fevers of the typhus, typhoid, remittent and intermittent types,
cholera infantum, scarlatina, dysentery, and diarrhoea, all confined to
densely populated tenements. The typhus and typhoid fevers have been of
a malignant type in two houses, twelve out of eighteen cases proving
fatal.
Ninth Ward: The prevailing diseases during the past season have been
typhoid fever, dysentery, diarrhoea, scarlet fever, measles, and a few
cases of variola.
[Sidenote: Seeds of Disease Uncontrolled]
Sixth Ward: The seeds of disease exist everywhere, and although
removable and susceptible of sanitary control, they are yet
uncontrolled, and at any time may spring into activity and a terrific
life, that shall only have the power and effect of death. Cholera,
when it visits these shores again, will first break forth here, if
proper sanitary measures be neglected. Typhus fever nests exist in
all parts of the district; and it has been traced from these nests to
every ward in the city, spreading the disease not only in the worst
localities, but into the homes of the industrious, the wealthy, and the
highest classes of society. This disease is now on the increase, and if
proper sanitary measures are not adopted to remove the predisposing and
the infecting causes, we may again have an epidemic of that scourge.
Fourteenth Ward: There have been attended in this district, during
the last year, over 200 cases of typhoid and typhus fever by one
dispensary physician; also, 70 cases of dysentery, and 50 cases of
smallpox. There is one particular locality which has contributed to the
spread and intensity of the fever contagion, viz.: the little street
known as Jersey Street. It is always filthy, and the effluvia arising
therefrom is extremely offensive. The privies are generally full nearly
to overflowing, and the yards are also in a dirty condition, heaps of
refuse matter being allowed to remain and to accumulate continually
in many of them. There is no sewer in this little street, though the
streets at each end are sewered.
[Illustration: A PERPETUAL FEVER-NEST: REAR TENANT-HOUSES IN WASHINGTON
STREET, 1865]
[Sidenote: Where Disease Flourishes]
Tenth Ward: The most prominent diseases during the past year have been
phthisis, typhoid and scarlet fevers, cholera infantum, dysentery,
smallpox, and diphtheria. They were most prevalent in the poorest part
of the district, having the lowest ground, the filthiest streets, and
the most dense population of poor and careless people, who are crowded
in the numerous tenant-houses, shanties, and small dwellings, which
were built for one or two families, but are now made to contain from
five to ten.
Nineteenth Ward: The diseases that have chiefly prevailed during the
past season are dysentery, diarrhoea, cholera morbus, cholera infantum
and the exanthematous fevers. They were of the most frequent occurrence
in the most crowded and insalubrious quarters.
Fifteenth Ward: Since the commencement of the survey, scarlet fever,
typhoid fever, smallpox, and cholera infantum have prevailed in the
tenant-houses of this ward. Six cases of smallpox occurred in one of
three thickly peopled rows of such dwellings, and the disease was
communicated to a child in an adjacent street, who had been playing in
the infected neighborhood. Seven cases of typhoid also occurred in a
court among children, and this was within a few doors of better class
houses.
Eleventh Ward: Typhus and typhoid fevers have been found prevailing
in all sections of this district. Smallpox, scarlatina, measles, and
pulmonary diseases are met with in almost every street. Typhus is the
most typical of the preventable diseases that abound in the Eleventh
Ward. Cholera infantum and obstinate diarrhoeal maladies were prevalent
in the rear tenements and throughout the lowest streets during the
summer and autumn.
To give you an idea of the wide prevalence of these diseases, I will
notice one or two more in detail.
[Sidenote: Smallpox]
Smallpox is the very type of preventable diseases. We have a safe
and sure preventive in thorough vaccination. And yet this loathsome
disease is at this moment an epidemic in New York. In two days’ time,
the inspectors found 644 cases, and in two weeks, upward of 1,200;
and it was estimated that only about one-half were discovered. In
many large tenant-houses, six, eight, and ten cases were found at the
same time. They found it under every conceivable condition tending to
promote its communicability. It was in the street cars, in the stages,
in the hacks, on the ferry-boats, in junk-shops, in cigar-stores,
in candy-shops, in the families of tailors and seamstresses, who
were making clothing for wholesale stores, in public and in private
charities. I hold in my hand a list of cases of smallpox found
existing under circumstances which show how widespread is this disease.
