Chapter IV: New York, the Unclean (2)

“In this condition of life the ties of nature seem to be unloosed. Maternal instinct and filial affection seem to participate in the general decay of soul and body. A kind Providence, whose hand is visible even here, mercifully provides that the almost inevitable decay and death which man’s criminal neglect entails on the offspring of the unfortunate who dwell in these dreary mansions, shall elicit comparatively feeble pangs of parental anguish. To the physical and moral degradation, the blight of these miserable abodes, where decay reigns supreme over habitation and inhabitant alike, may be plainly traced much of the immorality and crime which prevail among us. The established truth, that, as the corporeal frame deteriorates, man’s spiritual nature is liable also to degenerate, receives its apt illustration here.”

[Sidenote: Prevailing Diseases]

But, sir, acute diseases, and those frequently of the most destructive character, prevail at all seasons among the tenant-house population, and generally with fearful fatality. Although the last summer and autumn were unusually healthy, these records show the prevalence of a vast amount of diseases among the poor of New York. These diseases are of a kind that always originate in or are aggravated by the crowding of families in unventilated apartments, want of sunlight and pure air, house and street filth, etc.

First Ward: The diseases prevalent in this district the past season have been principally typhus, measles, diarrhoea, dysentery, cholera morbus, cholera infantum, and marasmus. Diarrhoeal diseases are most prevalent in those insalubrious quarters already described, and at a season when the exciting causes are at their greatest stage of development and activity.

Second and Third Wards: Typhus fever made its appearance in tenant-houses, and in two or three instances spread through all the families immediately exposed. At one place the disease attacked successively every member of the family immediately exposed, but was prevented from spreading further by free ventilation.

Fifth Ward: The slips, in consequence of receiving the sewerage of the district and surrounding parts of the city, are generally foul and the undoubted source of much sickness. Smallpox has prevailed more extensively than for many years back. Typhus and typhoid fevers have been prevalent over the whole district.

Eighth Ward: The prevailing diseases of the past season have been 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.

[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.

“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.

_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.

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]

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.

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:

“Most of the children who arrive in this city from foreign ports, 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.

“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.”

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.

[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]

The medical officer of health for the City of London, a gentleman 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.

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: