with the remarkable absorptive power 
 of milk, and the facility with which it undergoes decompo- 
 sition. The atmosphere of a filthy cow stable, laden as it 
 is with putrefactive germs, cannot but act deleteriouslj 
 upon the milk exposed therein. 
 
8 
 
 To further carry out the object of protecting the milk 
 suppty, a critical examination by qualified veterinarians 
 has been conducted, for the past six months^into the con 
 dition of the milch cows of the city, and measures have 
 been put into execution with reference to the eradication 
 of tuberculosis and contagious pi euro-pneumonia, believing 
 that milk from animals thus affected is highly injurious, 
 and that the continuance of such animals in a herd casts 
 suspicion on all the milk produced. Arrangements are 
 now being perfected for the establishment of a quarantine, 
 to which will be sent all affected cows, where they will be 
 kept under the supervision of the health authorities until 
 it is deemed proper for them to return to the herds from 
 which they came. 
 
 It seems unnecessary to call attention to the necessity 
 for special effort in guarding the public against immature 
 or unripe vegetables and fruit, in times of cholera ; this is a 
 work which will suggest itself to every sanitary officer, and 
 therefore needs but an allusion here. 
 
 QUARANTINE. 
 
 Brooklyn, in common with other cities, must depend in 
 great measure for its protection from cholera upon the 
 Quarantine Authorities. The present arrangement by 
 which our water front is constantly patrolled by the police 
 renders it almost impossible for a vessel from an infected 
 locality to come to our docks and unload its cargo with- 
 out first obtaining the permit of the Health Officer of the 
 Port. It is of course among the possibilities that infected 
 material may reach the city in trunks or packages which 
 have found their way into our country through some other 
 port than the Port of New York ; but I feel that if we can 
 exclude from Brooklyn all cases and infected goods that 
 find their way by ship to the Port of New York, we will be 
 able to keep the disease from obtaining a foothold in our 
 city. The people of Brooklyn fully appreciate the diffi- 
 culties under which the present Health Officer, Dr. Wil- 
 liam M. Smith, labors, and take this opportunity to ex- 
 press that appreciation and to commend his watchfulness 
 and painstaking care ; and we assure him that any and 
 every effort which he may make, however arbitrary, with 
 the object of protecting the two million residents of New 
 York and Brooklyn, will be sustained. 
 
 We would also importune the Legislature of the State of 
 New York to withhold no means needed to uphold the 
 Health Officer in perfecting the Quarantine Station and its 
 appliances in the Harbor of New York. 
 
 I beg leave to submit to the Conference for its considera- 
 tion and ratification, if approved, the following proposi- 
 tions : 
 
 First. — That all surface wells should be closed at the 
 earliest possible moment, and that great care should be 
 
9 
 
 taken that the water supply of all cities, towns and vil- 
 lages shall be of undoubted purity. 
 
 Second. — That all privy vaults should be abolished 
 wherever water-closets can be supplied, and that wher- 
 ever the existence of such vaults is necessary thai they 
 should be rendered water-tight in such a manner as to pre- 
 vent the saturation, not only of the ground surrounding 
 them, but also of the materials of which they are built, and 
 thai the contents of such vaults should be kept constantly 
 disinfected, and removed to a proper place at frequent in- 
 tervals. 
 
 Third. — That all stagnant ponds should be disinfected, 
 and when possible the water removed by drainage or pump- 
 ing, and the further accumulation prevented by filling with 
 fresh earth or other material free from garbage or other 
 filth. 
 
 Fourth. — That great care should be exercised to keep at 
 all times clear and free from obstruction all sewers, into 
 which passes the refuse from dwellings, factories and 
 other buildings, and that such examinations should be 
 made as will detect imperfect plumbing in all buildings 
 and the defects immediately corrected. 
 
 Fifth. — That extraordinary care should be exercised in 
 reference to all tenement houses, lodging-houses, and in 
 general, all places where large numbers of human beings 
 congregate, that no accumulation of garbage or other filth 
 be permitted in cellars or yards, and that frequent and 
 thorough cleaning and white washing of such structures be 
 required ; and that householders should frequently and 
 thoroughly examine their yards, cellars, closets and other 
 out of the way places, to see that no filth of any kind has 
 been deposited there. 
 
