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THE CITY THAT WAS
[Illustration: PUBLIC SCHOOL ADJOINING SLAUGHTER-PEN, 1865]
THE CITY THAT WAS
_By_ STEPHEN SMITH, A. M., M. D., LL. D.
COMMISSIONER OF THE METROPOLITAN BOARD OF HEALTH, 1868–1870;
COMMISSIONER OF THE BOARD OF HEALTH OF NEW YORK, 1870–1875
[Illustration]
PUBLISHED BY FRANK ALLABEN
NUMBER THREE WEST FORTY-SECOND STREET, NEW YORK
COPYRIGHT, 1911, BY FRANK ALLABEN
To the Memory of
Dorman Bridgman Eaton
My thanks are due especially to Mr. Frank Allaben and my son, Mr.
Sidney Smith, for their service in carrying this book through the press.
STEPHEN SMITH.
_NOTE BY THE PUBLISHER_
_The story of a great life-saving social revolution, the mightiest in
the nineteenth century and one of the most momentous in the history
of civilization, is told here for the first time. It is told from the
standpoint of the transformation of the City of New York, by a chief
actor in the event._
_Only by forcing ourselves into a receptive mood can we of the present
credit the half of what is set before us concerning The City That
Was. The shocked imagination rebels. It seeks relief in assuming that
even a trained expert, a contemporaneous witness and investigator of
the conditions described, in writing after they have passed away,
unconsciously yields to the historian’s temptation to throw the past
into dramatic relief by starting exaggerations._
_Dr. Smith, however, leaves us no room for doubt. The appalling chapter
in which he lays bare the New York of 1864 is a contemporaneous
document. It is a physician’s report of a systematic medical inspection
of New York in that year, as delivered before a Legislative Committee a
few months later by the very physician who had directed the inspection._
_Nevertheless, The City That Was is not New York alone. She is but a
type. Her condition, with variations, may be multiplied, during the
early years of the nineteenth century, by the total of the cities,
towns, and villages in the world. In the work of regeneration some of
these anticipated her. Others, including all throughout the territory
of the United States, were aroused through her agitation and inspired
by her example._
_As a student of local history, the writer thought himself familiar
with the many phases of the growth of New York; but the condition of
the City as late as the period of our Civil War, as here depicted,
startled him as might a revelation. He believes that no seriously
minded man or woman can afford to ignore this volume. We owe it to
ourselves and to one another fully to face its lesson._
_We shall be shocked; we shall be filled with horror; but accepting the
city that now is, great as her faults may be, with a new gratitude,
we shall turn with anointed sympathy and understanding to any earnest
voice that pleads for the city that should be. And, indeed, other
volumes which Dr. Smith himself has in preparation, as suggestive and
as interesting as this one, may help us on in this direction._
_FRANK ALLABEN_
CONTENTS
I
A BLIND METROPOLIS AND HER DYING CHILDREN
Healthy or Unhealthy: Which?--Two Centuries and a Half Unhealthy--A
Plague-Stricken Town--Enormous Sacrifice of Life
II
A GREAT AWAKENING IN ENGLAND
The Scourge of 1849--A Town That Was Immune--The Word Fitly Spoken
III
THE AWAKENING IN AMERICA
Apathy in the United States--An Incident That Counted--A Fever
Nest--The Unknown Owner--Fear of Publicity--Agitation for
Reform--The Citizens Association--A Health Bill--Sanitary
Inspection of New York--An Anomaly in Law--Introduction of
an Epoch-Making Bill
IV
NEW YORK, THE UNCLEAN
Alarm of Medical Men--A Systematic Investigation--A House-to-House
Inspection--The Medical Experts--Plan of Inspection--Each
Room Examined--Period of the Inspection--Distribution of
Population--Tenant-House Packing--Avoidable and Inevitable
Disease--Filthy Streets--Street Filth and Disease--Dead
Animals--Filthy Courts and Alleys--Cesspool Abominations--
Unbelievable Vileness--Special Nuisances--Cellar Population:
Dens of Death--496 Persons Under Ground--A Visit to the
Cave-Dwellers--Tenant-House Population--Cat Alley--Rag
Pickers Row--Tenant-House Degeneration--The Rioters--
Tenant-House Rot--Tenant-House Cachexy--Prevailing Diseases--
Seeds of Disease Uncontrolled--Where Disease Flourishes--
Smallpox--Smallpox in Tailored Garments--Typhus Fever--
Intestinal Affections--Living at a Sewer’s Mouth--The Normal
Death-Rate--Death-Rate of New York--New York, London, and
Liverpool Compared--Constant Sickness--Where the Death Pressure
Is Greatest--Some Scapegoats: Foreign Immigration--The
