of large experience, thus defines a health organization capable of
answering the demands of a large and growing town: “The object of
this organization lies in a word: inspection, inspection of the most
constant, most searching, most intelligent, and most trustworthy kind,
is that in which the provisional management of our sanitary affairs
must essentially consist.” The results of this work of voluntary
sanitary inspection which I have before me prove on every page the
truth of the above statement. No health organization without daily
inspection would have any efficiency.
Of the value of such thorough inspection in the suppression of
epidemics, and in the prevention of disease, there are abundant
examples. The people of a populous town of England, becoming alarmed at
the approach of cholera in 1849, organized a corps of inspectors, whose
duty it was to visit from house to house, and inquire for cases of
premonitory diarrhoea, and when found to apply the remedy at once. The
result was that cholera did not visit that town. The same systematic
house-to-house visitation was adopted in some poor districts of London
in 1854, and there was an almost complete exemption of those parts of
the city, while some quarters of the wealthy, which were not under such
surveillance, suffered severely.
[Sidenote: Inspection Must Be Thorough]
But it is essential that this inspection should be by thoroughly
qualified medical men, and it must consist in a house-to-house
visitation. Disease must be sought for, found, its incipient history
completely made out, the causes upon which it depends reported, and its
remedy suggested. Every case of death should be visited, and all the
circumstances attending the development of the disease, if it belong
to the preventable class, should be rigidly investigated and reported,
in order that the central bureau may apply the proper remedy.
[Illustration: FEVER-BREEDING STAGNANT WATER, EIGHTH AVENUE, BETWEEN
75TH AND 76TH STREETS, 1865]
Striking examples of the value of medical sanitary inspection are
furnished by this voluntary organization. One inspector found
diarrhoeal affections very prevalent in a settlement in an up-town
ward, and for a long time was baffled in his efforts to discover the
cause. He was finally led to examine the water of a neighboring well,
which the people used. This water appeared to be of an excellent
quality, but on examination by Prof. Draper, it was found to contain a
large amount of organic matter, derived either from a sewer or privy.
Prof. Draper pronounced it liquid poison. The mystery was at once
solved, and the proper remedy suggested.
In another instance a very contagious disease was found in a
tenant-house, and after a long course of inquiry it was at length
discovered that a washer-woman, living in the basement, had taken in
sailors’ clothing. The sailors were found, the ship visited from which
they came, and there the disease was found. None but medical men can
prosecute such investigations with success, or suggest the proper
remedy. If such a corps of sanitary inspectors were daily patrolling
their districts, visiting from house to house, searching out sanitary
evils, advising and aiding the people in the adoption of preventive
measures, no epidemics of smallpox, typhus, scarlet fever, or cholera
would ever gain more than a transient foothold. The sanitary inspector
would truly become an officer of health and would be everywhere welcome.
[Sidenote: The Remedy]
The remedy for our evils must be apparent; and this remedy is suggested
in such terse unqualified language by the City Inspector above quoted,
that I call the attention of the committee especially to this remark,
as a proper guide in your deliberations. In the City Inspector’s report
for 1861 we find the following:
“The stay of pestilence, to be effectual, must be prompt, and equally
prompt must be the interposition of barriers against the introduction
of disease, which may be kept back, but, once introduced, can with
difficulty be checked or extirpated. For these reasons, there should
be a power existing in other hands that may be ready to be used at
the moment the exigency may arise.” * * * “The remedy, apparent to
every one, must consist in the adoption of laws transferring the power
of sanitary regulations to some other authority of a different order
of instruction in sanitary science.” * * * “The first groundwork of
reform, in the opinion of the undersigned, is to bestow upon some other
body, differently constituted, all power over the sanitary affairs of
the city; and, until this is done, all other proposals of reform will
be deprived of their essentially beneficial features. To escape present
complications is the first great point to be gained; and this point
secured, simplicity, promptness, and efficiency may be substituted for
inefficiency, complication, and delay.”
Accepting this as the first step in reform, the practical question
arises: How shall that body be constituted to which is to be confided
the sanitary interests of New York?
[Sidenote: An Efficient Health Board]
If the experience of other large cities is of any value, or, indeed,
if we rely simply on common sense, the following are indispensable
prerogatives in any well-organized health board:
1. It should be independent of all political influence and above all
partisan control.
2. It should combine executive ability with a profound knowledge of
disease and the proper measures of prevention. To this end the board
should be composed in part of men especially accustomed to the dispatch
of business, and in part of medical men of great skill and experience.
3. It should have a corps of skilled medical officers as inspectors,
which should be the eyes, the ears, in a word, the senses of the board,
in every part of the city, searching out disease, investigating the
causes which give rise to it, the conditions under which it exists,
the means of its propogation, and the most effectual mode of its
suppression.
