Alarm of Medical Men

The illustrations in this chapter, with the frontispiece of the
book, have all been reproduced from the elaborate report published
by the Council of Hygiene of the Citizens’ Association. My address
before the Legislative Committee is here given as it then appeared in
_The New York Times_ of March 13, 1865, with the correction of some
typographical errors. It consisted of a detailed presentation of the
facts recorded and sworn to by the medical inspectors employed by the
Citizens’ Association, together with photographic illustrations which
were made by them.

Mr. Chairman: I have been requested to lay before you some of the
results of a sanitary inspection of New York City, undertaken and
prosecuted to a successful completion by a voluntary organization
of citizens. There has long been a settled conviction in the minds
of the medical men of New York, that that city is laboring under
sanitary evils of which it might be relieved. This opinion is not mere
conjecture, but it is based upon the daily observations which they are
accustomed to make in the pursuit of professional duties.

Familiar, by daily study, with the causes of diseases, and the laws
which govern their spread, they have seen yearly accumulating about and
within the homes of the laboring classes all the recognized causes of
the most preventible diseases, without a solitary measure being taken
by those in authority to apply an effectual remedy. They have seen
the poor crowded into closer and closer quarters, until the system
has actually become one of tenant-house packing. They have witnessed
the prevalence of terrible and fatal epidemics, having their origin
in or intensified by these conditions, and many of their professional
brethren have perished in the courageous performance of their duties to
the poor and suffering.

Cognizant of these growing evils, and believing that they are
susceptible of removal, they have repeatedly and publicly protested
against the longer tolerance of such manifest causes of disease and
death in our city. Large bodies of influential citizens have been
equally impressed with the importance of radical reform in the health
organizations of New York, and have strenuously labored, but in vain,
to obtain proper legislative enactments.

[Sidenote: A Systematic Investigation]

To give practical effect to their efforts, it was determined in May
last to undertake a systematic investigation of the sanitary condition
of the city. For this purpose a central organization was formed, and
when I mention the names of its leading members, I give you the best
assurance that the work was undertaken in the interests of science and
humanity. The president was Dr. Joseph M. Smith, one of the ablest
writers on sanitary science in this country, and among its members
were Drs. Valentine Mott, James Anderson, Willard Parker, Alonzo
Clark, Gurdon Buck, James R. Wood, Charles Henschel, Alfred C. Post,
Isaac E. Taylor, John W. Draper, R. Ogden Doremus, Henry Goulden, Henry
D. Bulkley, and Elisha Harris.

In prosecuting this inquiry the Association was guided by the
experience of similar organizations in Great Britain, where sanitary
science is now cultivated with the greatest zeal, and is yielding the
richest fruits. As a preliminary step to the introduction of sanitary
reforms, many of the populous towns of England made a more or less
complete inspection of the homes of the people to determine their
condition, and to enable them to arrive at correct conclusions as to
the required remedial measures. The English Government undertook a
similar investigation through its “Commissioners for Inquiring into
the State of Large Towns and Populous Districts,” and the voluminous
and exhaustive reports of that Commission laid the foundation of the
admirable sanitary system of that country.

The first object of sanitary organization was apparently, therefore,
to obtain detailed information as to the existing causes of disease
and the mortality of the population, and as to the special incidence
of that mortality upon each sex, and each age, on separate places, on
various occupations; in fact, to present a detailed account of what
may be called, in commercial phrase, our transactions in human life.

[Sidenote: A House-to-House Inspection]

Evidently the best method of arriving at such knowledge was by a
systematic inspection. And that inspection must be a house-to-house
visitation, in which the course of inquiry not only developed all the
facts relating to the sanitary, but equally to the social condition of
the people. It must necessarily be required of the inspector that he
visit every house, and every family in the house, and learn by personal
examination, inquiry, and observation, every circumstance, external and
internal to the domicile, bearing upon the health of the individual.

To perform such service satisfactorily, skilled labor must be
employed. No student of general science, much less a common artisan,
was qualified to undertake this investigation into the causes of
disease; however patent these causes might be, he had no power to
appreciate their real significance. Minds trained by education, and
long experience in observing and treating the diseases of the laboring
classes, could alone thoroughly and properly accomplish the work

[Sidenote: The Medical Experts]

Happily, experts were at hand and prepared to enter upon the
task, viz.: the dispensary physicians. The daily duties of these
practitioners have been for years to practice among the poor, and study
minutely their diseases; and thus they have gained an extensive and
accurate knowledge of the sanitary and social condition of the mass of
the people. Many of these practitioners have been engaged in dispensary
service, and in a single district, for ten to twenty years. They have
thus become so familiar with the poor of their district, though often
numbering 40,000 to 50,000, that they know the peculiarities of each
house, the class of disease prevalent each month of the year, and to a
large extent the habits, character, etc., of the families which occupy

From this class of medical men the Council selected, as far as
possible, its corps of Inspectors. As a body, they represent the best
medical talent of the junior portion of the profession of New York.
Many occupy high social positions, and all were men of refinement,
education, and devotion to duty. They entered upon the work with the
utmost enthusiasm; engaging in it as a purely scientific study.

Everywhere the people welcomed the Inspectors, invited them to examine
their homes, and gave them the most ample details.