Floating Population--Can the Causes of Disease Be Removed?--
Improvements During the Inspection--How to Improve the People--
Can Diseases Be Prevented?--Can Populous Towns Be Improved?--
Cleanliness Preserves from Epidemics--Importance of Sanitary
Government--The Entire Country Concerned--Smallpox in a Hotel
Bedroom--New York Inoculates the Nation--Inefficiency of
Health Organizations--Without Sanitary Government--The City
Inspector’s Department--Sanitary Inspection--Inspection Must Be
Thorough--The Remedy--An Efficient Health Board
V
VICTORY
Effect of the Hearing--Triumph at Last--The Reform National in Its
Results
VI
THE LEGAL WORK OF DORMAN BRIDGEMAN EATON
Unrecognized Pioneers--A Constructive Reformer--Character of
Previous Agitation--Incompetent Health Officers--Reform
Movement Born--The Right Man--A Board with Extraordinary
Powers--The Fight for the Bill--A Law Enacted and Sustained--
The Regeneration of New York--Epidemics Checked--Sanitation in
Other Cities--Reorganization of the Fire Department--Creation
of a Dock Department--Reform of the Police Judiciary--Mental
Traits of Dorman B. Eaton
VII
THE OCCULT POWER OF FILTH
Filth Diseases--The Scheme of Sanitation Changed--The Mystery of
Infection--How Infection Works--What the Germ Is--The Function
of Bacteria--Bacteria for Every Condition--The Deadly Tubercle
Bacillus--How Bacteria Affect the Body--The Toxin Secreted--
Bacteria Aim to Destroy the Body--Man’s Defenses--Destroy the
Bacteria--The Value of Germicides
VIII
A CLOSING WORD
Cleanliness Next to Godliness--Invisible Agencies in Filth--A
Higher Civilization
ILLUSTRATIONS
PUBLIC SCHOOL ADJOINING SLAUGHTER-PEN, 1865 _Frontispiece_
PLAN OF ROOKERY HOLDING 1000 PERSONS 60
A CROWDED SECTION OF THE CITY 61
A TENANT-HOUSE CUL-DE-SAC NEAR CITY HALL 70
CUL-DE-SAC NEAR SLAUGHTER-HOUSE AND STABLES 71
PLAN OF CELLAR--“WORSE THAN A STYGIAN PIT” 73
SLAUGHTER-PENS IN REAR OF TENANT-HOUSES 77
SIXTH STREET CATTLE MARKET, 1865 78
REGION OF HIDE-CURING, FAT-GATHERING, ETC. 79
REGION OF BONE-BOILING AND SWILL-MILK NUISANCES 80
PLAN OF ROOKERY BETWEEN BROADWAY AND BOWERY 83
PLAN OF CELLAR OCCUPIED BY TWO FAMILIES 85
PLAN SHOWING REAR TENANT-HOUSES NEAR A STABLE 89
RIVINGTON PLACE, 1865 92
GOTHAM COURT, CHERRY STREET, 1865 95
TRANSVERSE SECTIONAL ELEVATION OF GOTHAM COURT 96
“THE GREAT EASTERN” 98
A PERPETUAL FEVER-NEST 106
REGION OF SMALLPOX AND TYPHUS FEVER 111
PLAN OF FEVER-NEST, EAST 17TH STREET 114
BIRD’S-EYE VIEW OF FEVER-NEST NEAR FIFTH AVENUE 115
PLAN OF MONROE STREET FEVER-NEST 117
A SIXTH WARD FEVER-NEST 126
PLAN OF TYPICAL FEVER-NEST, 1865 130
PLAN OF REAR CUL-DE-SAC 134
FEVER-BREEDING STRUCTURE NEAR CENTRAL PARK 139
STAGNANT WATER, CENTRAL PARK WEST 148
I
A BLIND METROPOLIS AND HER DYING CHILDREN
A great problem was left for the first civilized inhabitants of New
York to determine. Nature had made ample provision for the metropolis
of the western hemisphere. But two possibilities were attached to its
occupation by man--it could be healthy or unhealthy, at the option of
the people.
[Sidenote: Healthy or Unhealthy: Which?]
The conditions which made for health were: two large rivers of pure
water, from the mountains and the sea, flushed its shores, carrying the
outflow of its waste far away seaward; its soil could be thoroughly
drained; its sewerage could be so constructed as to convey to the
sea all forms of domestic waste and surface filth; its southern
exposure towards the ocean insured sunlight and sea breezes; its
inland situation supplied to its atmosphere the life-giving virtues of
abundant vegetation; the climate was temperate.
The conditions which made for unhealthiness were: large areas of sodden
marsh lands; a rock formation of shale, having a dip of the strata,
nearly perpendicular, admitting the flow of surface water to great
depths, thus poisoning springs and wells; numerous streams flowing into
the rivers; large ponds of stagnant water; fierce summer heat.
[Sidenote: Two Centuries and a Half Unhealthy]
From the year 1622 to the year 1866, a period of two hundred and
forty-four years, the people elected that the city should be unhealthy.
The land was practically undrained; the drinking water was from shallow
wells, befouled by street, stable, privy, and other filth; there were
no adequate sewers to remove the accumulating waste; the streets were
the receptacles of garbage; offensive trades were located among the
dwellings; the natural water courses and springs were obstructed in the
construction of streets and dwellings, thus causing soakage of large
areas of land, and stagnant pools of polluted water.