 Sixth. — That the food supply be vigorously watched to 
 exclude from the market all unwholesome meat; all milk 
 adulterated or from diseased animals; and all unripe fruits 
 and vegetables ; and that cow-stables be kept, at all times, 
 clean, well whitewashed and free from all excremental ac- 
 cumulations. 
 
 Seveiitli. — That all garbage, kitchen and household re- 
 fuse should be promptly removed from dwellings, stores 
 and other buildings to a proper place where it may be de- 
 stroyed by fire or otherwise disposed of in such manner as 
 to occasion no nuisance. 
 
 Eighth. — That such material should never be used in the 
 filling of lots or disposed of by throwing the same in streets 
 or vacant property where it may decompose and exhale of- 
 fensive and deleterious gases. 
 
 Ninth. — That in view of the practical results reported by 
 that eminent sanitarian, Edwin Chadwick, Esq., C. B., the 
 
10 
 
 authorities of all public institutions, and individuals as 
 well, have their attention drawn to the great importance of 
 the personal cleanliness of the persons committed to their 
 charge, as one of the most efficient means of warding off an 
 attack of cholera, and of reducing its force when once it 
 has appeared. 
 
 Tenth. — That all authorities of states, cities or villages 
 be urged to adopt measures which will result in the amelio- 
 ration of all conditions such as have been referred to in the 
 foregoing propositions, with the warning that in the opinion 
 of this conference such conditions if permitted to continue 
 will greatly promote the spread of cholera when it comes, 
 and with the assurance that if requisite measures are 
 promptly taken to remove them, the disease will be less 
 likely to attack a community so prepared, and if attacked 
 such a community will be better able to cope with the dis- 
 ease and to reduce its ravages to a minimum. 
 
 CONCLUSION. 
 
 In concluding this report, permit me to direct attention 
 to the importance of this conference which is now assem- 
 bled in convention. In my judgment it is the most impor- 
 tant, from a sanitary standpoint, which has ever convened 
 in the United States, and to its deliberations the attention 
 of the whole country is directed. From it will be expected, 
 in concise and available form, recommendations by which 
 communities may prepare themselves for the threatened in- 
 vasion, and methods for its control when once it has ap- 
 peared. It behooves us, therefore, to proceed with great cau- 
 tion, and to consider carefully and thoroughly all sugges- 
 tions which may be made, and if need be to assemble again 
 at an early date to adopt what in the wisdom of this con- 
 ference may seem best, so that when our labors are com- 
 pleted we may issue to the public such a plan as shall meet 
 its wants and be recognized by medical and other men of 
 science as having its foundation in the most advanced knowl- 
 edge now attainable, and competent to meet the ends for 
 which it was prepared. 
 
 - Kespectfullv, 
 
 J/H. RAYMOND, 
 
 Commissioner of Health. 
 
10a 
 
 ADDENDUM. 
 
 The ten propositions printed on pages 8 to 10 of this 
 pamphlet were, on motion, referred by the Conference to 
 the proper Committee, and by them carefully considered. 
 This Committee reported them back, with amendments, 
 and the following eleven propositions were unanimously 
 adopted by the conference : 
 
 First. — That all surface wells should be closed at the 
 earliest possible moment, and that great care should be 
 taken that the water supply of all cities, towns and vil- 
 lages shall be of undoubted purity. 
 
 Second. — That all privy-vaults should be abolished 
 wherever waterclosets can be supplied, and that wher- 
 ever the existence of such vaults is necessary that they 
 should be rendered water-tight in such a manner as to pre- 
 vent the saturation, not only of the ground surrounding 
 them, but also of the materials of which they are built, and 
 that the contents of such vaults should be kept constantly 
 disinfected, and removed to a proper place at frequent in- 
 tervals. 
 
 Third. — That all stagnant ponds, when practicable, 
 should be disinfected, and when possible the water re- 
 moved by drainage or pumping, and the further accumula- 
 tion -prevented by filling with fresh earth, or other material 
 free from garbage or other filth. 
 
