Manhole Elegy (マンホール哀歌（エレジー）, Manhōru erejī) is the 19th chapter of Dorohedoro.
The story starts during a rainy night in Hole, a mysterious man tells someone that "It won't take long". Back in The Hospital Kasukabe is talking to Kaiman about how Magic Users are weakened by the effects of Hole's rain, the lizard head pays not too much attention while cooking gyozas for his friend. Nikaido is waiting in her room, still recovering from the surgery and cursing the fact is raining, wondering if there is no other choice than use her magic to help Kaiman to recover his face and memories.
Kaiman kicks the door and brings Nikaido's dinner, a charcoal-like gyozas with raw garnish inside, nevertheless she still eats them while asking why he is cooking if the hospital is supposed to have a catering delivery for patients. Vaux explains that they are their only lodger (mostly because the amount of magic users coming to the city decreased considerably thanks to them) so there is no delivery for the Magic User Victim Guard, at the same time Kaiman orders a pizza. Kasukabe address the recently disappearances of people without leaving a trace, after they eat, Kaiman tells Nikaido to get better and they all leave her to rest.
Vaux and Kasukabe ask the lizard head what happened to Nikaido to have so many wounds aside the big mushroom in her back, and shows a little card they found in her clothes, the professor explains that was made by a Devil and only high class magic users have them. Kaiman stop him knowing where this is going, and the doctors explain to him that they operated Nikaido with their own hand, her physiology is different than them, she is in fact a magic user. In that moment Kaiman hears a scream and runs to his friend room to find she is gone, quickly jumping to the streets to chase whoever kidnap her, thinking how could be possible that Nikaido didn't put a fight and got capture so easily, remembering Kasukabe's early explanation of how rain weak sorcerers.
The lizard head chase them to the sewers where he find the corpses of the missing people, rotten and half ate in the refuse water, and with them a giant mutant cockroach blocking the way. Kaiman engage in a fight with the creature but its unable to even scratch it and is overpowered by it, even having part of his arm rip apart, thinking there is no use to fight the monster, Kaiman escapes while the cockroach eats the piece of his flesh. Finding a door and the end of the corridor, he sees Nikaido wounded in the floor and the mysterious man from early yelling about how she "Doesn't have a pearl" Kaiman is about to kill him when he calls "Jonson" the giant cockroach from earlier and restrain Kaiman in the floor while the man talks about how he can become a Magic User using "Black Pearls", nothing more than human bodily waste as Kaiman yells at him. The man is about to gouge the Lizard head body when his legs are chopped and fed to Jonson to get out of the room, he bleeds to death while telling Kaiman that he saw him before his head was transformed, and his friend was there too, also lamenting that he couldn't become a sorcerer to leave Hole. The chapter ends with Vaux and Kasukabe accompanying Kaiman with Nikaido in his back, telling how the man was also a victim of the city's pitfalls, leaving to the hospital once again. Kaiman believes they are forgetting something, meanwhile Jonson is still eating his previous owner's foot in the sewers