Later, in these centuries of neglect of sanitary precautions, came
the immigrants from every nation of the world, representing for the
most part the poorest and most ignorant class of their respective
nationalities. This influx of people led to the construction of the
tenement house by landowners, whose aim was to build so as to incur
the least possible expense and accommodate the greatest possible
number. In dark, unventilated, uninhabitable structures these wretched,
persecuted people were herded together, in cellars and garrets, as
well as in the body of the building, until New York had the largest
population to a square acre of any civilized city.
The people had not only chosen to conserve all the natural conditions
unfavorable to health, but had steadily added unhygienic factors in
their methods of developing the city.
[Sidenote: A Plague-Stricken Town]
The result was inevitable. New York gradually became the natural home
of every variety of contagious disease, and the favorite resort of
foreign pestilences. Smallpox, scarlet fever, measles, diphtheria,
were domestic pestilences with which the people were so familiar
that they regarded them as necessary features of childhood. Malarial
fevers, caused by the mosquitoes bred in the marshes, which were
perfect culture-beds, were regularly announced in the autumnal months
as having appeared with their “usual severity.” The “White Plague,” or
consumption, was the common inheritance of the poor and rich alike.
With the immigrant, came typhus and typhoid fevers, which resistlessly
swept through the tenement houses, decimating the poverty-stricken
tenants. At intervals, the great oriental plague, Asiatic cholera,
swooped down upon the city with fatal energy and gathered its enormous
harvest of dead. Even “Yellow Fever,” the great pestilence of the
tropics, made occasional incursions and found a most congenial field
for its operations.
[Sidenote: Enormous Sacrifice of Life]
Failure to improve the unhealthy conditions of the city, and the
tendency to aggravate them by a large increase of the tenement-house
population, offensive trades, accumulations of domestic waste, and the
filth of streets, stables, and privy pits, then universal, caused an
enormous sacrifice of life, especially among children. This fact is
strikingly illustrated by the following comparison of figures taken
from the official records.
The standard ratio of deaths to the total living in a community, where
the death-rate is normal under proper sanitary conditions, has been
fixed by competent authority at about 15 in 1,000 of population. The
death-rate in New York, in the five years preceding 1866, averaged 38
in 1,000 population, which is 23 in excess of the normal standard of 15
in the 1,000. In a city with a population of 1,000,000, the estimated
population of New York in 1865, a death-rate of 38 in the 1,000 means
23,000 deaths annually from preventable diseases.
Mortality statistics computed on a scale of forty years, the period
during which New York has been under an intelligent sanitary
government, still more impressively show the former waste of life
through municipal neglect of the elementary principles of public
hygiene. The lesson which these figures teach should be engraven on
the memory of every man, woman, and child. Our authority is the annual
report of the Department of Health of the City of New York, for the
year 1908, in which appears the following statement.
“A remarkable decrease in the death-rate has taken place within the
past forty years, a decrease comparing each decennial rate with the one
immediately preceding represented by seven, seven, and eighteen per
cent respectively, and comparing that of the first decennium with the
individual year under review, a decrease of forty-seven per cent.”
II
A GREAT AWAKENING IN ENGLAND
[Sidenote: The Scourge of 1849]
Cholera was approaching the shores of England. The alarm of the people
was intense. The enormous devastations of that pestilence on its
first and only previous visit to that country, in 1832, were vividly
recalled by the elder people. The only known preventive measures were
“flight, fasting, and prayer.” As the pestilence was believed to
be a “visitation of God” on account of the sins of the people, the
clergy petitioned the Prime Minister to proclaim a day of “fasting and
prayer,” with many expressions of sorrow at the prevailing national
vices which had finally provoked the wrath of the Almighty. The Prime
Minister replied in substance as follows:
“Do works meet for repentance. First make your homes and their
surroundings clean and wholesome; then you may with propriety
ask Almighty God to bless your efforts at protection against the
approaching epidemic.”
This response of the highest official of the Kingdom to the usually
humble and devout petition of the clergy, when the people were
threatened with an epidemic, was received with profound astonishment
by the religious classes, with ridicule by the masses of the people,
but with commendation by sanitarians. The popular agitation was great.
The clergy protested with solemn asseverations their belief that
pestilences were always indications that national sins had become
intolerable to the Almighty, and only fastings and prayers could
appease His wrath.
The people at large gave no heed either to the clergy’s admonition to
fast and pray, or to the Prime Minister’s advice to clean their homes
and their surroundings; but, with their usual disregard of the domestic
diseases with which they were constantly familiar, gave no thought to
approaching danger. But the sanitarians very earnestly urged the people
of their respective localities to act upon the advice of the Prime
Minister, assuring them that cholera was a disease which prevailed more
generally and severely in localities and homes where there was the
greatest amount of “filth.”
The epidemic of 1849 came and went with its apparent usual great
disturbances of the people. “Flight” and “fasting and prayers” had
their natural results, the former being effectual when undertaken in
time, and the latter without sensible influence over the mortuary
records.
[Sidenote: Can Diseases Be Prevented?]
Then the net results of this visitation of cholera were officially
determined by the Registrar-General, one fact attracted wide attention
and created a profound and lasting impression on the minds of the
common people. A town in the interior of England reported no case of
cholera, though the epidemic had prevailed with great virulence in the
communities surrounding it.