[Sidenote: Plan of Inspection]

The plan of inspection adopted by the Council was as follows: The city
was divided into thirty-one districts and an Inspector selected for
each, care being taken to assign to each inspector a district with
which he was most familiar. The Inspector was directed to commence his
inspection by first traversing the whole district, to learn its general
and topographical peculiarities. He was then to take up the squares in
detail, examining them consecutively as they lie in belts.

Commencing at a given corner of his district, he was first to go around
the square and note: 1. Nature of the ground. 2. Drainage and sewerage.
3. Number of houses in the square. 4. Vacant lots and their sanitary
condition. 5. Courts and alleys. 6. Rear buildings. 7. Number of
tenement houses. 11. Drinking shops, brothels, gambling saloons, etc.
12. Stores and markets. 13. Factories, schools, crowded buildings. 14.
Slaughter-houses (describe particularly). 15. Bone and offal nuisances.
16. Stables, etc. 17. Churches and school edifices.

Returning to the point of starting, he was to commence a detailed
inspection of each building, noting: _a._ Condition and material of
buildings. _b._ Number of stories and their height. _c._ Number of
families intended to be accommodated, and space allotted to each.
_d._ Water supply and house drainage. _e._ Location and character
of water-closets. _f._ Disposal of garbage and house slops. _g._
Ventilation, external and internal. _h._ Cellars and basements, and
their population. _i._ Conditions of halls and passages. _j._ Frontage
on street, court, alley–N., E., S. or W. 18. Prevailing character of
the population. 19. Prevailing sickness and mortality. 20. Sources
of preventible disease and mortality. 21. Condition of streets and
pavements. 22. Miscellaneous information.

[Sidenote: Each Room Examined]

He entered each room, examined its means of ventilation and its
contents, noted the number of occupants by day and by night, and
carefully estimated the cubical area to each person. Whenever any
contagious or infectious disease was discovered, as fever, smallpox,
measles, scarlatina, the Inspector made a special report upon the
dwelling. This report embodied specific answers to a series of
questions, furnished in a blank form, requiring him 1. To trace and
record the medical history of the sick person. 2. To ascertain and
record facts relating to the family and other persons exposed to the
patients and to the causes of the malady. 3. To report the sanitary
condition of the domicil. 4. To report the statistics and sanitary
condition of the population of that domicil. 5. To report upon the
sanitary condition of the locality or neighborhood and its population.
6. To preserve and make returns of these records. 7. To prepare on
the spot the necessary outlines or data for the sketching of a map or
descriptive chart of the domicil, block, or locality.

Each Inspector was supplied with a notebook and a permanent
record-book; in the first he constantly made notes as his examination
proceeded, and in the latter these notes were expanded and put on
permanent record. These permanent record-books are the property of the
Association and embrace for the most part minute details concerning
every building and tenement occupied by the laboring classes, as also,
grog-shops, stables, vacant lots, slaughter-houses, etc.

Each Inspector was furnished with materials for drawing, and was
directed to make accurate drawings of the squares in his district,
locating each building, vacant lot, etc., and distinguishing the
character and condition of each by an appropriate color. Many of these
drafts of districts are beautiful specimens of art, and as sanitary
charts enable the observer to locate infectious and contagious
diseases, and with the aid of the permanent records, to determine the
internal and external domiciliary conditions under which they occur.

I have been thus minute in specifying the details of the plan of
inspection, the qualifications of the Inspectors, and the means
employed, in order that the character of the work and the value of the
results obtained may be properly appreciated.

[Sidenote: Period of the Inspection]

Early in the month of May the work of thoroughly inspecting the
insalubrious quarters, where fever and other pestilential diseases
prevail, had been commenced, and the fact was soon ascertained that
smallpox and typhus fever were existing and spreading in almost every
crowded locality of the city. It was not until about the middle of
July that the entire corps of Inspectors was engaged. The work was
then prosecuted with vigor and without interruption to the middle of
November, when it was completed. The Inspectors met regularly every
Saturday evening to report to a committee on the part of the Council
the progress of their work, and to receive advice and instruction in
regard to all questions of a doubtful character.

On the completion of the inspection each Inspector was required to
prepare a final report embodying the general results of his labors.
These reports have all been properly collated, under the direction of
the Association, and are now passing through the press. They will soon
appear in an octavo volume of about 400 pages, largely illustrated,
with maps and diagrams. It will be the first interior view of the
sanitary and social condition of the population of New York, and will
abundantly demonstrate the fact that, though a great and prosperous
commercial centre, she does not afford happy homes to hundreds of

[Sidenote: Distribution of Population]

Before proceeding to an analysis of this work, it will be necessary
to notice the topographical peculiarities of our city, and the
distribution of its population. New York is an island having an area
of about thirty-four square miles, inclusive of its parks. Unlike
Philadelphia, London, and most other large cities, which have a
background of hundreds of square miles upon which to extend according
to the exigencies of the population or of business, New York is limited
in its power of expansion, and must accommodate itself to its given
area. While it is true that a large business population will gather
upon the adjacent shores, it is equally true that these non-residents
will be of the better class. The laboring population will, for the most
part, remain upon the island, and must be accommodated in the city
proper, as they are compelled to live near their work.

New York has, thus far, grown without any control or supervision, until
its population is estimated at 1,000,000 of persons. Of this number, at
least one-half are of the laboring and dependant classes, compelled
to live under such conditions as they find in their homes, without any
power, either to change or improve them. Following the natural law
which governs the movements of such a population, the wealthier or
independent class spreads itself with its business arrangements over
the larger proportion of the area, and the poorer or dependent class is
crowded into the smallest possible space.

[Sidenote: Tenant-House Packing]

Already New York has covered about 8 of its 34 square miles with
the dwellings of a population not far from 1,000,000, and all its
commercial and manufacturing establishments. And the result is, as
might have been anticipated, the dependent class, numbering fully
one-half of the people, is crowded into tenant-houses which occupy an
area of not more than two square miles. Such crowding amounts literally
to packing.

For example, it is estimated that there are three contiguous blocks
of tenant-houses which contain a larger population than Fifth Avenue;
or, again, if Fifth Avenue had front and rear tenant-houses as densely
packed as tenant-houses generally are, there would be a population of
100,000 on that single avenue. A single tenant-court in the Fourth Ward
is arranged for the packing of 1,000 persons.


_Arranged for the Packing of 1,000 Persons_]

[Illustration: SECTION OF CITY 240 BY 150 FEET, OCCUPIED BY 111

A resident of the same Ward reports that: “On a piece of ground 240
feet by 150, there are 20 tenant-houses, occupied by 111 families,
5 stables, a large soap and candle factory, and a tan-yard, the
receptacle of green hides. The filth and stench of this locality are
beyond any power of description.” In general, it may be stated that the
average number of families to a house among the poor is 7, or about 35

[Sidenote: Avoidable and Inevitable Disease]

It is necessary also to make a single explanation, to render more
apparent the bearing of the facts developed. For the purposes of
sanitary inquiry, the causes of disease are divided into those which
are inevitable, and those which are avoidable or removable, and hence
it follows that diseases and deaths are divided into those which are
inevitable and those which are preventable. For example: Of unavoidable
causes of disease, we have vicissitudes of weather, accidents, old age,
physical degenerations, etc.

Of avoidable or removable causes of disease we have those conditions
around or within our dwellings or places of business or resort, errors
in our mode of living, etc., which vitiate health, or rather tend to
diseases, and yet which can be removed or changed by human agency. For
example, a country residence may be most favorably located for health,
and yet decaying vegetable matter in the cellar, or a cesspool so
situated as to allow the gaseous emanations to be diffused through the
house, will expose all the inmates to fevers, diarrhoea and dysentery.

These would be preventable diseases, and all the deaths therefrom would
be preventable, and hence unnecessary deaths. In like manner in cities,
all diseases and deaths due to causes which human agencies can remove
are preventable. And it is a melancholy fact that fifty per cent of the
mortality of cities is estimated to be due to such causes, and is hence

In reviewing the result of this inspection, I shall call your attention
only to the more patent causes of disease found existing, and to the
preventable diseases discovered, and their relation to these causes.
In this evidence you will find ample proof that radical reforms are
required in the health organizations of New York.

[Sidenote: Filthy Streets]

I will first notice the causes of disease which exist external to our
dwellings, and which are the most readily susceptible of remedy. The
first that attracts attention in New York is the condition of the
streets. No one can doubt that if the streets in a thickly populated
part of a town are made the common receptacle of the refuse of
families, that in its rapid decomposition a vast amount of poisonous
gases must escape, which will impregnate the entire district, penetrate
the dwellings, and render the atmosphere in the neighborhood in
a high degree injurious to the public health. In confirmation of
this statement, I will quote the City Inspector, who, in a former
communication to the Common Council, says:

“As an evidence of the effect of this state of things upon the health
of the community, I would state that the mortality of the city, from
the first of March, has been largely on the increase, until it has
now reached a point of fearful magnitude. For the week ending April
27th, there were reported to this department one hundred and forty
more deaths than occurred during the same week of the previous year.
Were this increase of mortality the result of an existing pestilence
or epidemic among us, the public would become justly alarmed as to the
future; but although no actual pestilence, as such, exists, it is by no
means certain that we are not preparing the way for some fatal scourge
by the no longer to be endured filthy condition of our city.”

The universal testimony of the sanitary inspectors is that in all
portions of the city occupied by the poorer classes, the streets are in
the same filthy condition as that described by the City Inspector, and,
that street filth is one of the most fruitful causes of disease.

[Sidenote: Street Filth and Disease]

Says the Inspector of the Eighth Ward: “Laurens, Wooster, Clark, and
Sullivan are in a most filthy condition, giving off insalubrious
emanations on which depend the many cases of fever, cholera infantum,
dysentery, and pulmonary diseases. I have observed that near where
other streets cross the above-named streets there is a greater
proportionate amount of sickness; and this fact I have shown by special
reports of typhus and typhoid fever in Grand and Broome, and dysentery
in Spring.”

The Inspector of the Sixth Ward says: “Domestic garbage and filth
of every kind is thrown into the streets, covering their surface,
filling the gutters, obstructing the sewer culverts, and sending forth
perennial emanations which must generate pestiferous disease. In winter
the filth and garbage, etc., accumulate in the streets, to the depth
sometimes of two or three feet. The garbage boxes are a perpetual
source of nuisance in the streets, filth and offal being thrown all
around them, pools of filthy water in many instances remaining in the
gutters, and having their source in the garbage boxes.”

The Inspector of the Seventh Ward says: “The whole most easterly
portion of the district, the streets and gutters are very filthy with
mud, ashes, garbage, etc.”

The Inspector of the Thirteenth Ward says: “The streets are generally
in a filthy and unwholesome condition; especially in front of the
tenant-houses, from which the garbage and slops are, to a great
extent, thrown into the streets, where they putrefy, rendering the air
offensive to the smell and deleterious to health. The refuse of the
bedrooms of those sick with typhoid and scarlet fevers and smallpox is
frequently thrown into the streets, there to contaminate the air, and,
no doubt, aid in the spread of those pestilential diseases.”

Says the Inspector of the Ninth Ward: “The effect of dirty streets
upon the public health is too well known, and too often insisted upon,
to need any exposition in this report. The largest number of cases of
cholera infantum, cholera morbus, and kindred disease, is always found
in localities where the streets are dirtiest.”

The Inspector of the Seventeenth Ward writes: “The two following
localities present the appearance of dung-hills rather than the
thoroughfares in a civilized city, viz.: Sixth Street, between Bowery
and Second Avenue, and Eleventh Street, between First and Second

[Sidenote: Animals Dead]

The Inspector of the Eleventh Ward says: “As a rule, the streets are
extremely dirty and offensive, and the gutters obstructed with filth.
The filth of the streets is composed of house-slops, refuse vegetables,
decayed fruit, store and shop sweepings, ashes, dead animals, and
even human excrements. These putrifying organic substances are ground
together by the constantly passing vehicles. When dried by the summer’s
heat, they are driven by the wind in every direction in the form of
dust. When remaining moist or liquid in the form of “slush,” they emit
deleterious and very offensive exhalations. The reeking stench of the
gutters, the street filth, and domestic garbage of this quarter of
the city, constantly imperil the health of its inhabitants. It is a
well-recognized cause of diarrhoeal diseases and fevers.”

The Inspector of the Eighteenth Ward reports: “The streets in the
eastern part of the district, east of First Avenue especially, have,
for the past six months, been in a most inexcusably filthy condition.
The pavement here is uneven, there are deep gutters at either side of
the streets, filled with foul slops, in which float or are sunk every
form of decaying animal and vegetable matter. Occasionally, at remote
and irregular intervals, carts come round, these stagnant pools are
dredged, so to speak, and their black and decayed solid contents raked
out. If there be anything on earth that is ‘rank and smells to heaven,’
these gutters do on such occasions, especially in the summer months.
The streets in this part of the city are the principal depositories
of garbage. In some instances heaped up at the sides of the streets,
in others thrown about promiscuously, the event in either case is the
same, if it be allowed to remain day after day, as it usually is. After
having passed through every stage of decay, after having corrupted
the surrounding air with its pestilential smell, it gradually becomes
dessicated and converted into dust by the summer sun and the constantly
passing vehicles. And now every horse that passes stirs it up, every
vehicle leaves a cloud of it behind; it is lifted into the air with
every wind and carried in every direction.

“Those who are directly responsible for this state of things suffer
no more than the cleanly and thrifty who are so unfortunate as to
live anywhere the wind, blowing from this quarter, reaches them. And
what a _pulvis compositum_ is it to breathe into the lungs! As we
pass by, our mouths become full of it, we draw it in with our breath.
It is swallowed into the stomach, it penetrates our dress and clings
until it has covered our perspiring skin. Surely no dumping-ground, no
sewer, no vault, contains more filth or in greater variety than did
the air in certain parts of our city during the long season of drought
the past summer. And wherever the wind blows, the foul corruption is
carried; by a process as sure and universal as the diffusion of gases,
is it conveyed throughout the city. Such, often, is the air drawn into
the lungs with every respiration, of the poor sufferer stifled with
consumption or burning with fever. No barrier can shut it out, no
social distinction can save us from it; no domestic cleanliness, no
private sanitary measures can substitute a pure atmosphere for a foul

But I need not multiply these quotations. It will suffice to state that
during the week ending August 5th, a special inspection of all the
streets was made and they were found to be reeking, and, indeed, almost
impassable, with filth. And to-day they are in, if possible, a still
worse condition than ever before.

[Sidenote: Filthy Courts and Alleys]

Closely allied to the streets are courts and alleys. These cul-de-sacs
leading to, and adjoining the close and unventilated homes of the poor,
are almost universally in a more filthy condition than the adjacent
street. They are the receptacles of much of the waste of the house,
and are rarely cleaned. The air of these places during the summer is
often the most stifling and irrespirable, and yet as it descends it
enters the closely packed tenant-house and furnishes to the inmates the
elements of disease and death. Says the Inspector of the Fourth Ward:


“Slops from rear buildings of such premises are usually emptied into
a shallow gutter cut in the flagging and extending from the yard, or
space between front and rear buildings, to the street. This is often
clogged up by semi-fluid filth, so that the alley and those parts of
the yard through which it runs are not infrequently overflown and
submerged to the depth of several inches. There are more than four
hundred families in this district whose homes can only be reached
by wading through a disgusting deposit of filthy refuse. In some
instances, a staging of plank, elevated a few inches above the surface,
is constructed through the alleys.”


_New York, 1865_]

[Sidenote: Cesspool Abominations]

In the court is found generally that most pestiferous of all the
sources of civic uncleanliness and unhealthiness–the privy and
cesspool. These receptacles are rarely drained into the sewers, and
consequently require for their cleanliness the frequent and faithful
attention of the scavenger. The reports of the sanitary inspectors
prove that this work is most irregularly and imperfectly done. Hundreds
of places were found where these nuisances existed within, under or
beside large tenant-houses, creating a vast amount of disease and
death. Numerous instances of this kind are detailed in these reports,
which are almost too revolting to be believed. I will quote but one or
two illustrations:

“The privies (two in one) of Nos. — and — West Twenty-fourth Street
need instant cleaning. They are overflowing the yard, and are very
offensive. The privy No. — Seventh Avenue, as in the preceding two
adjoining houses, is in the yard, and adjoins the house, and is on a
line with the southerly wall of house No. — (the adjacent house),
which has a back area; the wall of said area being part of the
foundation of the privy. At times the fluid portion of the privy oozes
through its own and the area wall.