 Fourth. — That great care should be exercised to keep at 
 all times clear and free from obstruction all sewers, into 
 which passes the refuse from dwellings, factories and 
 other buildings, and that such examinations should be 
 made as will detect imperfect plumbing in all buildings 
 and the defects immediately corrected. In this connection 
 special attention is directed to the necessity for the 
 thorough ventilation of all soil and waste-pipes, and to the 
 dangers connected with un trapped and unfiushed soil- 
 waste and overflow-pipes. 
 
 Fifth. — That extraordinary care should be exercised in 
 reference to all tenement houses, lodging houses, and in 
 general, all places where large numbers of human beings 
 congregate, that no accumulation of garbage or other filth 
 be permitted in cellars or yards, and that frequent and 
 thorough cleaning and whitewashing of such structures be 
 required ; and that householders should frequently and 
 thoroughly examine their yards, cellars, closets and other 
 out of the way places, to see that no filth of any kind has 
 been deposited there. 
 
10b 
 
 Sixth. — That the food supply be vigorously watched to 
 exclude from the market all unwholesome meat ; all milk 
 adulterated or from diseased animals; and all unripe fruits 
 and vegetables ; and that cow stables be kept,«»at all times, 
 clean, well whitewashed and free from all excremental ac- 
 cumulations. 
 
 Seventh. — That all garbage, kitchen and household re- 
 fuse should be promptly removed from dwellings, stores 
 and other buildings to a proper place, where it may be de- 
 stroyed b}^ fire or otherwise disposed of in such manner as 
 to occasion no nuisance. 
 
 Eighth. — That such material should never be used in the 
 filling of lots or disposed of by throwing the same in streets 
 or vacant property where it may decompose and exhale of- 
 fensive and deleterious gases. 
 
 Ninth. — That the attention of the authorities of all in- 
 stitutions, both public and private, and of individuals as 
 well, be drawn to the great importance of maintaining a 
 habit of personal cleanliness in the persons under their 
 charge s as being one of the most efficient means of warding 
 off an attack of cholera, or if it has once appeared, of 
 greatly reducing its virulence and fatality. 
 
 Tenth. — Should the cholera appear in any place in this 
 country, the health authorities of the place should have 
 immediate notice of the first cases in order that prompt 
 action may betaken for complete isolation and disinfection. 
 
 Eleventh. — That all authorities of states, cities or villages 
 be urged to adopt measures which will result in the amelio- 
 ration of all conditions such as have been referred to in the 
 foregoing propositions, with the warning that, in the opinion 
 of this conference such conditions, if permitted to continue, 
 will greatly promote the spread of cholera when it comes, 
 and with the assurance that, if requisite measures are 
 promptly taken to remove them, the disease will be less 
 likely to attack a community so prepared, and if attacked, 
 such a community will be better able to cope with the dis- 
 ease and to reduce its ravages to a minimum. 
 
APPENDIX. 
 
 EXTRACT FROM THE MINUTES OF THE BROOKLYN COMMON 
 
 COUNCIL, 
 
 November 24th, 1884. 
 
 From Department of Health : 
 
 Department of Health, 
 November 24th, 1884. 
 
 To the Honorable the Common Council : 
 Gentlemen : 
 The experience of this department concerning the privy- 
 vanlts, as existing in this city, is snch that they can only 
 be regarded as a constant danger to the public health, and 
 more esrjecially are they to be feared in times of threatening 
 pestilence. It appears to the Commissioner that the time 
 has now fully come when vaults of every description should 
 be abolished in localities where the streets are sewered, in 
 order that excremental matter may be at once carried away 
 from human habitations, rather than to longer permit its 
 accumulation and decomposition so near to the dwelling and 
 sleeping rooms of citizens as that the ah' of these rooms can 
 be rendered impure and a source of danger to health. 
 
 With this is forwarded a circular, in which the reasons 
 for this opinion are more fully set forth, and to which is 
 asked your careful attention and consideration. 
 
 circular of information. 
 