4. It should have a close alliance with the police, which must be its
arm of power in the prompt and efficient execution of its orders.
V
VICTORY
[Sidenote: Effect of the Hearing]
The effect of this startling exhibition of the horrible sanitary
condition of New York, both upon the joint committees and the large
audience, was evidently very profound. And this effect was heightened
by the early denials by the then City Inspector and his followers of
the truth of the description of the condition of special localities,
and the immediate exhibitions by the speaker of the sworn statements
of the Physician-Inspectors of the Citizens’ Association, with
photographic illustrations. Pressed by members of the committee to
state when he last had these places inspected, he admitted that they
had never been inspected by his Department.
Intense interest was manifested in the custom of wholesale dealers in
clothing of having their goods manufactured in tenement houses; in the
fact that Inspectors had often found such clothing thrown over the beds
or cradles of children suffering from contagious diseases, as scarlet
fever, measles, smallpox; and in the evidence that these diseases were
distributed widely over the country by this infected clothing. Several
of the committee seemed much disturbed, as did the audience, during a
recital of cases, and when the hearing closed, one of the committee
said to me, in an excited manner, “Why, I bought underwear at one of
those stores a few days ago, and I believe I have got smallpox, for I
begin to itch all over!”
Indeed, the effect of the discussion before the joint committees
was so favorable, that several members declared that the bill would
immediately pass both Houses without opposition. But the City Inspector
secured delay by requesting another hearing, in order to investigate
the facts presented in my quotations from the report of our inspection.
This delay gave him the desired opportunity to defeat the bill,
by means at his command and by methods familiar to that class of
politicians.
But the public, and especially the medical profession, both of the city
and the State, had become so interested in the measure that at the next
election it became a prominent issue and led to the defeat of seventeen
candidates for the Legislature of 1866 who had voted in opposition.
[Sidenote: Triumph at Last]
It is said that epidemics are the best promoters of sanitary reform,
and very opportunely cholera made its dread appearance in Europe late
in 1865, and from its rate of progress it seemed likely to visit our
shores early next year. These favoring conditions led to the passage
of the “Metropolitan Health Law” among the first measures of the
Legislature in 1866.
The struggle and final triumph of the people of New York, in their
efforts to secure adequate health protection, were national in their
influence. And this influence was emphasized by the first acts of the
Metropolitan Board. Scarcely had it organized when cholera made its
appearance in New York. There was the usual alarm among the people, and
large numbers left the city. But the new health laws and ordinances,
administered by an intelligent, scientific authority, demonstrated the
_raison d’être_ of their existence.
The first case of cholera was promptly isolated, the house and
its surroundings cleansed and disinfected, and rigid supervision
established. The second case, which appeared in another part of the
city, was treated in a similar manner and with the same results. A
third, fourth, fifth, and finally many cases appeared in different
parts of the city during the season, apparently brought from localities
in the vicinity where the epidemic prevailed with its usual severity;
but in New York no two cases occurred in the same place, so effectually
was each case treated.
Within one month public confidence in the power of the board to control
the spread of the disease was firmly established; people who had fled
returned to their homes; business in commercial districts, which was
at first suspended, was resumed; and the health department became the
most popular branch of the city government, a position which it has
maintained uninterruptedly for nearly half a century.
[Sidenote: The Reform National in Its Results]
This popular triumph of sanitation is largely due to the perfection of
the original Metropolitan Law, which has been declared, officially and
judicially, to be the most complete piece of health legislation ever
placed on the statute books. From that fountain of legal lore the whole
country has been supplied with both the principles and the details of
sanitary legislation.
The agitation in New York rapidly extended over the entire country,
and other cities secured the necessary authority, the Metropolitan Law
being the basis of such health legislation. Within a decade nearly
every municipality in the land had its health laws and sanitary
ordinances and a competent authority to enforce them.
The enormous influence which this reform has had upon the health and
domestic life of the people can never be estimated. A reference to
the former and present sickness and death-rates of New York enables us
to approximate the vast saving of life and consequent prevention of
sickness and human misery that has resulted from health laws founded
on the Metropolitan Law and intelligently but rightly enforced. Before
the passage of that law the annual death-rate of the city fluctuated
between 28 and 40 per 1,000 population; since that law went into
effect it has steadily fallen until it has reached the low figure of
fifteen to the thousand, or a saving of more than twenty thousand lives
annually when the population of New York was only about one million,
and of nearly 10,000 lives of the present population. If we extend
this estimate to the whole country, of ninety-five million people,
we may gain a faint conception of the inestimable benefits which the
application of sanitary knowledge to the daily life of a people can
accomplish.