Bedding of a fatal case of smallpox was sold to a rag-man; case in a
room where candy and daily papers were sold; case on a ferry-boat;
woman was attending bar and acting as nurse to her husband who had
smallpox; girl who was making cigars while scabs were falling from her
skin; seamstress who was making shirts for a Broadway store, one of
which was thrown over the cradle of a child sick of smallpox; tailors
making soldiers’ clothing, have their children, from whom the scabs
were falling, wrapped in the garments; a woman selling vegetables had
the scabs falling from her face, among the vegetables, etc., etc.
Instances of this kind can be quoted at any length, but these examples
are sufficient to show that smallpox spreads uncontrolled throughout
our city. And they show, too, how this disease is disseminated abroad.
Says the Inspector of the Fourth Ward:
[Sidenote: Smallpox in Tailored Garments]
“In localities where smallpox prevailed I found, in some instances
within a few feet of the patients, tailors at work for our best
clothing establishments. Such infected vestments--worse than the tunic
of the Centaur--bring disease and death not only to the wearers, but
to many others. The occupant of the crowded tenant-house procures from
such a source a coat or a blanket, and soon a loathsome pest attacks
the young and unprotected members of his family, and ultimately spreads
through the entire quarter, destroying life after life and endangering
the health of a whole community.
“Smallpox, suddenly breaking out in some secluded rural district, often
owes its unsuspected origin to the above causes. In the remote solitude
of the ocean the seaman opens the chest in which he has deposited such
obnoxious apparel, and from this Pandora’s box scatters the seeds of
pestilence among his comrades, which, ripening, shall spread its germs
to distant ports.”
Or, what is more striking, take the following from the report of the
Inspector of the Fifth Ward:
“The largest wholesale establishments for the sale of dry goods
on this side of the Atlantic Ocean are in immediate contact with
the tenant-houses of the worst class, and which are infested with
smallpox and typhus fever. The two freight depots and the principal
passenger depot of the Railroad Company are in the same close
association with these nests of infection. In the region immediately
surrounding are also situated several hotels, and a large number of
boarding-houses, whose inmates are thus in danger of personal contact
with these diseases any moment. West Broadway, running through the
very centre of the district, is traversed by five different lines of
railway cars, with an average of five cars passing every minute, and
carrying millions of passengers yearly by the very doors of these
houses. Broadway, at but a short distance removed, is the principal
thoroughfare of the city. Hudson Street on the west is also a leading
route for city travel; and the cross streets of the district are
traversed daily by multitudes to reach various lines of steamboats,
cars, and steamships, which leave the city opposite this point.
[Illustration: A REGION OF SMALLPOX AND TYPHUS FEVER, 1865]
“All this large amount of daily travel passes through a region always
containing cases of typhus fever, and largely infected with smallpox.
Is it any cause of surprise that cases of these diseases are here
contracted, to be carried to distant sections of the country, there to
develop themselves, to the surprise and alarm of whole neighborhoods?
It is also well to remember that several large livery stables
are located in the immediate neighborhood, whose vehicles, it is
well-known, are frequently employed to carry persons, suffering from
these diseases, to hospitals, or to attend at funerals. These vehicles
are, perhaps, immediately afterward driven to the various car and
steamboat lines to secure passengers, who are thus exposed in the most
dangerous manner to these diseases.”
[Sidenote: Typhus Fever]
Second only to smallpox as a preventable disease, but of a more fatal
character, is typhus fever. Typhus is greatly aggravated by domestic
filth, and by overcrowding, with deficient ventilation. The inspectors
found and located by street and number no less than 2,000 cases of this
most contagious and fatal disease. Commencing in a large tenant-house
in Mulberry Street, it was traced from locality to locality, in the
poorer quarters, until it was found to have visited nearly every
section of the city. It became localized in many tenant-houses and
streets, where it still remains, causing a large amount of sickness and
mortality.