 Department of Health of the city of Brooklyn, ) 
 
 Office of the Commissioner, V 
 
 Municipal Department Building. ) 
 
 In consequence of frequent inquiries made at this Depart- 
 ment, concerning the best sanitary disposal to be made of 
 night-soil within the city, the following circular of informa- 
 tion has been drawn up, giving the experience of this and 
 other Health Offices as ito the safest methods of getting rid 
 of human waste. That which follows in quotation marks 
 is essentially a reprint from an article prepared by Dr. J. 
 H. Raymond, Commissioner of Health, for the American 
 Public Health Association, at its meeting held at Detroit, 
 in 1883 : 
 
 " Privies are of four kinds : First, The simple excavation 
 in the earth, either with or without sides of plank or loose 
 stones, so constructed as to facilitate the soaking away into 
 the surrounding soil of the liquid portion of the tilth, and 
 thus avoiding the too frequent demands upon the purse of 
 the owner in its emptying. The earth about such vaults 
 soon becomes saturated with the excrementitious matter 
 deposited in them, and these impurities are by the ' ground 
 
12 
 
 water' carried farther and farther into the soil, thereto de- 
 compose and give off pernicious gases ; or to find their way 
 by percolation into the neighboring well, tg pollute the 
 water therein contained. It has been frequently observed 
 that when the cobblestone privy-vault is being emptied 
 the excrement which was forced into the interstices between 
 the stones when the vault was full, oozes back again into 
 the vault, thus showing that this ground soakage is not an 
 imaginary evil. 
 
 "It is quite a prevalent idea that such vaults are unob- 
 jectionable, because it is said that earth is a disinfectant, 
 and that such vaults are practically earth-closets. It is 
 hardly necessary to say that this claim cannot be sustained. 
 The analogy between the yard-vault and the earth-closet 
 would be more exact if in 'the earth-closet the same earth 
 was used over and over again. This we know cannot be 
 done, as when it is once saturated its deodorizing power is 
 exhausted. 
 
 " Another kind of vault is what is commonly denomina- 
 ted the 'water-tight' vault. This is similar to the one just 
 described, save that it is constructed on sides and bottom 
 with brick laid in cement. This method of construction is 
 adopted to prevent the ground soakage referred to. But 
 another evil arises which is equally objectionable. The 
 bricks being porous, absorb the fecal matter, and when 
 these vaults have been in use a few months they become 
 permanently polluted, and no amount of cleaning can deo- 
 dorize them. If it should chance that infected discharges, 
 as from a typhoid or choleraic patient, formed a part of 
 their contents, what is there to prevent the spongy sides of 
 these vaults becoming infecting centres for the propagation 
 of these diseases ? 
 
 "A third kind of vault is one which, constructed like 
 that last mentioned, is, in addition, connected with the 
 sewer. This sewer connection is of little use, for in most 
 cities the use of water is restricted, and in Brooklyn none 
 of the waste water from the dwelling is permitted to dis- 
 charge into the vault for fear that stopcocks will be opened 
 and water allowed to run to waste in attempts to wash out 
 the vault when it becomes offensive. The only water, then, 
 which finds its way into such vnults is the rain water from 
 the roof of the building, which is discharged into them, by 
 the leaders. In wet seasons even this is not sufficient 
 to flush them properly, and in the summer months, 
 when for many weeks but little rain falls, the excre- 
 ment is not carried into the sewers, but accumulates as 
 in the other kind of vaults. Indeed, this rain water 
 is rather a disadvantage than otherwise; not being suf- 
 ficiently abundant to flush the vault, it yet supplies 
 moisture, one of the conditions necessary to the putrefac- 
 tion of the organic material contained in the vault. 
 
 " A fourth kind of vault is represented by the school- 
 house sink. Being made of metal and furnished with ap- 
 pliances to fill it with water and empty it at pleasure, it 
 would seem to have the necessary requisites for the purposes 
 
13 
 
 to which it is applied, without creating a nuisance. As 
 commonly constructed, however, it is certainly objection- 
 able. It is the practice to set the metal tank low in the 
 ground, and then build arcon it several rows of brick laid 
 in cement. This is practically a brick vault with metal 
 bottom, and is open to the objections made against, the so- 
 called 'water-tight ' vault already described. 
 
 "If these 'sinks' are to be used, they should be set 
 even with the ground, without masonwork of any kind to 
 act as an absorbing surface. The freezing, to which these 
 vaults are liable, can be provided against by inclosing 
 them in well-built structures, instead of the ordinary 
 privy-honse. The seats should be hung on hinges so as to 
 permit of easy access to all the interior. Much will depend 
 upon the care bestowed upon such a vault whether it will 
 or will not become offensive. It needs daily emptying, 
 cleansing, and refilling with clean water, and unless intelli- 
 gently and faithfully watched, will in the end become a 
 nuisance. 
 