VI
THE LEGAL WORK OF DORMAN BRIDGEMAN EATON
The following chapter consists of the address delivered by Dr. Stephen
Smith on the occasion of the memorial service of Hon. Dorman B. Eaton,
January 21, 1899. We have inserted it immediately following his
historic review of the events which led up to the great public health
reform of 1865–1866, not only because it is a fitting tribute to the
memory of one to whom the citizens of New York are indebted for many
improvements in the administration of the municipal government, but
because it brings together in one compact perspective the legal and
sanitary requirements of modern preventive medicine.--F. A.
[Sidenote: Unrecognized Pioneers]
The progress of the race is largely affected in each generation by
a few pioneers who, with toil and sacrifice, prepare the way for
the advance. Of these pioneers some blaze the future course in the
unexplored and trackless forest; others remove the obstructions which
impede the builders; while a few expert engineers bridge the rivers,
tunnel the mountains and lay broad and deep the foundations of the
great highway along which humanity passes to a higher civilization.
Unfortunately these pioneers are not always known to public fame, and
far too often, though benefactors of their race, pass away without a
proper recognition of their services.
This apparent neglect is not due to a lack of appreciation of their
work by the people, but rather to the fact that their labors are
performed in obscurity, and hence are unknown. Far in the wilderness,
or deep in the tunnel, or in the mire of the caisson, they toil all
unseen by their generation, sacrificing health and often life while
searching for the true pathway or laying its foundations. When the
bridges are builded, the tunnels completed, and the broad highway is
thrown open for travel and traffic, few or none of the passing throng
give a moment’s thought to the labors and sacrifices of the builders,
or the tribute of a sigh to the memory of those who perished at their
work.
Impressed with a sense of public obligation and of a duty to the memory
of a citizen with whose labors and sacrifices in the interests of
this city I had great opportunities to become familiar, it has been
a grateful task to place on record some of the incidents in the life
of Hon. Dorman B. Eaton as they came under my personal observation.
He was by nature, education, and association a reformer of the civil
administration. Born and bred in the rural communities of Vermont,
educated at Harvard, a partner of the famous Judge Kent, of this city,
and an associate of men of the type of William Curtis Noyes, Charles
O’Conor, and others of equal reputation, Mr. Eaton was admirably
equipped for the great work to which he devoted so much of his life and
energies.
[Sidenote: A Constructive Reformer]
Nor was he a reformer whose methods were simply destructive of what he
regarded as wrong or evil in the municipal government; on the contrary,
his mind was eminently constructive, and consequently he sought to
remedy defects by substituting the new and best for the old and worst
with as little friction and disturbance as possible. Thus he quietly
and without observation, as a master builder, laid foundations and
reared the massive superstructures of four of the best-organized and
most efficient departments of our city government--viz., the Department
of Health, the Fire Department, the Department of Docks, the Police
Judiciary.
[Sidenote: Character of Previous Agitation]
My personal acquaintance with Mr. Eaton began in the year 1864, when
we became associated in an effort to secure reforms in the sanitary
government of the City of New York. Although prior to this date there
had been periods of agitation in favor of a more efficient health
organization, especially when epidemics, like cholera, visited the city
and the utter worthlessness of our health officials became apparent,
yet there had been no such organized effort as that of 1864. Previous
agitation had, however, been very useful in preparing the way for the
final struggle, by creating a popular interest in these reforms and in
rendering the public mind both sympathetic and receptive.
[Sidenote: Incompetent Health Officers]
In 1855 the Academy of Medicine applied to the Legislature for relief
from the evils of an insufficient health organization, and as a result
a committee of that body investigated the sanitary condition of the
city. It appeared that there were four separate departments devoted to
the conservation of the public health. First, was the Board of Health,
composed of the Aldermen and Mayor. When this body was organized as
a Board of Health it had supreme power, both in the abatement of
nuisances and the expenditure of money. So much and so justly was this
board feared, that Fernando Wood, while Mayor, refused to call it into
existence during an epidemic of cholera, declaring that the Board of
Health was more to be feared than the pestilence.
Second, was the Commissioners of Health, composed of the Mayor and the
Recorder, the City Inspector, the Health Commissioner, the Resident
Physician, and the Port Health Officer. This body had no adequate power
and was perfectly useless both for good and evil.
Third, was the Resident Physician, whose duties were limited to
visiting the sick poor.
Fourth, was the City Inspector, a most formidable official politically,
for he had the right to expend annually $1,000,000 without “let or
hindrance.” His jurisdiction extended to the cleaning of the street,
gathering vital statistics, and preserving the public health by the
appointment of health wardens for each ward.