At Mulberry Street, in a notoriously filthy house, it has existed
for more than four years. This house has a population of about 320,
which is renewed every few months. During the period alluded to, there
have been no less than 60 deaths by fever in this single house, and
240 cases. To-day this fever is raging uncontrolled in that house,
creating more orphans than many well-fought battles. Every new family
which enters these infected quarters is sure to fall a victim to this
pestilential disease.
[Illustration: PLAN OF FEVER-NEST, EAST 17TH STREET, 1865
_Here 85 Cases of Typhus Occurred in One Season_]
The tenant-house No. -- East Seventeenth Street, which reaks with
filth, gives the same history; upward of 85 cases, with a large
percentage of deaths, occurred in this single house during the past
season. And still it remained unclean and open to new tenants. I
could mention scores of these houses in every part of the tenant-house
district where typhus has apparently taken up its abode, and from
whence it sends out in every direction its deadly streams.
Not only have single houses become centres of contagion, but this
fever has, in many instances, become localized in crowded streets,
which to-day are almost impassable on account of the heaps of garbage,
and the courts and alleys of which are reeking with filth, making
them great centres of pestilence. From many of these tenements whole
families have been swept away.
[Illustration: BIRD’S-EYE VIEW OF FEVER-NEST, 1865, NOT FAR FROM
BROADWAY AND FIFTH AVENUE]
Jersey Street, a short but uncleaned avenue, adjacent to a fashionable
part of Broadway, is another great depot of fever, which, according to
these records, frequently contained upward of thirty cases in progress
at one time. East Eleventh Street, between First and Second Avenues,
now, as all the past summer, in a horribly filthy condition, is a
local habitation of fever of the worst type. The same statement may be
made of nearly every district where the tenant-houses are especially
crowded, and the streets, courts, and alleys are unusually filthy.
[Sidenote: Intestinal Affections]
Intestinal diseases, as cholera infantum, diarrhoea, dysentery, typhoid
fever, etc., which arise from, or are intensely aggravated by the
emanations from putrescible material in streets, courts, and alleys,
or from cesspools, privies, drain pipes, sewers, etc., were prevalent
in the tenant-house districts, creating, as usual, a vast amount of
sickness, and a large infant mortality. Very generally these diseases
were directly traceable to the decomposing filth, and in some instances
were stopped by the removal of the nuisance.
The Inspector of the Eighth Ward reports: “Cholera infantum has
probably consigned many more to the grave during the past summer than
all other diseases in my inspection district. In every case examined I
have found it associated with some well-marked course of insalubrity;
vegetable and animal decomposition have been the most prominent causes.
That fifty per cent die from preventable causes in my inspection
district I do not doubt.”
The Inspector of the Sixth Ward says: “The mortality among children is
fearfully high, many families having lost all their children; others
four out of five or six.”
[Sidenote: Living at a Sewer’s Mouth]
[Illustration: PLAN OF MONROE STREET FEVER-NEST, 1865]
The Inspector of the Ninth Ward says he found among the people living
near the mouth of an open sewer: “That no less than twenty-nine cases
of dysentery and diarrhoea, five of which had terminated fatally, had
occurred during the three weeks immediately preceding his inspection.”
He adds: “Now, when we take into consideration the fact that there are
only twenty-two dwellings on this square (a considerable portion of it
being occupied by a large lumber-yard), and that all these cases had
occurred within a period of about twenty-one days, the ratio becomes
appalling. How many cases may have occurred subsequently, I have not
sought to ascertain, my time being fully occupied in the inspection of
the other parts of my district. But a still more direct and specific
action of the poisonous emanations proceeding from this obstructed
sewerage, manifested itself in the dwelling on the corner of West and
Gansevoort streets, which is in the closest proximity to the outlet
of the sewer. Here I learned, upon inquiry, that typhoid fever had
prevailed almost continuously during the preceding winter, and I found
three severe cases of dysentery at the time of my visit.”
But I will not occupy time with further details of the evidence which
this inspection furnishes of the vast accumulation of the causes of
unhealthiness which exist in New York, and of the wide prevalence of
contagious diseases arising therefrom or aggravated thereby.