 " It will readily be seen from these considerations that the 
 first three kinds of vaults should be unqualifiedly con- 
 demned as being unsanitary in every sense, and. that the 
 fourth kind should only be used when it is properly con- 
 structed, and when there is no doubt of its receiving an intel- 
 ligent supervision, without which, in fact, all con- 
 trivances for the same object will inevitably lie- 
 come sources of offense. In case the yard-vaults 
 are abolished, to be substituted by water-closets, 
 great care should be taken to see that their filthy contents 
 are totally removed before they are filled w r ith earth, as it not 
 unfrequently happens that in the erection of new buildings 
 or of extensions to old ones, the site of the former privy- 
 vault becomes the site of the new structure. It is a mis- 
 take to suppose that the earth which is used in filling such 
 a vault will disinfect, deodorize and absorb the excrement. 
 
 " In an instance that has come under my personal obser- 
 vation, a vault which had been thus filled eleven years be- 
 fore was again opened, and its contents were found to be 
 preserved so perfectly that no one could have told by either 
 the sense of smell or sight that it had ever been out of use. 
 
 " The water-closet is designed to supersede the vault, 
 and there is, in my opinion, no location or condition in 
 which it cannot do so with great advantage to the public 
 health. It receives the excrement at the moment of its dis- 
 charge from the body and permits its passage at once into 
 the sewer, instead of retaining -it close to dwellings for an 
 indefinite period, as does the yard-vault. Aside from the 
 exhalation of offensive odors which is thus prevented, 
 this rapid disposal of the human waste is an important 
 matter in preventing the spread of those diseases, notably 
 typhoid fever, in which the recent discharges are regarded 
 as comparatively non-infecting, but of which the virulence 
 increases as time passes, so that the retention of such waste 
 in the vault greatly increases the chances of propagation. 
 We often hear objections to the abolition of the yard-vault 
 
14 
 
 from those who have been accustomed to its use, on the 
 ground that any structure designed for this purpose should 
 be outside the dwelling, and such persons seem to think 
 that nothing will accomplish this but the %> vault. Expe- 
 rience has shown that water-closets can be placed in yards 
 without difficulty, provided proper precautions are taken to 
 prevent freezing. ' ' 
 
 It is the unanimous opinion of sanitary authorities that 
 privy-vaults and cesspools in yards, with their putrefying 
 contents, are the principal agents in the development and 
 spread of zymotic diseases. 
 
 In order to carry into effect the foregoing proposed action, 
 the Commissioner requests your Honorable Body to unite 
 with him in the repeal of Sanitary Ordinance, section 177, 
 which reads as follows : 
 
 " Section 177. That all cesspools or privy vaults shall be 
 water-tight, and when on lots adjacent to sewers shall be 
 connected with the same, in the manner required by the 
 regulations of the Board of City Works,' 1 
 
 and in the adoption, in its place, of the following new sec- 
 tion, namely: 
 
 Section 177. That no privy vault, cistern, cesspool or 
 other excavation to be used for the reception of liquid waste 
 drainage, excrement or sewage shall be built, erected or 
 constructed in connection with any building, or upon any 
 premises situated upon, or adjoining any sewered street, 
 avenue or place ; and no such vault, cistern, cesspool or ex- 
 cavation, heretofore constructed or used upon any premises 
 so situated shall be f uther used for said purpose without a 
 permit from the Department of Health. All such premises 
 shall be adequately provided with proper water-closets and 
 connected with the sewer in such manner as to carry im- 
 mediately away all liquid waste, excrement and drainage 
 therefrom. And no privy-vault, cistern or cesspool shall be 
 constructed or used upon any unsewered street unless the 
 said vault, cistern or cesspool shall be made and kept water 
 tight in the manner and form approved by the Depart- 
 ment of Health.* 
 
 Very respectfully, 
 
 R. M. WYCKOFF, 
 
 Secretary. 
 