On inquiry as to the cause of this remarkable feature of a pestilence
that hitherto had shown no respect for persons or localities, it was
learned that certain citizens of this town were deeply impressed
with the reasonableness of the Prime Minister’s suggestions, and had
organized and taken action accordingly. Volunteer committees composed
of the leading men and women were selected. One was to secure thorough
cleaning of the streets and public places; another was to cause an
inspection of every residence and its surroundings and secure complete
cleanliness; a third was to obtain reports of all cases of sickness and
require immediate isolation and treatment when there was the slightest
symptom of cholera.
This town had its “fastings and prayers,” but not until its citizens
had done works meet for repentance; and then it asked the divine
blessing on its efforts to protect itself--and its prayers were
abundantly answered.
But there was another phase of this place’s experience not less
impressive than its escape from cholera. There was a great diminution
of such diseases as diphtheria, typhoid, erysipelas, scarlet fever,
measles, and other low forms of sickness, so fatal in the homes of the
poor, during the period that the citizens exercised so much care in
securing cleanliness.
[Sidenote: The Word Fitly Spoken]
“A word fitly spoken is like apples of gold in pictures of silver.”
A word fitly spoken broke the spell of centuries, and completely
revolutionized human history. That word was spoken, not at the
suggestion of science, nor by a scientist, but, at the dictation of
common sense, by a layman who happened to be in authority. It was
a plain, simple word, which was understood by the people and which
appealed to their common sense.
A new era now dawned upon the domestic life of the English people.
Every household learned that cleanliness had not only saved a town
from a visitation of cholera, but had reduced the contagious and
infectious diseases always present in their homes. The Health Officer
of England gave tremendous force to the revelation that had been made
by officially characterizing and classifying cholera and the whole
brood of domestic scourges as “filth diseases.” This was a most happy
term, because it suggested not only the source of these diseases, but
the simple and effectual remedy that every householder could apply.
It became popular in the sanitary literature of the period, and thus
permeated all classes, until the most humble family knew its import and
complied with its suggestion.
The next visitation of cholera to England was met by the simple remedy
of domestic and civic cleanliness; and so manifestly effectual was
this measure that the pestilence lost its former terrors. But the
great and lasting gain to the people, which grew out of the original
proclamation of the Prime Minister that cleanliness of the home and its
surroundings was the best preventive of cholera, was the discovery of
the fact that nearly all diseases which afflict the individual family,
and in a larger sense the whole community, have their origin in or are
intensified by decomposing waste matter, the “filth” of the sanitarian,
in and around their homes.
So profoundly impressed with this fact were the laboring classes,
and so earnest did they become in their zeal for sanitation, that
sanitary measures entered into the political campaign. On one occasion
a prominent candidate was so disturbed by the numerous inquiries which
the audience made as to his views in relation to current questions of
local sanitation, that he cried out in despair, “_Sanitas sanitatum, et
omnia sanitas!_”
III
THE AWAKENING IN AMERICA
[Sidenote: Apathy in the United States]
During the score of years that the great awakening of the people of
England to the value of cleanliness of the individual, the home, and
the municipality, as the true remedial measure against foreign as
well as domestic pestilences was in progress, extending from 1846 to
1866, the people of the United States remained profoundly apathetic
in relation to all questions of improvement of the public health and
the prevention of epidemics. Cholera ravaged their cities in 1849, and
again in 1854, without meeting other obstruction than the occasional
fumes of sulphur. Days of fasting and prayer were religiously observed;
but, for the most part, the terror-stricken people fled to the country
to escape what they believed to be inevitable death if they remained in
their town homes.
The object lesson which the people of England had learned from the
experience of one town, and had so successfully applied in several
visitations of epidemics, was known to a few students of sanitary
science and administration in different parts of this country and
efforts had been made by them, from time to time, to awaken public
interest in sanitation of the home and the municipality, but very
little progress was made. A few cities had health organizations which,
for the most part, were devoted to political schemes and purposes, with
no pretense to knowledge of the objects or methods of sanitation.
[Sidenote: An Incident That Counted]
As the simple suggestion of the Prime Minister, that cleanliness of the
home and its surroundings was the best measure of protection against
cholera, contained the germ of practical sanitary reform in England, so
an incident in the writer’s experience became the potential force that
gave to New York a most complete system of health laws and ordinances,
and an efficient administrative department of health. In a larger sense
it may, with justice, be claimed that this incident contained the germ
of health reform that has given to this entire country the most perfect
system of municipal, state, and national health administration in the
civilized world.
The incident referred to occurred in the fifties of the last century.
New York was in the grip of the deadly typhus. This was sometimes
called the “Spotted Fever,” from the dark spots which appeared on
the body of its victims, and also “Emigrant Fever,” because it was
brought to this country by the immigrants, especially by those who
came from Ireland. Indeed, the Irish immigrants suffered so generally
and severely that the disease was sometimes called the “Irish Fever.”
Immigration from Ireland was at that time at its flood and the typhus
was so prevalent among these poverty-stricken people that the hospitals
were overcrowded by them and large numbers were treated in tents, both
on Blackwell’s Island and at the quarantine grounds on Staten Island.
Having completed a two years’ term of service on the interne medical
staff of Bellevue Hospital, where large numbers of typhus cases were
treated, I was placed in charge of the tents on Blackwell’s Island by
the Commissioner of Charities. Soon after entering upon the service, I
noticed that patients were continually admitted from a single building
in East Twenty-second Street.
[Sidenote: A Fever Nest]
Impressed with the importance of closing this fever-nest, I visited the
tenement and was not surprised at the large number of cases of fever
which it furnished our hospital. It is difficult to describe the scene
that the interior of the house presented to the visitor. The building
was in an extreme state of dilapidation generally; the doors and
windows were broken; the cellar was partly filled with filthy sewage;
the floors were littered with decomposing straw, which the occupants
used for bedding; every available place, from cellar to garret,
was crowded with immigrants--men, women, and children. The whole
establishment was reeking with filth, and the atmosphere was heavy with
the sickening odor of the deadly typhus, which reigned supreme in every
room.
The necessity of immediately closing this house to further occupation
by immigrants, until it was thoroughly cleansed and made decently
habitable, was imperative, and I made inquiries for the responsible
owner. I found that the house was never visited by anyone who claimed
to be either agent or owner; but that it was the resort of vagrants,
especially of the most recent and destitute immigrants; that they came
and went without let or hindrance, generally remaining until attacked
by the prevailing epidemic of fever, when they were removed to the
fever hospital.
[Sidenote: The Unknown Owner]
After considerable inquiry in the neighborhood I found a person who
was the real agent of the landlord; but no other information could be
obtained than that the owner took no interest in the property, and
that the agent was under instructions not to reveal the owner’s name.
A suggestion to this agent, to have the house vacated and put in good
condition for tenants, was refused with a contemptuous remark as to the
absurdity of furnishing such vagrants and immigrants better quarters in
which to live.
As there was no Health Department to which an appeal could be made, the
Metropolitan Police Department was visited and the matter laid before
its president, Mr. Acton. He directed the secretary, Mr. Hawley, a
lawyer, to examine the health laws and ordinances to determine what
measures were in the power of the police to enforce. A search was
made, and the result was that neither law nor ordinance under which
the police could take action was found. Mr. Acton advised that the tax
lists be examined, to find who paid taxes on the property, and thus
discover the responsible party to its ownership, and then that appeal
be made directly to him to authorize the necessary improvements. An
examination of the tax list revealed that the owner was a wealthy man,
living in an aristocratic neighborhood, a member of one of the most
popular churches of the city.
The condition of his tenement house was brought to his attention, and
its menace to the public health as a fruitful fever nest was explained.
He was very angry at what he declared was an interference with the
management of his property, and asserted, in the most emphatic manner,
that as the house yielded him no rent, he would not expend a dollar for
the benefit of the miserable creatures who had so wrecked the building.
With the failure of this appeal to the owner, I had exhausted,
apparently, every legal and moral means of abating a nuisance dangerous
to life and detrimental to health.
[Sidenote: Fear of Publicity]
In this extremity I visited the office of the _Evening Post_ and
explained the matter to Mr. William Cullen Bryant, then editor of that
newspaper. He was at once interested in the failure of the power of
the City Government to remedy such a flagrant evil. In the absence of
laws and ordinances, Mr. Bryant proposed to make the case public in all
of its details, and for that purpose suggested that the police should
cause the arrest of the delinquent owner, and he would send a reporter
to make notes of the case. A charge was made against the landlord, and
he was required to appear at the Jefferson Market Court. On entering
the court he was confronted by the reporter, pad and pencil in hand,
who pressed him with questions as to his tenement house.
Greatly alarmed at his situation, the owner inquired as to the purpose
of the reporter, and was informed that Mr. Bryant intended to publish
the proceedings of the court in the _Evening Post_, and to expose
his maintenance of a fever nest of the worst description. He begged
that no further proceedings be taken, and promised the court that he
would immediately make all necessary improvements. He promptly vacated
the house, and made such a thorough reconstruction of the entire
establishment that it became one of the most attractive tenements in
that East Side district. For many years that house continued to be
entirely free from the ordinary contagious diseases of the tenement
houses of the city. It is an interesting fact that the landlord
subsequently thanked the writer for having compelled him to improve his
tenement house; for he had secured first-class tenants who paid him
high rents.
[Sidenote: Agitation for Reform]
This incident came to the attention of several prominent citizens,
physicians, lawyers, and clergymen, who became profoundly impressed
with the revelation that there were no laws under which such a glaring
violation of the simplest principles of health, and even of common
decency, could be at once corrected.
For many years there had been a growing sentiment in favor of a reform
of our health regulations, stimulated by the writings of Dr. John H.
Griscom, Dr. Joseph M. Smith, Dr. Elisha Harris, and others, and the
Academy of Medicine had occasionally passed resolutions favoring
adequate health laws; but no results had been secured.
It was now resolved to organize a society devoted expressly to sanitary
reform, and the “Sanitary Association” came into existence. For several
years this body annually introduced a health bill into the Legislature,
but the measure was regularly defeated through the active opposition of
the City Inspector, whose office would be abolished if the bill became
a law.