The investigation showed that this department, the only one which
actually exercised public health functions, was permeated with
corruption, ignorance, and venality. The City Inspector was the
lowest type of ward politician, the vital statistics were crude and
unreliable, there was no pretense of cleaning the streets, and the
health wardens were for the most part keepers of saloons. It was shown
in the evidence that no health warden ever dared to visit a house where
there was a case of contagious disease. One, who was asked the best
method of preventing smallpox, replied: “Burn sulphur in the room.”
Another, asked to define the term “hygiene,” said: “It is a mist rising
from wet grounds.”
[Sidenote: Reform Movement Born]
The report of this committee created a profound sensation and gave the
first impetus to a reform movement. A number of prominent physicians
and influential citizens became deeply interested in the subject and
determined to secure proper legislation. Health bills were annually
prepared and sent to the Legislature only to be rejected under the
direction of the City Inspector, whose $1,000,000 was expended freely
in the lobby at Albany. But the agitation increased in force with
successive defeats, a large and still larger number of people were
added to the ranks of the reformers of the Citizens’ Association in
1864, with Peter Cooper as President and upwards of a hundred of the
leading citizens as members.
The moving spirit in organizing and managing this powerful body was Mr.
Nathaniel Sands, an ardent and enthusiastic sanitarian. Two departments
were created in the Association, through which the principal work
was to be done; viz., a Council of Law and a Council of Hygiene. Mr.
Eaton was an active member of the former, and I was for a considerable
time Secretary of the latter. Thus we were brought into frequent
consultation over a public health law, which the Association had
determined to have prepared for the next Legislature.
It was decided that the Council of Hygiene should make a first draft
of the bill in which should be incorporated the necessary sanitary
provisions. This draft was then to be submitted to the Legal Council
for completion in legislative form. As secretary of the Council of
Hygiene I had to prepare the first draft of the bill, which was done
along the lines of former bills and seemed to the members to be a very
perfect piece of work. When, however, the bill came from the Legal
Council, scarcely a shred of the original draft was recognizable.
[Sidenote: The Right Man]
Though the Legal Council was composed of the leading lawyers of the
city at that time, the revision and completion of the health law was
committed to Mr. Eaton, a junior member. This selection proved to be of
immense importance to the immediate sanitary interests of this city,
and secondarily to the creation and administration of the health laws
of the United States. The field of sanitary legislation was entirely
uncultivated in this country at that time, and the principles on which
health laws should be based were unrecognized, except by the more
advanced students.
Mr. Eaton fortunately proved to be one of the few citizens who had kept
pace with the progress of sanitary reforms in England, and entered
fully into the spirit of the great movement that for a quarter of a
century had agitated the people of that country. Alarmed by the high
death-rate annually reported by the Registrar-General, and informed
that the larger part was due to preventable diseases, the public
demanded adequate remedial measures of the government. The contest was
long and most exciting, the issues often being carried into the arena
of politics. The Prime Minister once declared that there was such a
craze about sanitation that the rallying cry of an election campaign
might well be “_Sanitas sanitatum, et omnia sanitas_.”
The triumph of the reformers was finally complete, and England adopted
a code of health laws that are models of excellence, and which, in
their enforcement, have made its cities and towns the healthiest in the
world.
When our health bill came from the hands of Mr. Eaton it was evident in
every line that he had made an exhaustive study of the English health
code and had become thoroughly imbued with its spirit. The language
was not altogether familiar, and in the involved sentences there were
intimations of extraordinary powers quite unknown to our jurisprudence.
When he brought the completed bill before the Legal and Medical
councils for adoption it was subjected to a most searching criticism.
While most of its sections were clear and readily understood, there
were portions which were so obscure, owing to the methods of expression
employed, that the legal members were in doubt as to the proper
construction to be put upon them, while the medical members were
altogether at a loss as to their meaning.
[Sidenote: A Board With Extraordinary Powers]
Mr. Eaton explained the theory of modern health legislation as
illustrated by the English laws, and contended that a thoroughly
organized and efficient board of health must have extraordinary powers,
and must not be subordinated to any other branch of the civil service,
not even to the courts. What it declared to be a nuisance--dangerous
to life and detrimental to health--no one should call in question. When
it ordered a nuisance to be abated within a given fixed time no mandate
should avail to stay its action or the enforcement of its decree.
A board of health, in his opinion, should make its own laws, execute
its own laws, and sit in judgment on its own acts. It must be an
_imperium in imperio_. England, the foremost country in the world in
the cultivation of sanitary science and in the application of its
principles to practice, had by its legislation for a quarter of a
century established a precedent which it was right and safe for us to
follow.