The next point of inquiry is as to the effect of these conditions upon
the public health of the city. Our constituted health authorities
claim that notwithstanding this excessive concentration of the causes
of disease around and in the homes of half of our population, the
death-rate of New York is very low. To properly understand this
statement, we must inquire what is the rate of death from inevitable
causes.
[Sidenote: The Normal Death-Rate]
It has been estimated by careful writers on vital statistics that 17 in
1,000 living persons annually die from inevitable causes. That is, in a
community of 1,000 persons living under circumstances such that persons
die only from old age, cancer, casualties, etc., 17 will die annually,
and no more. And this number is the maximum that will die without
the occurrence of some disease due to a removable cause. Taking this
standard as the absolute necessary death-rate, we can readily estimate
the number of unnecessary or preventable deaths which occur in any
community.
Says the Registrar-General of England (Twentieth Annual Report): “Any
deaths in a people exceeding 17 in 1,000 annually are unnatural deaths.
If the people were shot, drowned, burnt, poisoned by strychnine,
their deaths would not be more unnatural than the deaths wrought
clandestinely by diseases in excess of the quota of natural death--that
is, in excess of seventeen in 1,000 living.”
[Sidenote: Death-Rate of New York]
Taking this as the standard, let us see how the death-rate of New
York compares with it. It is claimed by the city officials that
notwithstanding the vast accumulation of the universally-recognized
causes of disease, New York has a low death-rate. It is not reasonable
to suppose this statement true, nor is it true, as will presently
appear. It is stated very truly in the City Inspector’s Report for
1863, that “it is only by taking a connected view of a period of years
that a correct judgment can be formed of the state of health of a
city,” and upon this basis let us determine what is the mortality of
New York.
Take the 11 years preceding the last census, viz., 1860, excluding,
however, 1854, the year of the cholera. I select this period because it
includes the three last census returns, and it is only where we have
the census returns with the mortality records that we have accurate
data for our estimates. Now, the City Inspector’s own records (reports
of 1863, page 192) show that during the period referred to, the
death-rate of New York City was never below 28 in the 1,000, and twice
exceeded 40 in the 1,000, the average being as high as 33 in the 1,000.
These deductions are made directly from the City Inspector’s Reports,
and, as they are claimed to be infallible, these conclusions cannot be
controverted.
Now, when you remember that the highest death-rate fixed by sanitary
writers for inevitable deaths is 17 in 1,000, and that all deaths above
that standard are considered preventable, it is apparent what a fearful
sacrifice of life there is in New York. Estimated at the very minimum
death-rate of the last decennial period, viz.: 28 in 1,000, New York
annually lost 11 from preventable deaths in 1,000 of her population, or
upwards of 7,000 yearly, on an average, giving the enormous sum total
for this period of 77,000 preventable deaths.
It may be urged that cities never can attain to this standard of
healthfulness, but English writers maintain that the rate of 17 in the
1,000 is the true measure of the public health, and that even the most
populous towns may yet be brought up to it. Nor can we doubt that there
is much plausibility in the assertion, when we find the mortality in
Philadelphia fall to 18 in 1,000, and that of London gradually descend
from 30 in 1,000 to 22 in 1,000.
[Sidenote: New York, London, and Liverpool Compared]
It is maintained, also, that New York has a lower death-rate than
London or Philadelphia. Let us see how far this assertion is sustained
by the records of the health authorities of those cities. During the
decennial period preceding, but including 1860, and excluding 1854,
as in the former comparison, the minimum mortality in London was 20
in 1,000, the maximum 24 in 1,000, the mean about 22 in 1,000. These
figures are from the Registrar-General Reports.
The rate of mortality of Philadelphia for the same period was as
follows: Minimum 18 in 1,000, maximum 23 in 1,000, mean about 20 in
1,000. These figures are from the report of Dr. Jewell, long the able
Health Officer of that city. Placed in their proper relation, these
mortality statistics read as follows: The number of deaths to the 1,000
living for the ten years, 1850–60 inclusive, but exclusive of 1854, is
for
Min. Max. Av.
London 20 24 22
Philadelphia 18 23 20
New York 28 41 33
If, then, New York had as low an average death-rate as Philadelphia,
she would have saved 13 in 1,000 of her population during that period,
or in 1860, 10,577. These figures may seem excessive, but they are
careful deductions from the annual returns of the several cities.