 Extracts from "Precaution against Cholera," an address 
 by Edwin Chadwick, C. B., before the Association of Pub- 
 
 * No privy- vault, sink, cistern or cesspool shall hereafter be made or 
 rebuilt in the city of Brooklyn, within twenty feet of any dwelling or factory, 
 without a special permit in writing from this Board. All vaults, sinks, cis- 
 terns and cesspools shall be made and kept water-tight. This must be done 
 in the following manner : The inner four inches of the bottom and sides 
 must be of hard brick soaked in tar, or dipped and laid in hot roofing cement ; 
 if tar-soaked biicks are used, the inner surface of the vault, cesspool, etc., 
 must in all cases be covered over with roofing cement, applied hot. 
 
15 
 
 lie Sanitary Inspectors, at 1 Adams street, Adelplii, 
 Monday, Aug. 11, 1884: 
 
 .'* The pro.ved secret of cholera prevention is cleansing, 
 
 keeping clean, pure water, drainage, looking after all 
 epidemic localities, getting the people out of them. We 
 found in old times that not many yards separated deadly 
 spots from safe ones. For treatment, house-to-house visi- 
 tors to look after premonitory diarrhoea, and one of the 
 most essential provisions is some place for treating cases as 
 close as possible to the attacked house. Removal of a col- 
 lapsed or recovering case to a distance means death, and 
 the best thing to do, whenever it can be done, is to remove 
 the unattacked out of the house and to keep the patient at 
 home, The house to be thoroughly cleansed before being 
 again occupied, Generally a fortnight's airing and lime- 
 washing is enough." 
 
 " But whilst much preventive service may be effected 
 by cleansing of places, very extensive prevention may be 
 effected by active measures for the cleansing of persons. 
 At the last epidemic visitation of cholera, which fell severely 
 upon Limehouse, the children of the pauper half-time 
 school there were distinguished by their entire exemption 
 from any choleraic attack. The distinction was due to the 
 careful head-to-foot washing with tepid water. The like 
 distinction of immunity was presented in other half-time 
 district schools in the metropolis. Indeed, we had experi- 
 ences of its efficiency in ordinary times, which enables me 
 to present it as a factor of at least one-third in sanitation. 
 Thus, in a children's institution, where the death-rate was 
 twelve in a thousand, it was pervaded by sewer gases. 
 These were cleaned away, when the death-rate was reduced 
 by one-third. Then followed provision for regular daily 
 head-to-foot ablution, when the death-rate was reduced by 
 another third. The experience is similar with the washed 
 populations of prisons. Sewer gas got into the Pentonville 
 prison and the cholera got in with it, but the other well 
 situated and well drained prisons, with their well washed 
 populations, presented, examples of entire immunity from 
 the epidemic, as they do now from the ordinary epidemics 
 which ravage the outside populations. Attention to the 
 principle may be commended to you for your personal 
 protection during your service. Nurses trained on 
 Miss Nightingale's principle, who devote themselves to the 
 specialty of nursing in the most infectious cases, those of 
 scarlatina, give themselves head to foot ablutions with 
 tepid water twice a day, and give themselves a daily change 
 of clothes, and with attention to ventilation in the patient's 
 bedroom, and to other precepts of Miss Nightingale on 
 nursing, secure complete protection to others as well as to 
 themselves. Health officers who have gone without harm 
 through the most dire plagues declared to the Academy of 
 Medicine of France that they owed their security to the 
 double head-to-foot washing with warm water. It is satis- 
 factory, amidst the low retrograde sanitary administration, 
 
16 
 
 and the great loss of life occasioned by it in France, to ad- 
 duce a valuable sanitary improvement from thence. The 
 Colonel of an infantry regiment, Colonel Lewis, has intro- 
 duced a method by which he gives a superior cleansing 
 with tepid water at a tenth of a penny per head, per man. 
 The man undresses, steps into a tray of tepid water, and 
 after being wetted with a spray, soaps himself thoroughly, 
 when, with a two-handed pump, a powerful spray of tepid 
 water washes him from head to foot. Perhaps there is a 
 double soaping. This is really a most valuable sanitary in- 
 vention. The work is done better with five gallons of 
 water, as against eighty of the bath, and in less than five 
 minutes of time instead of twenty. In Germany they are 
 advancing uj)on it in rapidity by arrangements of recesses, 
 in rows, in which men enter in squads, and are subjected 
 to simultaneous douches of tepid water. In fact, the 
 cleansing hj the jet has been introduced into Australia for 
 bleaching the fleeces of sheep. They tumble the sheep into, 
 tanks of warm soapsuds. They are taken out and a power- 
 ful jet of wanned water is directed upon them, when the 
 bleaching is effected, which reduces the weight of the fleece 
 by one- third, at an expense of twopence each. 
 
