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coffin opened at the house (marked on accompanying sketch I). Within a few days a brother of George, named Charlie, aged five, was taken ill and died from diphtheria. Willie West, aged six, a cousin of the aforenamed (at the house marked II) was the next, he died; then his mother, Julia West, was taken ill and died; then Howard W., aged three, died. (At the house marked III) Morris Stanton lost two children, both from diphtheria, about the same time. 'An aunt and uncle of the two first mentioned children had diphtheria, but both recovered (at the house marked IV). These cases all occurred between January 12th and February 14th, 1881. Duane West, having lost his wife and children, left the house marked II, and shortly afterward it was occupied by another family. I do not know their names, but a relative of theirs, who paid them a visit, was shortly afterward very ill from diphtheria and, I think, died.

SPECIAL INVESTIGATIONS Of Disease in RICHMOND COUNTY.

As one of the earliest results of the observations and records instituted by the Board of Health of New Brighton was a demonstration of the fact that the death-rates in different districts of the exceptionally salubrious and beautiful town of Castleton, within that Board's jurisdiction, vary so greatly as to be accountable only upon the supposition that local causes and domestic conditions will adequately explain the excessive mortality in particular streets and upon numerous well defined areas in the township. The State Board invited Dr. Alfred L. Carroll, the recent president of the local Board of Health, in Castleton, to undertake certain investigations concerning the endemic fevers and other diseases in the counties of Richmond, Kings and Westchester. His preliminary report is here appended, and it relates to only the first quesions submitted to him for his examination and reply:

Notes on Some of the Sources of Endemic Diseases in Richmond County.

BY ALFRED L. CARROLL, M. D.

Richmond county, the surface of which, throughout nearly its whole extent, consists of a bed of glacial drift and disintegrated magnesian rock of varying thickness, has long held prominent rank among the malarial regions of the State, and during the past year its endemic fevers have shown a marked increase in prevalence and in severity. Intermittents and remittents have in an unusual number of instances assumed the pernicious form, and "typho-malarial" fevers have prevailed in several localities. As regards these latter, two classes of cases appear to be distinguishable: one in which true enteric fever and malaria co-exist in the same person, and another wherein common filth-poisoning superadds its depressing influence to a malarial attack.

The accompanying sketch will show the localities of the less usual endemic fevers as far as my present information extends. Of the lower part of Westfield, I have no recent knowledge, but in past times the district about Tottenville and Pleasant Plains has produced severe forms of malarial fevers and numerous cases of typhoid. No tract of any extent in the country is free from malarial diseases, even the higher elevations of Castleton and Middletown furnishing numerous examples. Along the shores lie about eight thousand acres of salt marsh; scattered

through the interior are ponds and swampy lands, aggregating many hundred acres, whilst the quasi stratification of the drift by the waters of the receding glacier has left over the greater part of Staten Island beds of impervious clay. In 1874 a committee of the Richmond County Medical Society reported that "not less than one-half, and in many portions four-fifths of the prevailing diseases are either directly caused or seriously aggravated by the malign influences resulting from insufficient drainage," and subsequent experience affords no ground for modifying this statement.

There are two misleading features about all maps purporting to indicate the topography of endemic disease: First, because greater density of population gives to certain localities an apparent pre-eminence of unhealthfulness; and, second, because domestic insanitary conditions are often the principal, if not the only, factors in the production of miasmatic disorders. Especially is this true of the malarial class of fevers. The chart of Castleton, for instance, being based upon the number of cases of malarial fever reported, necessarily attracts attention chiefly to the thickly settled wards on the shore of New Brighton, whilst some outlying districts wherein the telluric conditions are as bad, or worse, enjoy on paper a seeming immunity, simply because they are very sparsely, or not all, inhabited. On the other hand, in places where the natural environment is least unfavorable, faulty household arrangements may induce, so to speak, an artificial paludal miasm. Decaying vegetable matter in a damp cellar, or soakage of the adjacent soil with "kitchen slops," may effectively imitate in miniature the morbific conditions of natural marsh lands, especially where, as is often the case, furnaces are contrived to carry cellar-air into the upper rooms of houses, creating in addition an indraught of the ground atmosphere laden with the products of decomposition. The not infrequent occurrence of intermittent fever during the depth of winter has in all instances within my observation seemed attributable to sources of the latter kind. Reference to the map of Castleton (in which alone any registration of disease has been attempted) shows certain groupings of cases, some of which deserve particular mention. In the fourth ward, the lateral soakage of the "Factory Pond," and of the backed-up stream feeding it, has induced saturation of the retention soil for a wide surrounding region; but, beside this, faulty grading of streets and obstruction of natural drainage channels, either by the public authorities, or by private property owners, have held back the surface water in many places. In the absence of sewerage, nearly every house in this thickly populated district has its leaching cess-pool, except where the brook serves as a convenient conduit for house refuse, and a plentiful supply of organic matter is thus instilled into the damp earth. The neighborhood on the south and south-east of thispond, and the adjoining portion of the third ward, show a high "consumption rate," and have also furnished during the past year the greatest number of cases of diphtheria, scarlatina, and diarrheal disorders.

The settlement at the northern portion of Broadway and Burgher avenue consists, for the most part, of ill-constructed houses, built upon the site of a former alluvial basin, which originally formed the outlet for the surface-drainage of a considerable extent of upland. The filling in of this basin, as I am informed, comprised a large amount of organic rubbish, and the careless habits of many of the residents

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augment the pollution of the undrained made-ground. The streets in this neighborhood have been raised, in some instances, several feet, with the result of flooding most of the cellars in rainy seasons. Numerous as are the malarial markings here, and in the previously-described vicinity, it is to be remembered that probably two-thirds of the sufferers from intermittent fever in such a population rely upon patent medicines, or counter-prescribing druggists, instead of consulting a physician, and thus elude medical observation.

In Davis avenue I am assured that malaria is of comparatively recent introduction; its gradual increase has fallen under my own notice. Some years ago the village authorities raised the shore end of the avenue, and filled in the lower part of its declivity to such a height as to destroy its carrying capacity for surface water. This, with the obstruction of a natural drainage-channel, which formerly ran through private property, on the western side of the avenue, has dangerously, aggravated the evils of soil-humidity.

A localized endemicity of malarial and septic diseases, in marked contrast with the comparative healthfulness of the surrounding neighborhood, is noticeable in a cluster of cottages between second and third streets, in the Second ward. The ground here is soaked with sewage from cow-yards and stables, privies, and cess-pits; house-refuse and garbage are accumulated on the premises, or cast into the gutters, whilst the street-gradings impede, rather than promote, surface drainage. Diphtheritic and septic fevers have been of frequent occurrence. These examples are specified as illustrating the proposition that, throughout the built-up portions of New Brighton, malarial conditions are largely of artificial creation. From Tompkinsville to West New Brighton the drift is underlaid by a massive bed of serpentine, with a general north-westerly slope from an altitude of 280 feet to the shore of the Kill-von-Kull, the valleys of undulation in the high-lands affording no impediment to soil-drainage if their courses were respected. There are few, if any, streets wherein the surface water could not be easily deported by proper surface-grading. An ample water supply has recently been introduced by a private company, and it is to be feared that the greatly-increased use of water thus facilitated will, in many places, aggravate the evils of soil saturation until cess-pools are replaced by sewerage.

The picturesque "Clove valley," which forms an outlet from Silver lake (the only natural sheet of water in this region), and from much of the surrounding upland, has been injured by the construction of a chain of artificial ice-ponds, the level of which is alternately raised and lowered. The miasmatic influences thus created have rendered some localities absolutely untenantable.

From the margin of the serpentine westward the town of Northfield is underlaid by triassic sandstone, intersected by a trap-dyke, extending from Port Richmond to the mouth of the Fresh Kills. The general level of this sandstone, interspersed with basin-like depressions, offers a drainage problem of some difficulty throughout the region from Graniteville to Springville.

The districts on the south and east of the belt of gneiss, comprising nearly the whole of the towns of Westfield and Southfield, lie upon cretaceous beds of clays and sands, covered in most parts by drift or alluvial deposit. The marshes along the shores of the Kills and Lower

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