And yet it is reiterated year after year by the City Inspector, that
“New York City, at this day, can lay claim to the privilege of being
numbered with the most healthy in the world.”
With what consummate justice did Dr. Jewell administer this withering
rebuke to our pretentious official. “It is unnecessary,” he says, in
his report of 1860, “to comment upon this extraordinary statement, when
the above figures contradict so positively the assertion. It is to be
regretted that the inspector had not availed himself of the above
statistical information, which would have obliged him to have presented
a widely different statement, although one indicating a more severe
pressure of sanitary evils, upon the health of their population, than
his report develops.”
[Sidenote: Constant Sickness]
But excessive as is this death-rate, it is not the full measure of the
penalty which we pay to the demon of filth. A high death-rate from the
diseases which it engenders or intensifies, always implies a large
amount of sickness. It is estimated by competent authority that there
are 28 cases of sickness for every death. On this basis of estimate
what an enormous amount of unnecessary sickness exists in our midst!
Nor is this a mere supposition. I have an accurate census of many
groups of families of that portion of our population who live immured
in filth, and here we find the constant sickness-rate excessive. It is
no uncommon thing to find it 50, 60, and 70 per cent.
[Sidenote: Where the Death Pressure Is Greatest]
I wish now to call your attention to the fact that great as is our
mortality and sickness rate, its excess is not equally distributed
over the entire population, but falls exclusively upon the poor and
helpless. One-half, at least, of the population of New York have a
death-rate no higher than the people of a healthy country town, while
the death pressure upon the other half is frightfully severe. For
example, the Seventeenth Ward, which is inhabited principally by the
wealthy class and has but few tenant-houses, has a death-rate of but 17
in 1,000, or only the death-rate from inevitable causes; but the Sixth
and Fourth Wards, which are occupied by the laboring classes, have a
death-rate varying from 36 to 40 in 1,000.
Thus it appears that while the average death-rate of the city is very
high, it is principally sustained by those Wards where the tenant-house
population is the most numerous. We find this excess of mortality just
where we found the causes of diseases existing most numerously. And
when we sift the matter further, we find that the excess of mortality
is not even equally distributed over these populous poor Wards, but
is concentrated upon individual tenant-houses. For example, while the
mortality of the Sixth Ward is nearly 40 in 1,000, the mortality of its
large tenant-houses is as high as 60 to 70 in 1,000. The following is a
recent census of a large but not exceptional tenant-house of that Ward:
Number of families in the house, 74; persons, 349; deaths, 18, or 53 in
1,000; constant sickness, 1 in 3; deaths of children, 1 in 6, or at the
rate of 16 in 1,000.
The following table illustrates the distribution of the mortality of
New York among the different classes of inhabitants at the last census:
Average mortality of entire city 28 in 1,000
Mortality of better class 10 to 17 “ “
Mortality of tenant-house 50 “ 60 “ “
[Sidenote: Some Scapegoats--Foreign Immigration]
But I should not do justice to this branch of inquiry without noticing
the alleged causes of the high mortality of New York. The first is
the large foreign immigration. The reliance to be placed upon that
scapegoat may be readily shown. Emigration occurs to this country under
two conditions: 1. The emigrant is driven from home by famine, in which
case the poorer class emigrate, or, 2, he is allured by advantages for
labor or business, when the middle classes principally emigrate.
Now, it is under the latter circumstances that emigration generally
takes place to the United States. This is seen in the vast sums of
money which the emigrants now annually bring, and the amounts which
they return to their friends as the result of their labor. This class
is always very hardy and healthy, as is proved by the small mortality
that occurs _in transitu_ being but 4.31 per cent for ten years.
Besides, we have the official statements of the Commissioners of
Emigration that but 3 per cent remain in the city.
[Illustration: A SIXTH WARD FEVER-NEST WITH DEATH-RATE OF 53 IN 1,000]
But the City Inspector himself shows the utter fallacy of this alleged
cause of excessive mortality in his report for 1860, in which he makes
the true explanation, and attributes to its proper cause whatever
increased mortality arises from emigrants. He says: