although suffering from the effects of a protracted voyage, bad
accommodations, and worse fare, do not bring with them any marked
disease beyond those which, with proper care, nursing, and wholesome
air, could not be easily overcome. The causes of this excessive
mortality must be searched for in this city, and are readily traceable
to the wretched habitations in which parents and children are forced
to take up their abode; in the contracted alleys, the tenement house,
with its hundreds of occupants, where each cooks, eats, and sleeps in
a single room, without light or ventilation, surrounded with filth, an
atmosphere foul, fetid, and deadly, with none to console with or advise
them, or to apply to for relief when disease invades them.”
[Sidenote: The Floating Population]
Again, it is alleged that the floating population causes the excess of
deaths. But it has been established by Dr. Playfair that the floating
population is the most healthy. The same is true of wandering tribes,
of a moving army, and equally of individuals. But when they fix their
habitations or encamp, that moment the causes of disease begin to
gather about them, and unless sanitary regulations are carefully
observed, diseases, such as fever, diarrhoeal affections, etc., begin
to prevail.
The poor population of New York is to-day but an immense army in camp,
upon small territory, crowded into old filthy dwellings, and without
the slightest police regulation for cleanliness. If this army should
abandon its camp and begin a roving life in the country, all the
diseases now prevalent would disappear. And it must be added, that if
these deserted and uncleaned tenements should immediately be filled by
healthy people from the country, the new tenants would at once begin to
suffer from all the pestilential diseases now indigenous to that part
of the city.
I have now laid before you, as briefly as possible, the accumulated
evidence that New York is to-day full to repletion with all the causes
which originate and intensify the most loathsome and fatal diseases
known to mankind.
This evidence proves that at least half a million of its population are
literally submerged in filth, and half-stifled in an atmosphere charged
with all the elements of death. I have demonstrated that the legitimate
fruits of her sanitary evils is an excessively high death-rate and a
correspondingly large sickness rate.
[Sidenote: Can the Causes of Disease Be Removed?]
The all-important question which now concerns us as citizens, and
you as practical legislators, is, can these evils be remedied? We
answer, yes. In the first place the streets can be kept clean. Other
cities accomplish this object, and therefore New York can, and we have
striking illustrative examples. In certain portions of the city the
streets are as clean as this floor. They are swept daily, and scarcely
a particle of dust is left in the streets or gutters the year round.
But they are cleaned by private contract of the people residing upon
them. What individual enterprise can do for whole squares, surely a
corporation so lavish in money as New York ought to be able to do for
the city at large.
The courts, alleys, cesspools, and privies can be cleansed and kept in
good condition. There are tenant-houses which are as clean in all their
alleys, courts, and cellars as the best-kept private houses. These are
dwellings for the poor in which the landlord takes especial interest.
What is done for the surroundings of one of these houses, may be done
for all. But the tenant-houses of the worst class may be quickly placed
in a good sanitary condition.
[Sidenote: Improvements During the Inspection]
The inspectors furnish many examples of this fact. They were frequently
mistaken in their inspection for an official, and when their visit to
the tenant-houses was reported to the landlord, he hastened to renovate
the building. Some of the most filthy quarters were so completely
changed within forty-eight hours that the inspectors could scarcely
recognize the locality. The Inspector of the Eighth Ward says:
“The sanitary improvement in my district during the progress of my
inspection was plainly visible. Exceedingly filthy places, overflowing
cesspools, and privies, which were numerous in my first visit, were
suddenly cleaned. Often upon my second visit, with paper and pencil in
my hand to sketch the filthy scene, I would find the quarters cleaned
and whitewashed, and the air, instead of being laden with disagreeable
odors, would be comparatively pure and wholesome. Many of these sudden
transitions were from fear of the presumption that my inspection had
some official authority; but the greater part were brought about by
explaining to the people the necessity of cleanliness.
