legally remove night-soil from the city. After a time the contractors induced the withdrawal of the injunction, and the scavengers have worked in connection with the contractors. The work has, however, been done in violation of almost every specification of the agreement-as to facilities for the work, the obtaining of permits, use of disinfectants, price charged, etc., etc.

Dead Animals.-The same contractors pay the city one hundred dollars ($100) for the dead animals per year, and remove them.

Inspectors. On the 12th of March, Drs. Allen, Colton, Prentice, Bird, Fisk, and Baker reported at this Office for duty as Inspectors. The city was divided into five sanitary districts, and an Inspector appointed to each. One Inspector was detailed for special duty. The investigation of complaints made by citizens received special attention. At the same time a system of house to house inspection was instituted.

In April, six Assistant Inspectors were added to the force. To date, each house of nine hundred and six (906) blocks has been visited and carefully inspected as to its sanitary condition; resulting in the making of eight thousand six hundred and sixty-eight (8,668) complaints which have been forwarded to your office.

Cholera. During the month of June and earlier part of July there were cases of sickness whose characteristics simulated those of cholera, but the first distinctive case occurred July 8th. Its increase then, was not rapid and was mostly confined to localities in different sections of the city where there was the greatest amount of filth. Its principal field was in the southwestern part of the city in the Twelfth Ward-on a tongue of low land projecting into the bay, with streets made by earth drawn from a distance, leaving the intervening spaces depressed, to become the receptacle of stagnant water and various forms of filth. Many of the dwellings are built on these spaces, surrounded by foul pools of water, some on piles with water under the dwellings. These sunken lots have in many instances been partially filled by garbage and other substances liable to decompose, and on this, as a foundation, dwellings have been erected. In the construction of the streets no attempt was made to establish a system of drainage by culverts or otherwise, while the grade of the streets is such that the drainage upon the surface is very imperfect.

In such a location, with surroundings so detrimental to health, was a population whose powers of life were greatly reduced by the atmosphere in which they lived, whose poverty compelled the use of improper and often deficient food, and whose habits, in very many instances, were dissolute. In this ward two hundred and eighty-eight (288) of the eight hundred and sixteen (816) cases occurred.

The progress of the disease will be shown by the following table:

The following table shows the number of cases by wards:

Cholera Hospital, Hamilton Avenue.-The destitution and suffering among those having cholera were such that a public hospital was opened for their reception July 22d. On that day the police, by direction of the Board of Health, seized two buildings on the corner of Hamilton Avenue and Van Brunt street. They were occupied on the following day by cases removed from Walcott street, in the Twelfth Ward.

The following is the report of Dr. Wm. Henry Thayer, physician in charge of the Hospital:

J. T. CONKLING, M. D.,

BROOKLYN, Sept. 30, 1866.

Assistant Sanitary Superintendent, Metropolitan Board of Health:

SIR: I have the honor to report that a hospital was opened in the Twelfth Ward, at the corner of Hamilton avenue and Van Brunt street, for the reception of cholera patients, of which I was put in charge by your order on the 25th of July last, with Dr. P. L. Schenck as assistant physician.

The building was the best that could be obtained to meet the emergency. It is a large brick structure of two stories and a basement, having two sides open to the streets, with numerous windows. The first floor was used for the hospital ward, and consisted of one large room, about one hundred and ten feet by seventy feet. A portion was curtained off for females, and ventilation was not obstructed. The whole place was thoroughly cleansed, and the doors and windows were kept always open. The basement was used as a dispensing depot for chloride of lime and sulphate of iron for that quarter of Brooklyn. The adjoining building was used as a house of refuge for families removed on account of being attacked with cholera; and a number of families, especially of children, were taken in during the season.

One hundred and twelve patients were received into the hospital up to the 6th of September, when it was closed. Of these, eighty-four were cases of cholera, and twenty-eight of cholera-morbus, cholera-infantuin, dysentery, and diarrhoea. Of the eighty-four cases of cholera there entered :

In the first stage 13-of whom 12 recovered, 1 died.