 Apparatus on the principle stated ought to be attached 
 to schools, for relief from the foul atmosphere of filthy- 
 skinned children, which generates the eruptive diseases, 
 and is particularly needed for the poorer classes of the 
 single-chambered families, who have no convenience for the 
 process. It should be stated, as being proved, that a washed 
 pig puts on a fourth more flesh with the same amount 
 of food that is consumed by an unwashed pig. Irish cot- 
 tiers are beginning to find out this economy, and are pre- 
 senting their pigs as pinks of cleanliness. It is to be 
 hoped that in time they will find out this economy for 
 their children. Apparatus of the sort ought to be pro- 
 vided by manufacturers for the augmentation of the force 
 of their work-people. The foremost direction of sanitaiy 
 administrative force might well be given to the general ap- 
 plication of the principle of washing with .tepid water by 
 the jet as a most effective preventive factor, on which a 
 proclamation may be issued and promulgated from the 
 pulpit on the text, ' wash and be clean,' as a defense against 
 the coming pestilence, as well as against those we have 
 with us." 
 
 "The extension of large hospital accommodation is be- 
 ing called for as a means of providing for the coming dis- 
 ease. In our Metropolitan Sanitary commission, we made 
 careful inquiry, as I have stated, as to what did do and 
 what did not do on previous visitations. On our course 
 we found that transmission to the hospitals did not do ; 
 that in the advanced stages the mere act of lifting for re- 
 moval was fatal, and that sending the patients to the hos- 
 pital was, in a very large proportion of cases, sending them 
 to increased danger and to death, and, with all the defects 
 of the bad homes and their surroundings, it was the safest 
 course, it were a better chance to let them remain there. 
 
17 
 
 We therefore rejected positively the preparation of hos- 
 pitals for them, and relied mainly upon our policy of the 
 preventive treatment of the localit3 T , and house-to house 
 visitation and treatment of the premonitory symptoms. 
 Our opinion as to the danger of hospital treatment has 
 since been confirmed by Sir James Y. Simpson, who has 
 shown from irrefragable statistics that the large]- the hos- 
 pitals and the higher the dilative organization, the more 
 fatal the results, as against the smaller hospitals and as 
 agaist inferior home treatment. This course of research has 
 been since carried out in Paris, where there is the highest 
 curative organization, perhaps, of any in Europe, where the 
 conclusion of their failure as increased sources of dan- 
 ger is so strong, as to occasion a demand for the sup- 
 pression of the entire curative service of the large hospitals 
 as an excessively expensive failure. This is set forth in a 
 inemoire on the causes of pauperism and its remedies, by 
 Monsieur Baron, an awcatm the Civil Service, crowned by 
 the largest prize from our Academy of Moral and Political 
 Science of the Institute. In the paper, he cites evidence 
 incontestably proving that of one hundred wounded car- 
 ried to the hospital, nearly thirty died by the hospital, 
 who, if they had remained at home, would undoubtedly 
 have, recovered ; that the deaths in the hospital are as ten,- 
 whilst under home treatment by the Societe des Secours 
 Mutuels they are only as six ; that of those who escape, 
 the mean duration of the recoveries in the hospital is thirty- 
 six days, whilst of those treated at home it is only nineteen 
 days. Why, it is asked, such failures ( Should such an 
 excessively expensive organization be continued? It is 
 characteristic of the reactionary administration in France, 
 that with such undisputed conclusions, the practice of send- 
 ing cholera x>atients to the hospitals at Marseilles and 
 Toulon should be maintained, where it apparently can only 
 have been maintained to kill them. It is to be noted that 
 curative service for our home army had always kept the 
 beds of our army hospitals full, and never emptied them ; 
 whilst the preventative or sanitary service, so far as it has 
 been enabled, with an imperfect organization, has largely 
 emptied them, some of them by about one-half. Sanita- 
 tion has already emptied four thousand beds constructed 
 on curative estimates for the home army." 
 
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