[Sidenote: The Citizens Association]
In the early sixties the famous “Citizens Association” was organized,
with Peter Cooper as President, and a membership of one hundred of the
most prominent citizens. This was in the days of the Tweed régime, and
at a period when the City Government was most completely in his power.
The objects of the Association were reform in all branches of the
Municipal Government, the promotion of wise legislation, and the defeat
of all attempts to subordinate the city to the schemes for control by
Tweed and the coterie of politicians who were under his directions.
The friends of sanitary reform decided to attempt to secure proper
legislation through the Citizens Association. The application, by a
delegation, for the aid of this Association was well received and a
plan of procedure adopted. The secretary of the Citizens Association,
Mr. Nathaniel Sands, had been a member of the Sanitary Association, and
as an enthusiastic sanitarian had been disappointed at its repeated
failure to secure legislation. At his suggestion, it was decided to
create two committees, one on health and another on law, and through
these agencies to have the Citizens Association accomplish its work.
The first committee eventually came under my direction, while the
second was directed by Dorman B. Eaton, Esq.
In the Committee on Public Health were many of the more prominent
medical men of that period, as Dr. Valentine Mott, Dr. Joseph M. Smith,
Dr. James R. Wood, Prof. John W. Draper, Dr. Willard Parker, Dr. Isaac
E. Taylor. The Committee on Law was equally distinguished for its
membership, having on its list the names of William M. Evarts, Charles
Tracy, D. B. Silliman.
[Sidenote: A Health Bill]
It was determined, as a preliminary step, to prepare a “Health Bill”
and introduce it into the Legislature, which was that of 1864, and thus
learn the obstacles to be met; for efforts had repeatedly been made to
pass health bills without success. The bill was drawn along the lines
of previous bills, and was altogether inadequate in its provisions to
effect the required reforms. The effort, however, developed the fact
that the real opposition to health legislation was the City Inspector’s
Department. As that department exercised all of the health powers, any
proper health bill would abolish it altogether.
The City Inspector, at that time, was a grossly ignorant politician,
but as he had upwards of one million of dollars at his disposal, he
had a prevailing influence in the Legislature when any bill affected
his interests. At the hearing on the Association’s bill, the City
Inspector’s agents denied every allegation as to the unsanitary
condition of the city, and as the Association had no definite
information as to the facts asserted, the bill failed, as had all the
bills of the Sanitary Association during the previous ten years.
[Sidenote: Sanitary Inspection of New York]
In conference it was now decided to make a thorough sanitary inspection
of the city by a corps of competent physicians, draft a new and much
more comprehensive measure, and thus be prepared to confront the City
Inspector with reliable facts in regard to the actual condition of the
city. The Citizens’ Association consented to bear the expense of the
undertaking.
Under the auspices of the Association, and in the absence of the
secretary of the Committee on Health, Dr. Elisha Harris, who was at
that time in the service of the United States Sanitary Association,
I organized and supervised the inspection. The corps of inspectors
consisted of young physicians, each assigned to one of the districts
into which the city was divided. The work was completed during the
summer months of 1864, and the original reports of the inspectors
were bound in seventeen large folio volumes. These reports were
afterwards edited by the secretary, Dr. Elisha Harris, and published
by the Association in a volume of over 500 pages. The total cost to
the Association of this inspection and publication was $22,000; but it
richly repaid the Association, for it accomplished the object for which
it was undertaken.
This volunteer sanitary inspection of a great city was regarded by
European health authorities as the most remarkable and creditable in
the history of municipal reform. Too much credit can not be given to
the President of the Association, Peter Cooper, and to the Secretary,
Nathaniel Sands, for the constant support which they gave the Committee
on Health in the prosecution of this great undertaking.
Meantime the Committee on Law perfected a bill to be introduced at the
coming session of the Legislature, 1865. It was the joint product of
the Medical and Law Committees, and was made the subject of extensive
study and research, in order to embody in it every provision essential
to its practical operations.
At the request of the Committees I made the first draft for the purpose
of embodying the sanitary features as the basis of the bill. Former
health bills were restricted in their operations to the city of New
York, and the officers were appointed by the Mayor. As the government
of the city was dominated in all of its departments by Tweed, it was
decided to place the proposed new health organization under the control
of the State, by making a Metropolitan Health District, the area of
which should be co-extensive with that of the Metropolitan Police
District. This feature of the bill was also important because the
protection of the city from contagious diseases in outlying districts
required that the jurisdiction of the Board should extend to contiguous
populations.
The original draft having been approved by the Committee on Health, Mr.
Eaton was requested to perfect the bill by adding the legal provisions.
As he had recently made a study of the English health laws, he
incorporated many items especially relating to the powers of the Board
which were quite novel in this country.
[Sidenote: An Anomaly in Law]
One feature of the bill deserves mention; for it is an anomaly in
legislation and apparently violates the most sacred principle of
justice; viz., the power of the courts to review the proceedings
of a health board. The Committees concluded that a board which was
authorized to abate nuisances “dangerous to life and detrimental to
health” should not be subjected to the possible liability of being
interrupted in its efforts to abate them by an injunction that would
delay its action. Accordingly the law as so drawn that the Metropolitan
Board was empowered to create ordinances, to execute them in its own
time and manner, and to sit in judgment on its own acts, without the
possibility of being interrupted by review proceedings or injunctions
by any court.
Its power was made autocratic. The language of that portion of the bill
conveying these powers was purposely made very technical, in order
that only a legal mind could interpret its full meaning, it being
believed that the ordinary legislator would not favor the measure if
he understood its entire import. It is an interesting fact that the
first case brought into court under the law was an effort to prove the
unconstitutionality of this feature; but it was carried to the Court of
Appeals, and its constitutionality was sustained by a majority of one.
[Sidenote: Introduction of an Epoch-Making Bill]
On the assembling of the Legislature of 1865 the Metropolitan Health
Bill was formally introduced into both houses, and preparations made to
secure its passage. Mr. Eaton was selected by the Citizens’ Association
to advocate the legal provisions of the bill at the hearings before
the committees of the Legislature, and I was delegated to explain the
sanitary requirements of the measure. The first hearing occurred on
the thirteenth of February, before a joint committee of both houses,
Hon. Andrew D. White, senator, presiding. A large audience was present,
including the City Inspector and the usual retinue of office holders
in his department. The Citizens Association was represented by Rev.
Henry W. Bellows, Dr. James R. Wood, Dr. Willard Parker, Prof. John W.
Draper, and several other prominent citizens, in addition to Mr. Eaton
and myself.
Mr. Eaton first addressed the committee, and made an admirable
presentation of the legal features of the bill. He eloquently appealed
for its enactment into law, in order to create in New York a competent
health authority, with power to relieve the city of its gross sanitary
evils and adopt and enforce measures for the promotion of the public
health.
I followed him, my task being to show, from the existing condition of
the city, the imperative need of such legislation. My remarks on the
occasion were published in _The New York Times_ of March 16, 1865.
IV
NEW YORK, THE UNCLEAN
The illustrations in this chapter, with the frontispiece of the
book, have all been reproduced from the elaborate report published
by the Council of Hygiene of the Citizens’ Association. My address
before the Legislative Committee is here given as it then appeared in
_The New York Times_ of March 13, 1865, with the correction of some
typographical errors. It consisted of a detailed presentation of the
facts recorded and sworn to by the medical inspectors employed by the
Citizens’ Association, together with photographic illustrations which
were made by them.
Mr. Chairman: I have been requested to lay before you some of the
results of a sanitary inspection of New York City, undertaken and
prosecuted to a successful completion by a voluntary organization
of citizens. There has long been a settled conviction in the minds
of the medical men of New York, that that city is laboring under
sanitary evils of which it might be relieved. This opinion is not mere
conjecture, but it is based upon the daily observations which they are
accustomed to make in the pursuit of professional duties.
[Sidenote: Alarm of Medical Men]
Familiar, by daily study, with the causes of diseases, and the laws
which govern their spread, they have seen yearly accumulating about and
within the homes of the laboring classes all the recognized causes of
the most preventible diseases, without a solitary measure being taken
by those in authority to apply an effectual remedy. They have seen
the poor crowded into closer and closer quarters, until the system
has actually become one of tenant-house packing. They have witnessed
the prevalence of terrible and fatal epidemics, having their origin
in or intensified by these conditions, and many of their professional
brethren have perished in the courageous performance of their duties to
the poor and suffering.
Cognizant of these growing evils, and believing that they are
susceptible of removal, they have repeatedly and publicly protested
against the longer tolerance of such manifest causes of disease and
death in our city. Large bodies of influential citizens have been
equally impressed with the importance of radical reform in the health
organizations of New York, and have strenuously labored, but in vain,
to obtain proper legislative enactments.
[Sidenote: A Systematic Investigation]
To give practical effect to their efforts, it was determined in May
last to undertake a systematic investigation of the sanitary condition
of the city. For this purpose a central organization was formed, and
when I mention the names of its leading members, I give you the best
assurance that the work was undertaken in the interests of science and
humanity. The president was Dr. Joseph M. Smith, one of the ablest
writers on sanitary science in this country, and among its members
were Drs. Valentine Mott, James Anderson, Willard Parker, Alonzo
Clark, Gurdon Buck, James R. Wood, Charles Henschel, Alfred C. Post,
Isaac E. Taylor, John W. Draper, R. Ogden Doremus, Henry Goulden, Henry
D. Bulkley, and Elisha Harris.
In prosecuting this inquiry the Association was guided by the
experience of similar organizations in Great Britain, where sanitary
science is now cultivated with the greatest zeal, and is yielding the
richest fruits. As a preliminary step to the introduction of sanitary
reforms, many of the populous towns of England made a more or less
complete inspection of the homes of the people to determine their
condition, and to enable them to arrive at correct conclusions as to
the required remedial measures. The English Government undertook a
similar investigation through its “Commissioners for Inquiring into
the State of Large Towns and Populous Districts,” and the voluminous
and exhaustive reports of that Commission laid the foundation of the
admirable sanitary system of that country.
The first object of sanitary organization was apparently, therefore,
to obtain detailed information as to the existing causes of disease
and the mortality of the population, and as to the special incidence
of that mortality upon each sex, and each age, on separate places, on
various occupations; in fact, to present a detailed account of what
may be called, in commercial phrase, our transactions in human life.
[Sidenote: A House-to-House Inspection]
Evidently the best method of arriving at such knowledge was by a
systematic inspection. And that inspection must be a house-to-house
visitation, in which the course of inquiry not only developed all the
facts relating to the sanitary, but equally to the social condition of
the people. It must necessarily be required of the inspector that he
visit every house, and every family in the house, and learn by personal
examination, inquiry, and observation, every circumstance, external and
internal to the domicile, bearing upon the health of the individual.
To perform such service satisfactorily, skilled labor must be
employed. No student of general science, much less a common artisan,
was qualified to undertake this investigation into the causes of
disease; however patent these causes might be, he had no power to
appreciate their real significance. Minds trained by education, and
long experience in observing and treating the diseases of the laboring
classes, could alone thoroughly and properly accomplish the work
proposed.
[Sidenote: The Medical Experts]
Happily, experts were at hand and prepared to enter upon the
task, viz.: the dispensary physicians. The daily duties of these
practitioners have been for years to practice among the poor, and study
minutely their diseases; and thus they have gained an extensive and
accurate knowledge of the sanitary and social condition of the mass of
the people. Many of these practitioners have been engaged in dispensary
service, and in a single district, for ten to twenty years. They have
thus become so familiar with the poor of their district, though often
numbering 40,000 to 50,000, that they know the peculiarities of each
house, the class of disease prevalent each month of the year, and to a
large extent the habits, character, etc., of the families which occupy
them.
From this class of medical men the Council selected, as far as
possible, its corps of Inspectors. As a body, they represent the best
medical talent of the junior portion of the profession of New York.
Many occupy high social positions, and all were men of refinement,
education, and devotion to duty. They entered upon the work with the
utmost enthusiasm; engaging in it as a purely scientific study.
Everywhere the people welcomed the Inspectors, invited them to examine
their homes, and gave them the most ample details.
[Sidenote: Plan of Inspection]
The plan of inspection adopted by the Council was as follows: The city
was divided into thirty-one districts and an Inspector selected for
each, care being taken to assign to each inspector a district with
which he was most familiar. The Inspector was directed to commence his
inspection by first traversing the whole district, to learn its general
and topographical peculiarities. He was then to take up the squares in
detail, examining them consecutively as they lie in belts.
Commencing at a given corner of his district, he was first to go around
the square and note: 1. Nature of the ground. 2. Drainage and sewerage.
3. Number of houses in the square. 4. Vacant lots and their sanitary
condition. 5. Courts and alleys. 6. Rear buildings. 7. Number of
tenement houses. 11. Drinking shops, brothels, gambling saloons, etc.
12. Stores and markets. 13. Factories, schools, crowded buildings. 14.
Slaughter-houses (describe particularly). 15. Bone and offal nuisances.
16. Stables, etc. 17. Churches and school edifices.
Returning to the point of starting, he was to commence a detailed
inspection of each building, noting: _a._ Condition and material of
buildings. _b._ Number of stories and their height. _c._ Number of
families intended to be accommodated, and space allotted to each.
_d._ Water supply and house drainage. _e._ Location and character
of water-closets. _f._ Disposal of garbage and house slops. _g._
Ventilation, external and internal. _h._ Cellars and basements, and
their population. _i._ Conditions of halls and passages. _j._ Frontage
on street, court, alley--N., E., S. or W. 18. Prevailing character of
the population. 19. Prevailing sickness and mortality. 20. Sources
of preventible disease and mortality. 21. Condition of streets and
pavements. 22. Miscellaneous information.
[Sidenote: Each Room Examined]
He entered each room, examined its means of ventilation and its
contents, noted the number of occupants by day and by night, and
carefully estimated the cubical area to each person. Whenever any
contagious or infectious disease was discovered, as fever, smallpox,
measles, scarlatina, the Inspector made a special report upon the
dwelling. This report embodied specific answers to a series of
questions, furnished in a blank form, requiring him 1. To trace and
record the medical history of the sick person. 2. To ascertain and
record facts relating to the family and other persons exposed to the
patients and to the causes of the malady. 3. To report the sanitary
condition of the domicil. 4. To report the statistics and sanitary
condition of the population of that domicil. 5. To report upon the
sanitary condition of the locality or neighborhood and its population.
6. To preserve and make returns of these records. 7. To prepare on
the spot the necessary outlines or data for the sketching of a map or
descriptive chart of the domicil, block, or locality.
Each Inspector was supplied with a notebook and a permanent
record-book; in the first he constantly made notes as his examination
proceeded, and in the latter these notes were expanded and put on
permanent record. These permanent record-books are the property of the
Association and embrace for the most part minute details concerning
every building and tenement occupied by the laboring classes, as also,
grog-shops, stables, vacant lots, slaughter-houses, etc.