Of the twenty-eight cases of other diseases, twenty-five recovered and three died; the fatal cases were of cholera-infantum, in the children of parents dead of cholera. Patients that recovered, passed, with few exceptions, through all the stages. Fatal cases terminated chiefly in the stage of collapse; of the fifty that entered in collapse and died, forty-three died in that stage, and seven in the third stage.

The

I assume a division of cholera into three stages, which appears to be natural. stages are very distinct in character, and mark material changes in the general condition, in indications for treatment and in the prognosis. The first stage is marked by the peculiar vomiting and purging and cramps; the second is the algid stage, during which the former symptoms cease; the third is the stage of reaction or "secondary fever," which all pass through who survive the second. The term "collapse" describes the whole of the second stage; no definite line can be drawn between partial and complete collapse; the onset of the algid symptoms marks its commencement, and its progress is rapid and constant until death or reaction.

The first stage, reckoning from the beginning of vomiting, is usually short-a few hours only elapsing before the failure of the circulation, which sometimes indeed appears almost simultaneously with the vomiting. The stage of collapse is commonly longer, but is proportioned to the length of the first, coming to a fatal termination earlier when the first stage has been short. The third stage exceeds in length the aggregate of the first and second; extending to several days or a week, and when attended with serious complications it may run to a much longer period. The duration of cholera in fifty-two cases was satisfactorily obtained, as follows:

Average length of cases fatal in second stage, 31 hours; shortest case, 8 hours; longest, 75 hours.

Average length of cases fatal in third stage, 9 days; shortest case, 5 days; longest, 20 days.

Average length of cases that recovered in third stage, 7 days; shortest case, 4 days, longest, 11 days.

Dysentery, parotitis, abscess, pleuro-pneumonia, and parturition, occurred as complications during the third stage in some of the cases..

The following conclusions in regard to treatment are derived from the experience at the hospital-Absolute repose is indispensable. In the first and second stages all nourishment is hurtful. An unlimited allowance of water is objectionable, increasing the vomiting and not relieving the thirst. Small bits of ice or spoonfuls of water, repeated every five or ten minutes, are the most grateful, and do not increase the vomiting. Stimulants are useless during collapse; they are not absorbed and they aggravate the vomiting. They are not more effectual in this stage when given by the rectum. External heat rarely has any influence in restoring the warmth of the surface while collapse is deepening; it is useful in assisting the returning warmth when the second stage is passing into the third. Friction has no effect in restoring warmth, and is objectionable as interfering with the desirable repose. Sinapisms help to relieve cramps or abdominal pain, and to excite the circulation in the extremities. Upon reaction from collapse, nourishment becomes necessary, and should be given in concentrated liquid form, in small quantities, frequently repeated. Stimulants are also required at this period, in quantity according to the state of the circulation and the force of reaction. In case of the continuance of gastric irritability into the third stage, so that food cannot be retained, it may be given by the rectum. A sufficient amount of beef juice, with the addition of brandy if necessary, may be given by enema for many days, to meet the wants of the system. Convalescence is marked by the abatement of febrile action, a return of appetite, and improvement of the secretion, and indicates a fuller diet. Cholera in the first stage is amenable to active treatment, and such remedies as arrest the discharges and excite a new action in the portal circulation have a good effect; even during the commencement of collapse in some cases the system is susceptible to the influence of medicines; but in most cases the period for successful medication is brief. The natural tendency is to a fatal issue. A large proportion of the cases were too far advanced at their admission into hospital to afford any encouragement of successful treatment, and in some cases no medicine was given.

