Ten years ago such a thing would have been impossible in New York or in
any other large city. The tremendous agencies that now exist for the
medical enlightenment of the masses were then unheard of. A generation
ago New York was in a condition of almost primeval darkness concerning
questions of public health. Canton or Constantinople is to-day little
worse off than was America’s chief city then.
In 1866 the public health conditions of New York were in so low a state
that the average length of life of the inhabitants was thirty years.
In 1912 these conditions had been improved so that the average length
of life was sixty-six years. Thus the value of human life, reckoned in
terms of time alone, had more than doubled in less than half a century.
Let us go back to the year following the Civil War. The only paving
in New York then was of cobblestones, and many streets were unpaved.
All were in filthy condition, being irregularly cleaned by contractors,
who shirked their work. There was no general system for the removal
of ashes and garbage, and these were thrown loosely upon the streets.
In three quarters of the city, cellars were in foul condition, often
flooded with water and undrained. At that time, incredible as it may
seem to the modern New Yorker, few houses were connected with sewers.
Offensive trades, such as the boiling of bones, offal, and fat, were
carried on without hindrance. There were numerous cesspools and
cisterns overflowing with filth. Much of the city’s milk was obtained
from cows kept in dark, crowded, ill-ventilated stables and fed upon
swill from distilleries. The animals were diseased, and the milk was
unclean, unwholesome, and frequently was watered.
In alleyways and back yards great quantities of manure were allowed
to accumulate. Farmers sometimes bought it and carted it off for
fertilizing; but if no farmer happened to come along, the stuff stayed
there indefinitely. Outhouses were neglected, and never were properly
cared for by the scavengers, who worked for grafting contractors. The
practice of keeping swine in the built-up portions of the city was
common. The slaughterhouses were in horrible condition, and the offal
from these could not be properly cared for because of defective sewers.
Tenement-house conditions were as bad as they have ever been anywhere.
No space was left unoccupied. Sheds, basements, and even cellars were
rented to families and lodgers. The vast numbers of immigrants pouring
in, and the constricted space on Manhattan Island, made rents so high
that even a corner in a cellar brought an exorbitant price. Single
rooms were divided by partitions, and whole families occupied each
section.
In 1866 it was estimated that 20,000 People were then living in cellars
in New York. Ten years before that period many of the city houses had
been shaky from quick building; after the war, figuratively speaking,
they had fallen into the cellars. At that time New York could hardly
claim distinction as a great city. Travelers referred to it as an
overgrown village, into which had been shoveled slovenly hordes
of European immigrants. The annual death-rate was thirty-four per
thousand, while that of London was about twenty-three per thousand. And
it must be remembered that New York’s new population was composed of
vigorous men and women, the cream of other localities, with what should
have been healthy offspring, who had quickly centered here, ambitious
and active; whereas London was an ancient city, bearing the ills of
its own age. It must be remembered also that at that time the medical
profession knew little of bacteriology; antitoxins were unknown; people
lived like ostriches, with their heads in the sand concerning questions
of sex hygiene and child hygiene; and the science of sociology had yet
to be discovered.
Cities had always existed, it is true, but they had to be constantly
replenished by fresh blood from the country, and most of them had space
to spread out into the country, and thus absorb naturally some of the
health that comes from fresh air. But here was a city that had little
chance to spread. It was confined to a narrow, rocky island, and was
growing more rapidly than any other city in the history of the world.
“Bounded on one side by a bluff and on the other side by a sound,” it
was burrowing into the earth and climbing constantly into the air to
make room for its fast-growing population. It was the center of the
fiercest contest for money and power, yet it failed to hold long those
who came there. The men that made money went to Europe to spend it, and
those that fell in the fight went to the West to recuperate. Immigrants
that arrived there with money went on to the West or the South; those
without money stayed.
The result was that New York did not primarily become a city of
residence, but the resort of those who either through the necessity of
poverty or the necessity of ambition sojourned there. Of all American
cities it became the most artificial; there life came to be lived at
its highest tension; there the struggle for existence became fiercest.
It is apparent that in such a city Nature cannot be left to her own
devices. When man deserts Nature, she promptly retaliates by deserting
man. And, in substitution of so-called “natural” living, there has
been developed the present-day mode, built up of scientific analysis,
skilful treatment, and thorough organization.