[Illustration: PLAN OF A TYPICAL FEVER-NEST, 1865]
“Pools of filthy water from obstructions at the street corners, and
accumulated along the gutters, would quickly disappear, when the
people would be convinced of the deleterious effect upon the public
health. It will be well for the inhabitants of New York City, and
especially for those of this section, when there shall be laws not only
to compel them to keep their houses and surroundings clean and free
from the effluvia resulting from vegetable and animal decomposition,
but to prevent the overcrowding of tenant-houses, where fatal diseases
are generated, and where death walks around.”
[Sidenote: How to Improve the People]
The tenant-house population is susceptible of infinite improvement,
when once rescued from the reign of filth, and restored to a pure
atmosphere and clean homes. The poor live in these wretched tenements
because they are compelled to, and not from choice. They universally
complain that they cannot escape from domestic and street filth. It
surrounds and pervades their habitations, always accumulating, and
never diminishing. The most tidy house-wife, compelled to live in the
midst of this ocean of rubbish, with all its degrading associations,
soon finds the same level, and from this she can be rescued only by
giving her again a clean and well-ordered home. And such a home every
municipal government is bound to secure to the poorest and humblest
citizen.
Let the landlord be compelled to keep his house in good repair, supply
it with an abundance of pure water, connect the privy with the sewer,
open free ventilation, afford means for removal of garbage, and then
keep a careful oversight of his tenants, enforcing cleanliness. If this
were done, the tenant-house people would immediately improve, and the
death-rate, if we may judge from other cities, would fall one-fourth.
Again, the cellar population can be removed from their subterranean
abodes, and placed in better homes. Liverpool has solved this problem
for us.
In 1847 that city had a cellar population of 20,000; an ordinance was
passed forbidding the occupation of underground rooms as residences,
with certain restrictions, and within three years the great mass of
people in these subterranean haunts were removed to better tenements,
with a great reduction of the mortality of the city.
That city, formerly the most unhealthy in England, has continued
the reforms thus inaugurated by compelling landlords to improve
their tenant-houses, and the result is that it has become one of the
healthiest towns of Europe. London has recently taken similar action in
regard to cellar tenements. What these cities have done, New York can
and ought to do for her public health.
[Sidenote: A Town That Was Immune]
What the diseases which prevail with such fatality in the uncleaned
tenant-houses are for the most part preventable, we have the most
undoubted evidence. That smallpox is preventable is known to every
school-boy, and yet that loathsome disease to-day prevails throughout
all the tenant-house districts of New York, without the slightest
restraint on the part of our local authorities. Typhus is to-day
ravaging the homes of the poor without “let or hindrance,” and yet
cleanliness and pure air are sure preventives. Of this truth these
reports furnish many examples.
The fever-nest--West Thirty-third Street--is one of a row of
tenant-houses five stories high, and contains 16 families. It was in
a filthy condition, without Croton water, waste-pipes stopped, sinks
overflowing and emitting offensive odors; fever had prevailed all
winter, nearly every person in the house having had an attack, four
having died. It was never inspected by a city official. The owner was
induced to clean the house, and from that date not a case of fever has
occurred. The inspector who reports this case very justly adds: “If,
when the first case of fever occurred in this building, the owner had
been compelled to put it in a good sanitary condition, six human lives
would undoubtedly have been saved, besides a great amount of sickness.”
[Illustration: PLAN OF A REAR CUL-DE-SAC FEVER-NEST, 1865]
Cholera infantum and diarrhoeal affections are found in their greatest
intensity where putrescible animal matter and domestic filth exist.
Remove these causes, or remove the patients from the neighborhood, and
these diseases generally disappear at once. Diphtheria is found to be
most intense in the vicinity of unclean stables. It is, therefore, with
great propriety, that the entire class of zymotic diseases are now
called “filth and foul air” diseases by the English sanitary writers.
Remove the filth and foul air, and these diseases disappear as effect
follows cause.
[Sidenote: Can Populous Towns Be Improved?]
But while it is admitted that the streets of a town may be cleaned,
the condition of the poor improved, and diseases, under the most
favorable circumstances, prevented, it may be doubted whether the
sanitary condition of populous towns can be materially changed, and
the death-rate greatly reduced. Yet in England, where sanitary science
is enthusiastically cultivated, there is not only no doubt that large
towns can be thus improved, but that the mortality of London itself may
be no greater than that of the country.
Already, indeed, the London _Times_ boasts “that the average of
health throughout the City of London is higher than the average of
health throughout all England, taking town and country together. The
mortality in all England is at the rate of 22.8 in every 1,000 of the
population; in the City of London it is at the rate of 22.3 for every
1,000 inhabitants! The improvement has been progressive; it has been
slow, but steady and sure. Gradually the mortality has decreased, until
the yearly death roll of 3,763 has been reduced to 2,904 within a
period of nine years, during which the city has been under the rule of
the Sanitary Commission. The deaths this year--22.3 per 1,000, or one
in every forty-five of the inhabitants--are nine per cent below the
general average, and represent a saving of 286 lives. And secondly,
this gratifying result has been obtained in the face of obstacles which
seemed to be almost insurmountable.”
Liverpool affords a striking example of the power of sanitary measures,
rigidly enforced to improve the public health. It was formerly the most
unhealthy city of England, being the very home of typhus, smallpox,
and allied preventable diseases. But it adopted vigorous measures of
reform, improving its poorer districts, and the death-rate has fallen
eight in 1,000. Macclesfield, Salisbury, and many other English towns
have had their mortality reduced 8, 10, and 15 in 1,000 by the vigorous
prosecution of sanitary improvements. All the populous towns of that
country are moving in this reform, and, as a result, the general
death-rate of towns is approximating that of the country.
[Sidenote: Cleanliness Preserves from Epidemics]
The Health Officer of London announced that cleanliness would
preserve a town from the visitations of epidemics. But there must be
cleanliness of the streets, cleanliness of the courts, cleanliness
of the apartments, and cleanliness of the person. On the approach
of the cholera in 1849 the town of Worcester, England, determined
to test the theory, and set vigorously to work and cleaned the town
thoroughly, removing everything of an offensive nature, and adopting
the most stringent regulations against the accumulation of filth about
or within the homes of the people. The result was that this “destroyer”
of unclean cities made a Passover with the people of Worcester, for on
every lintel and door-post was written--Cleanliness, Cleanliness. Not
a house was entered, and the town was saved in the midst of the most
frightful desolation.
New Orleans is another striking example of the value of civic
cleanliness. Since, by military regulations, it is kept constantly in
a cleanly condition, it has had no visitation of its old enemy, yellow
fever.
The degree of public health of a town is therefore measured by its
cleanliness, and its capacity for health depends upon its capacity for
cleanliness.
[Sidenote: Importance of Sanitary Government]
There is scarcely a city which has such absolute need of an efficient
and intelligent sanitary government as New York. On its small
territory three, four, or five millions of people are yet to be
accommodated with houses. Already there are crowded upon less than
eight of its thirty-two square miles all of our commercial, business,
and manufacturing interests, and the houses of nearly 1,000,000 of
people. And in the natural relations of the poor and rich, the former
consisting of more than half of the entire population, are crowded into
less than a fourth of this area. Of what vast importance is it that a
wise and intelligent authority be vigilantly exercised, so that in its
future growth and expansion every condition pertaining to health shall
be secured to its inhabitants!
It is universally conceded that New York has in the highest degree all
the natural advantages of salubrity. Its climate is the mean between
the extremes of heat and cold; its topographical peculiarities are
admirably adapted for drainage and sewerage; its exposure is southern;
its shores are swept by two rivers, which bear seaward everything
that enters them beyond the power of the flowing tide to return it;
its rural surroundings are of the most healthful. In every respect
it is regarded by competent observers as most favorably located for
cleanliness, and the highest degree of public health. And there can
be no doubt, that should New York be placed under a wise sanitary
government, which would improve all its natural advantages for health,
it would become the cleanest and healthiest city in the world, and one
of the most delightful places of residence.
[Illustration: FLOOR-PLAN OF A NEW FEVER-BREEDING STRUCTURE NEAR
BROADWAY AND CENTRAL PARK, 1865]
[Sidenote: The Entire Country Concerned]
But this is not a matter which concerns the citizens of New York alone.
The people of the State have a vital interest in the public health of
our city. Connected as it is by means of rapid inter-communication
with all parts of the country, there is every facility offered for the
wide diffusion of the seeds of contagion. It is estimated by accurate
statisticians that no less than 250,000 persons pass in and out of
New York daily over the ferries and railroads. It could not fail to
happen that if any contagious disease prevailed in this city, it would
be carried into the country and widely disseminated. And such is now
a matter of daily occurrence. There is no doubt that nearly all the
epidemics of smallpox in country towns, and much of the typhus and
similar diseases, have their origin in New York. I have in my hand
letters from all parts of the State confirming this statement. They
strikingly illustrate the want of a good sanitary police in New York,
and the power of a great commercial centre to scatter disease broadcast
over the country.
A few of these cases will abundantly illustrate the point:
Dr. J. S. Sprague, of Cooperstown, Otsego County, reports the
occurrence of twenty-six cases of smallpox in that town, communicated
by one person in October, 1860, who took the disease at a hotel in our
city, in which a person with the disease had recently died. He was a
merchant, and came to the city on business.
Dr. C. C. F. Gay, of Buffalo, reports the case of a female, who arrived
from New York in November, 1860, and was removed from the cars of the
Erie Railroad to the State Line Road, and proceeded westward. As was
afterward ascertained, she had smallpox, and communicated the disease
at Columbus, Ohio, where there were three deaths produced by it. Four
deaths were directly traceable to this exposure, viz.: three milkmen
and one baggage man, all of whom came in contact with the sick woman.
W. T. Babbitt mentions the case of a young man who took the disease
in this city at a hotel where it was prevailing, at which he stopped
while on a visit here, in whom the disease appeared after his return to
Olean, in Cattaraugus County.
Dr. M. Jarvis, of Canestota, Madison County, relates the case of a
man who visited this city with horses for sale, and was attacked with
symptoms of smallpox some ten days after his return to Smithfield, in
that county, who communicated the disease to his family, from whom it
spread to others in that and, also, in a neighboring town.
[Sidenote: Smallpox in a Hotel Bedroom]
Dr. C. M. Noble, of Waverley, Delaware County, mentions the case of
a merchant of that place, who came to this city with his wife, and
went to one of our most frequented hotels. Being very much fatigued,
they retired to the room provided for them without any particular
examination of it--but found in the morning that they had been put in a
room from which a patient with smallpox had just been removed, without
its having been cleansed. The gentleman was seized with a malignant
form of that disease after his return home. Two deaths and six cases of
smallpox and varioloid resulted from this case.
Dr. S. W. Turner, of Chester, Connecticut, gives also two cases, one
of smallpox and one of varioloid, in that and a neighboring place,
which could be traced to this city.
Dr. Snow, the vigilant Health Officer of Providence, R. I., states that
smallpox is rarely known in that city, except when imported from New
York.
[Sidenote: New York Inoculates the Nation]
I could repeat these details until it was shown that nearly every town
in the State, and nearly every city in the country, has been inoculated
by New York with this most loathsome disease. The most striking and
most melancholy instances of the free dissemination of contagion are
found in the army, where whole regiments have been stricken with
smallpox through infected clothing manufactured at the homes of the
poor, where the disease was prevailing. But these are facts too well
known to every medical man, and even to the community, to require
further illustration.
What terror smallpox creates in country towns when it attacks its first
victim, you very well know. The house where it occurs is quarantined,
and not unfrequently the sufferer is deserted by his friends, and left
to recover or die, as the case may be. Business with the country is
often suspended by the placards posted upon the highways, with the
terrifying word “Smallpox” upon them, and a finger pointing ominously
to the town. In nine cases out of ten, another finger should point
toward New York, as the source of the pestilence.
It has been estimated by a competent observer, that every case of
smallpox in a country town costs, by derangement of business alone,
more money than is annually expended upon its public schools. If
we add to this pecuniary loss the feverish excitement and popular
apprehension, and the sufferings and probable death of the victim from
want of proper care, we may but indifferently estimate the cost to the
country of the prevalence of this disease.
Now, this diffusion of contagion from New York, we contend, is
unnecessary. Every well-informed medical man knows that we may have a
sanitary police so vigilant, so efficient and so powerful, that it will
not only preserve the public health, but prevent the spread of disease
therefrom. We hold, therefore, that you are not only called upon to
protect the people of the City of New York from contagious disease,
but equally that you are bound to protect the people of the State
from dissemination of pestilence by every legislative safeguard which
sanitary science can suggest.
[Sidenote: Inefficiency of Health Organizations]
The Sanitary Committee of the Board of Health, during the prevalence of
cholera in 1849, remark in their report:
“The labors of your committee, during the past appalling season of
sickness and death, and the awful scenes of degradation, misery, and
filth developed to them by their researches, have brought into full
view the fact that we have no sanitary police worthy of the name; that
we are unprotected by that watchful regard over the public health which
common sense dictates to be necessary for the security of our lives,
the maintenance of the city’s reputation, and the preservation of the
interests of the inhabitants.”
[Sidenote: Without Sanitary Government]
This is a perfectly truthful statement of the present condition of New
York. Practically, it is a city without any sanitary government. In
its growth it is developing the natural history of a city that utterly
ignores all rules and regulations which tend to make the homes of its
people pleasant and healthy. It is the only city in the civilized world
which disregards the Platonic idea that in a model republic medical
men should be selected to preserve and promote the public health. Its
board of health, the mayor and common council, is an unwieldly body.
Its commissioners of health have limited powers, and are equally
incompetent.
[Sidenote: The City Inspector’s Department]
The City Inspector’s department, which alone has the machinery for
sanitary inspection and surveillance, is a gigantic imposture. Of
its forty-four health wardens, whose duty it should be to make
house-to-house inspections, searching out the cause of disease, and
using every known agency for the control and suppression of epidemics,
many are liquor dealers, and all are grossly ignorant. Not one has any
knowledge of medical subjects, nor dare they freely visit such diseases
as smallpox, typhus, or cholera.
During this entire voluntary inspection, extending over six months,
health wardens have rarely been known to visit infected quarters,
although smallpox, fever, etc., etc., have been prevalent, and the city
has been in a most disgracefully filthy condition. A single health
warden recently ventured to visit a house where smallpox existed in an
upper room; he sent for the attendant, and when she appeared, ordering
her not to approach him, he gave the following as the best means of
prevention: “Burn camphor on the stove, and hang bags of camphor about
the necks of the children.”
To what depth of humiliation must that community have descended,
which tolerates as its sanitary officers men who are not only utterly
disqualified by education, business, and moral character, but who have
not even the poor qualification of courage to perform their duties. But
perhaps the most decisive proof of the utter and hopeless inefficiency
of our multiform health arrangements is found in the fact that all the
evils from which we now suffer have grown up under their care. A late
City Inspector thus emphatically gave expression to the popular feeling
in regard to existing organizations:
“With such a system, can there be a wonder that the sanitary condition
of the city is not improved? * * * Nor must the consideration be
kept from view, that the members of the common council, the board
of health, and commissioners of health are all, from the manner of
their appointment, subject to partisan influence. To expect a perfect
sanitary system, under such a condition of things, is to expect an
impossibility.”
[Sidenote: Sanitary Inspection]