During the first two weeks of the hospital, cases were treated variously—with Squibb's mixture of camphor, chloroform, and opium, with chloroform and opium, brandy and capsicum, camphor and chloroform, acetate of lead, mineral acids, friction and external heat. After this time nearly every patient in the first or second stage was treated with calomel. Of thirteen patients admitted in the first stage, twelve were treated with calomel exclusively and recovered; no calomel was used in the remaining case, which was fatal in six days. Of fifty-seven admitted in the second stage, twenty-three were treated with calomel, of whom six recovered, three exhibited partial reaction, and four passed out of collapse and died in the third stage. Calomel was also used in three cases admitted in the third stage, in whom the choleraic discharges continued. Only one patient recovered of those admitted in the first or second stage, who was treated without calomel. It was used in various doses, from one to ten grains; if in small doses, it was continued every hour till some appearance of improvement or the approach of death; if in ten-grain doses, every hour till thirty or forty grains had been taken. The method preferred was the use of the largest doses. The immediate effect was commonly the arrest of the discharges, and where improvement took place it was usually manifested in about twelve hours by the commencement of dark-brown or green stools, with sensible relief of epigastric disturbance and thirst, and returning warmth. Reaction was generally gradual. Diarrhoea in the third stage was not more severe in cases thus treated than in those where no calomel was used; and it was quite as troublesome in those who had onegrain doses as in those who had ten grains. Only five patients had mercurial stomatitis, and those only in very mild degree and without salivation.

The other remedies used were not employed extensively enough to give a valuable

experience; none of them gave encouragement for retaining them, and they were abandoned in favor of calomel. Camphor was given, in several cases, in five-grain doses dissolved in chloroform, repeated four or five times an hour, without effect. Acetate of lead was used, sometimes with temporary relief of vomiting and purging, but with no sensible effect on the essential character of the disease. Brandy gave no relief. Capsicum only increased the epigastric uneasiness. Squibb's mixture sometimes produced a temporary advantage. Ten patients had no medicine whatever.

The third stage demands nourishment, tonics, and stimulants. Diarrhoea was treated with vegetable astringents, or the tincture of the sesqui-chloride of iron, or with opiate enemata. When there was a marked typhoidal condition and delirium was present, sulphate of quinia was used with good effect.

Were it consistent with the character of the present report, I should take the opportunity to present more fully the scientific history of the disease, and submit the views of its pathology which have been derived from my experience in this and former epidemics. I have, however, deemed it proper to confine myself to a concise statement of facts.

Very respectfully, your obedient servant,

WM. HENRY THAYER, M. D., Assistant Sanitary Inspector, Metropolitan Board of Health.

Cholera Hospital, City Park.-The spread of the disease along the water front of the city into the Second, Fifth, and Eleventh Wards rendered the transportation to the Hamilton Avenue Hospital most hazardous to the lives of the patients. No suitable unoccupied building being found in the proper location, the Common Council gave permission for the erection of buildings for hospital purposes in the City Park. These structures were completed and occupied August 15th.

The following is an abstract of the report of Dr. W. F. Swalm, Assistant Inspector in charge of this Hospital:

The hospital remained open until October 1st, a period of forty-nine (49) days, and during that time twenty-eight (28) patients were received. Of these eighteen (18) were affected with cholera. Of the cholera patients, eleven (11) died, the most of them having been admitted in collapse. The majority were of the lower class of society, from ill-ventilated apartments in crowded tenement-houses, wretchedly poor and filthy, and addicted to the use of intoxicating liquors.

Of the cases that died in collapse the duration was from twelve (12) to fifty (50) hours from the time of attack, and from five (5) hours to two (2) days from the time they were received into the hospital. Two died from consecutive fever. Those that recovered, were in the hospital from two (2) to eighteen (18) days.

The main treatment was ten grains of calomel given at first, followed every hour by one grain until some change is experienced, either the cessation of the vomiting and purging or a change in the character of the dejections. Rarely over thirty grains were given. Artificial heat to surface and extremities, sinapisms to calves of legs and wrists for cramps, small pieces of ice by the mouth, and teaspoonful-doses of green tea, cold, if retained. Afterwards, if