“The privy of the rear tenant-house No. — West Twenty-second Street
is used by 42 persons; it has five subdivisions, one for every two
families. The compartments are so small that a person can scarcely
turn round in them, and so dark that they have to be entered with an
artificial light. The cellar itself, as has been stated, is damp,
dark, and without ventilation. Under such circumstances the emanations
of the excrementious matter of 42 persons can find no escape; thus this
privy-cellar is worse than a Stygian pit.”

[Illustration: PLAN OF CELLAR]

The Inspector of the Fifth Ward says: “Very few tenements have
water-closets in the house; they have privies in the yards, which,
as a rule, are insufficient for the accommodation of the numbers
crowded into the houses; many are not connected with the sewers; are
seldom cleaned, being allowed to overflow in some cases, rendering the
neighborhood offensive with insalubrious emanations.”

The Inspector of the Fourteenth Ward states that: “The water-closets
are nearly all in the yards–but few being in the houses–and
connecting with the sewers. The greater number of these sewers are
in a filthy condition, being but seldom emptied. Many of those which
communicate with the privies are choked up by all sorts of offal being
thrown into them, thereby producing a very bad condition.”

[Sidenote: Unbelievable Vileness]

The Inspector of the Seventeenth Ward reports: “The privies of East
Eleventh Street, rear, are beneath the floored alley-way leading to the
building. Large holes in this floor allow ocular inspection from above,
and admit rain and dirt. These nuisances are almost always overflowing,
and the passage leading to them is full of fæcal matter. It would seem
impossible for human beings to create or endure such vileness. The
cellar is used by children and others as a privy; the foul air there
seems never to change.”

The Inspector of the Sixteenth Ward says: “The privies form one end of
the chief features of insalubrity. Nearly all of them are too small in
size and too few in number, and without ventilation or seat-covers.
About twelve were found locked securely, and on procuring the key
and inspecting the privy, such masses of human excrements were found
on the seats and floors as would justify the locking of the door to
protect unwary persons from injury. Occupants of rear buildings are the
principal sufferers from this insalubrity. The proximity of privies
is in some cases eight feet from the windows of rear houses; the odor
in these is, especially at night, intolerable. Instances of the kind
are to be found at Nos. –, — and — West Seventeenth Street, and
others. They are also too few in number; for example, No. — West
Nineteenth Street, where in the front and rear buildings more than one
hundred persons live who have one common privy, with a single partition
dividing it, and but four seats in all. Twenty-five persons are
expected to use one seat-opening.”

The Inspector of the Twentieth Ward says: “During my inspection I
reported a number which were filled, and at the same time in such
need of repair as to hazard the lives of those who entered them. The
proximity of these places to the houses in many cases is a fact to
which I would call your attention. One instance of this kind I may
state: At a house in Fortieth Street, between Broadway and Seventh
Avenue, the privy is situated about 10 feet from the door, and there is
another on a line 10 feet from the first, and still another within 10
feet of the last mentioned, making three privies within 30 feet, and
two of these belong to houses fronting on Broadway. The offensive odor
arising from these places contaminates the air of the houses in the
vicinity. This house, in Fortieth Street, is actually unfit to live in.
At the time of my inspection the noxious gases from these privies were
strongly perceptible in every part of the house.”

The Inspector of the Seventeenth Ward reports: “The privies are in
most cases in the rear court-yard. In about two-thirds of the houses
the privies are connected with the sewer. Overflowing privies are
frequently found. Sometimes they are located in a dark place, which
in all cases must be considered an evil. Such is the case in some
houses in Rivington, Stanton, Ninth and Eldridge streets. All these
places are filthy, and exceedingly offensive and dangerous to the whole
neighborhood; in some places the foundation of the privies being rotten
and broken, and fæcal matter runs into the cellar, as in No. — ‘Extra
Place,’ where diseases and deaths have occurred. The contents of a
privy in a court at No. — Fifth Street have, from a similar cause,
saturated the yard of premises on the Bowery, where several children
died during the summer.”

[Sidenote: Special Nuisances]

I will at this point simply allude to special nuisances. New York has
within the narrow limits of its present occupied area of about eight
square miles, in addition to its one million of people, and all its
commercial and manufacturing establishments, a vast number of special
nuisances, which are, to a greater or less degree, detrimental to its
public health. There are nearly 200 slaughter-houses, many of which
are in the most densely populated districts. To these places droves of
cattle, hogs, and sheep are constantly driven, rendering the streets
filthy in the extreme, and from them flow blood and refuse of the most
disgusting character.

WARD, 1865]

[Illustration: SIXTH STREET CATTLE MARKET, 1865]



In certain populous sections are fat-boiling, entrails-cleansing, and
tripe-curing establishments, which poison the air for squares around
with their stifling emanations. To these must be added hundreds of
uncleaned stables, immense manure heaps, etc., etc. But I shall not
dwell further on these subjects, and the evidence regarding them.

[Sidenote: Cellar Population–Dens of Death]

I pass from the consideration of the external to the internal
domiciliary conditions. The poorer classes of New York are found living
either in cellars or in tenement houses. It is estimated by the City
Inspector that 18,000 persons live in cellars. This is also about the
estimate of the police. The apartments of these people are not the
light and airy basement rooms of the better class houses, but their
homes are, in the worst sense, cellars. These dark, damp and dreary
abodes are seldom penetrated by a ray of sunlight, or enlivened by
a breath of fresh air. I will quote several descriptions from these
reports. In the Fourth Ward many of these cellars are below tide water.
Says the Inspector of that district:

“This submarine region is not only excessively damp, but is liable
to sudden inroads from the sea. At high tide the water often wells up
through the floors, submerging them to a considerable depth. In very
many cases the vaults of privies are situated on the same or a higher
level, and their contents frequently ooze through the walls into the
occupied apartments beside them. Fully one-fourth of these subterranean
domiciles are pervaded by a most offensive odor from this source,
and rendered exceedingly unwholesome as human habitations. These are
the places in which we most frequently meet with typhoid fever and
dysentery during the summer months. I estimate the amount of sickness
of all kinds affecting the residents of basements and cellars, compared
with that occurring among an equal number of the inhabitants of floors
above ground, as being about a ratio of 3 to 2.”

The Inspector of the Fifteenth Ward reports: “In a dark and damp
cellar, about 18 feet square and 7 feet high, lived a family of seven
persons; within the past year two have died of typhus, two of smallpox,
and one has been sent to the hospital with erysipelas. The tops of
the windows of this abode are below the level of the surface, and in
the court near are several privies and a rear tenant-house. Yet this
occurred but a short distance from the very heart of the city.”


_In its dark, damp cellar, 18 feet square by 7 high, lived 7 persons_


The Inspector of the Ninth Ward writes: “At Nos. –, –, — and —
Hammond Street, and also at No. — Washington Street, are inhabited
cellars, the ceilings of which are below the level of the street,
inaccessible to the rays of the sun, and always damp and dismal. Three
of them are flooded at every heavy rain, and require to be baled out.
They are let at a somewhat smaller rent than is asked for apartments
on an upper floor, and are rented by those to whom poverty leaves no
choice. They are rarely vacant.”

The Inspector of the Seventeenth Ward states that: “In 17 squares 55
houses contain 246 persons living in cellars entirely underground. As
a matter of course such cellars are unhealthy dwelling apartments.
Stanton Place has some of these miserable cellar-apartments, in which
diseases have been generated. These cellars are entirely subterranean,
dark and damp.”

[Sidenote: 496 Persons Under Ground]

The Inspector of the Sixth Ward says: “There has been some
improvement within the last few years–the cellar population having
been perceptibly decreased, yet 496 persons still live in damp and
unwholesome quarters under ground. In some of them water was discovered
trickling down the walls, the source of which was sometimes traced
to the courts and alleys, and sometimes to the soakage from the
water-closets. The noxious effluvia always present in these basements
are of a sickening character. Many of the cellars are occupied by
two or three families; a number are also occupied as lodging-houses,
accommodating from twenty to thirty lodgers. One, near the corner
of Elm and Worth streets, is now fifteen or sixteen feet below the
level of the street (the street having been raised ten feet). The
lodging-house keeper complained to the Inspector that her business had
fallen off some since the street was raised. As might be expected,
the sickness rate is very high; rheumatic disease, fevers, strumous
diseases, cholera infantum, etc., etc., running riot among the
population. Indeed, in nearly every basement disease of some kind has
been found peculiarly prevalent and fatal.”


Another Inspector says: “At No. — West Sixteenth Street, two families,
in which are thirteen persons, occupy the basement. It is so dark
that ordinary type can be seen with difficulty. In the other case the
people were healthy before entering the basement; since, however, they
have been ill; the mother has phthisis. Of twenty-four cellars, note
of which has been made, four only were in good sanitary condition. The
rest were more or less filthy, some indescribably so. One contained
urine, bones, and soakage from the privy.”

The Inspector of the Eighteenth Ward writes: “There are a few cellars
so dark that one cannot see to read in them, unless by artificial
light, except for a few hours in the day, by sitting close to the
window; and there are many basement rooms into whose gloomy recesses
not a single direct ray from the sun ever shone. The latter are, as a
rule, by half their depth below the level of the street. Dark and damp,
with very little chance for circulation of air, it would be difficult
to imagine a human being more completely beyond reach of sanitary
provisions. And when we consider that four large families often crowd
this subterranean floor, no words are needed to show their condition
deplorable. That a generally impaired vitality is promoted by living
in this unnatural way, ‘a nameless, ever new disease,’ there can be no
question; that these people will be especially prone to whatever form
of prevailing sickness may be about in the community, no one can doubt;
but whether there is any specific cause involved, capable of producing
definite forms of disease, is more difficult to determine.”

[Sidenote: A Visit to the Cave-Dwellers]

An Inspector thus describes a visit to one of these subterranean
abodes: “We enter a room whose low ceiling is blackened with smoke,
and its walls discolored with damp. In front, opening on a narrow area
covered with green mould, two small windows, their tops scarcely level
with the court-yard, afford at noonday a twilight illumination to the
apartment. Through their broken panes they admit the damp air laden
with effluvia, which constitutes the vital atmosphere inhaled by all
who are immured in this dismal abode. A door at the back of this room
communicates with another which is entirely dark, and has but this one
opening. Both rooms together have an area of about eighteen feet square.

“The father of the family, a day laborer, is absent. The mother, a
wrinkled crone at thirty, sits rocking in her arms an infant whose
pasty and pallid features tell that decay and death are usurping the
place of health and life. Two older children are in the street, which
is their only playground, and the only place where they can go to
breathe an atmosphere that is even comparatively pure. A fourth child,
emaciated to a skeleton, and with that ghastly and unearthly look which
marasmus impresses on its victims, has reared his feeble frame on a
rickety chair against the window sill, and is striving to get a glimpse
of the smiling heavens, whose light is so seldom permitted to gladden
its longing eyes. Its youth has battled nobly against the terrible
morbid and devitalizing agents which have oppressed its childish
life–the poisonous air, the darkness, and the damp; but the battle is
nearly over–it is easy to decide where the victory will be.”

But I need not multiply the evidences that 18,000 people, men,
women, and children (a goodly-sized town), are to-day living in our
city in a condition the most destructive to health, happiness, and
morals that could possibly be devised. As you look into these abodes
of wretchedness, filth and disease, the inmates manifest the same
lethargic habits as animals, burrowing in the ground. They are, indeed,
half narcotized by the constant inhalation of the emanations of their
own bodies, and by a prolonged absence of light and fresh air. Here we
never find sound health, while the constant sickness rate ranges from
75 to 90 per cent.

[Sidenote: Tenant-House Population]

Now, as to the second condition under which we find the laboring
classes. It is estimated by the police that the tenant-house population
of New York reaches the enormous figure of 500,000 or about half of the
total number of inhabitants. The great and striking fact in regard to
the domiciliary condition of the tenant-house class is overcrowding
and deficient sunlight and fresh air. The landlord of the poor
tenant-house has two principal motives–first, to pack as many people
as he can in a given space, and second, to make as few improvements and
repairs as possible.


The tenant-houses are of two classes, viz., the front and the rear. The
latter is closely allied to the cellar; being shut out from air and
sunlight, it is generally damp, gloomy, and filthy. The space between
the front and rear house, familiarly called the “well hole,” contains
the privy and cesspool, the emanations from which are closely confined
to this space, and slowly but constantly pervade with their disgusting
odors all the rooms and recesses.

The tenant-house has frequently been described by sensation writers,
with all its miseries, its diseases and its deaths. But no pen nor
pencil can sketch the living reality. It is only by personal inspection
that one can learn to what depths of social and physical degradation
human beings can descend. Said a committee appointed by your body to
investigate the condition of the tenant-houses of New York:

“Sitting together upon the same broken box, lying together upon the
same dirty straw, covered by the same filthy shreds, vieing with each
other in the utterance of foul obscenities, you have a picture of the
mass of corruption and squalid misery gathered inside the walls of that
unventilated building in Mission Place. In that single house there was
that which made the soul sicken and turn in horror from the sight.
Vice, with its pretentious brow, and wretchedness, with hollow cheek
and sunken, glazed eye, were there; hunger and lust stood side by side,
petit larceny and cold-blooded murder were holding converse.”

[Sidenote: Cat Alley]

The inspectors describe more or less minutely a large number of
tenant-houses, and also of groups:

“‘Cat Alley’ is the local designation of a group of dilapidated
tenant-houses in an alley on Cannon Street. The alley is unpaved,
and is excessively filthy. The privy is a small and broken-down
structure, covering only a part of the vault, which is now full
almost to overflowing. The inhabitants are degraded, both physically
and socially. In several of the domiciles, at the time of our last
inspection, there was neither bedstead nor table. Twelve of these
families were found in a wretched condition, and all the children we
saw were covered with dirt, and presented the intensest aspects of
scrofulous disease; their sore eyes, encrusted heads, and dehumanizing
appearance, told the story of want and neglect, and of greater evils to

“Five small houses, two and a half stories in height, including the
basements, each containing apartments for six families, front on
an alley called Rivington Place. This alley is always in a filthy
condition. The houses on it are small and overcrowded. The 30 families
that reside in these five houses have no other water supply than that
which two hydrants furnish in the exterior courtyard; while for this
population of nearly 200 persons, of all ages, there are but two privy
vaults, and, at the time of the last inspection of the quarters,
these vaults were filled nearly to the surface. In the year 1849, 42
individuals died here in three weeks of cholera, and not one recovered
that was taken sick. The reasons are plain: they have no ventilation,
and the houses being double, the exhalations from one apartment are
inhaled by the other.


“At No. — West Twenty-fifth Street, a wretched tenement of two
apartments, the rooms occupied by one family. The sitting-room is about
10×12 feet, and the bedroom about 5×12, without a single window or air
hole. These rooms were occupied in the hot month of July by a colored
female, having pulmonary consumption, and her two children. Here she
died, shortly after we made the inspection of her domicilium; having
no money nor friends, a Christian burial was denied her for four days,
although the neighbors acquainted the police of the fact, and they the
Health Warden.”

[Sidenote: Rag Pickers Row]

“Rag Pickers Row” is thus described: “The houses are of wood, two
stories, with attic and basement. The attic rooms are used to
deposit the filthy rags and bones as they are taken from gutters and
slaughter-houses. The yards are filled with dirty rags hung up to dry,
sending forth their stench to all the neighborhood, and are exceedingly
nauseous, operating upon me as an emetic. The tenants are all Germans
of the lowest order, having no national nor personal pride; they are
exceedingly filthy in person, and their bed-clothes are as dirty as
the floors they walk on; their food is of the poorest quality, and
their feet and heads, and doubtless their whole bodies, are anasarcous,
suffering from what they call rheumatism, but which is in reality a
prostrate nervous system, the result of foul air and inadequate supply
of nutritious food. They have a peculiar taste for the association of
dogs and cats, there being about 50 of the former and 30 of the latter.
The whole number of apartments is 32, occupied by 28 families, number
120 in all, 60 adults and 60 children. The yards are all small, and the
sinks running over with filth.”

[Sidenote: Tenant-House Degeneration]

Says a visitor in the Eighth Ward: “The instances are many in which
one or more families, of from three to seven or more members, of all
ages and both sexes, are congregated in a single and often contracted
apartment. Here they eat, drink, sleep, work, dress and undress,
without the possibility of that privacy which an innate modesty
imperatively demands. In sickness and in health it is the same.

“What is the consequence? The sense of shame–the greatest, surest
safeguard of virtue, except the grace of God–is gradually blunted,
ruined, and finally destroyed. New scenes are witnessed and
participated in, with a countenance of brass, the very thought of
which, once, would have filled the sensitive heart of modesty with
pain, and covered its cheek with burning blushes. The mind of one thus
brought in daily and nightly contact with such scenes must become
greatly debased, and its fall, before the assaults of vice, rendered
almost certain.”

[Illustration: GOTHAM COURT, ON CHERRY STREET, 1865]



Another writes: “These houses seem to be always open to newcomers, and,
in some way or other, they can accommodate them. I have found three
families, of men, women, and children, in one room; there they lived
and there they slept. Can any one doubt that there must be a rapid
declension of morals in both parents and children, or that a bar is
here opposed to moral and religious instruction, or that this state of
things is consequent on the circumstances and condition of life?”

I could give you many details of other tenant-houses, the reputation of
which is a reproach to any city in the civilized world. Such is “Gotham
Court,” “Rotten Row,” “The Great Eastern,” “Sebastopol,” “Quality Row,”
“Bummer’s Retreat,” etc. Speaking of the tenant-house, the Rev. Dr.
Muhlenburg says:

“‘Their homes!’ that cold and damp cellar, about as tenantable as your
coal vault! Do you call that a home for the distressed body, crowded
in one corner there, swollen with the pains of rheumatism? Or that
close apartment, heated or stifling in preparing the evening meal, on
the shattered stove–that suffocating room, where you would not stop
within for a moment–is that the home which you think so favorable
for the worn asthmatic, catching every breath as if the last? Ask any
clergyman, he will tell you with how little satisfaction he makes his
visits among the poor, when they are laboring among disease; how he
never has the heart to speak of comfort for the soul, when discomforts
of the body call so loudly for relief, and for which the scanty aid he
can minister seems akin to mockery!”

[Illustration: “THE GREAT EASTERN,” NUMBER 115 EAST 37TH STREET, 1865]

[Sidenote: The Rioters]

Mr. N. P. Willis who witnessed the “draft” riots thus truthfully and
graphically describes the inmates of tenant-houses:

“The high brick blocks and closely packed houses where the mobs
originated, seemed to be literally hives of sickness and vice. It
was wonderful to see, and difficult to believe, that so much misery,
disease and wretchedness can be huddled together and hidden by high
walls, unvisited and unthought of, so near our own abodes. Lewd, but
pale and sickly young women, scarce decent in their ragged attire,
were impudent and scattered everywhere in the crowd. But what numbers
of these poorer classes are deformed–what numbers are made hideous
by self-neglect and infirmity! Alas! human faces look so hideous with
hope and self-respect all gone! And female forms and features are made
so frightful by sin, squalor, and debasement! To walk the streets as
we walked them, in those hours of conflagration and riot, was like
witnessing the day of judgment, with every wicked thing revealed, every
sin and sorrow blazingly glared upon, every hidden abomination laid
bare before hell’s expectant fire? The elements of popular discord
are gathered in these wretchedly constructed tenement houses, where
poverty, disease, and crime find an abode. Here disease in its most
loathsome forms propagates itself. Unholy passions rule in the domestic
circle. Everything, within and without, tends to physical and moral

[Sidenote: Tenant-House Rot]

Such, Mr. Chairman, is the external and internal sanitary condition
of the homes of 500,000 people in the City of New York to-day, as
revealed by this inspection. It requires no extraordinary amount of
medical knowledge to determine the physical condition of this immense
population, living under such circumstances. Even though no devastating
epidemic is found ravaging the tenant-house, yet the first sight of the
wretched inmates convinces you that diseases far more destructive to
health and happiness, because creating no alarm, are wasting the vital
energies, and slowly but surely consuming the very tissues of the body.

Here infantile life unfolds its bud, but perishes before its first
anniversary. Here youth is ugly with loathsome diseases and the
deformities which follow physical degeneracy. Here the decrepitude
of old age is found at thirty. The poor themselves have a very
expressive term for the slow process of decay which they suffer, viz.:
“Tenant-house Rot.” The great majority are, indeed, undergoing a slow
decomposition–a true eremacausis, as the chemists term it. And with
this physical degeneration we find mental and moral deterioration. The
frequent expression of the poor, “We have no sickness, thank God,”
is uttered by those whose sunken eyes, pale cheeks, and colorless
lips speak more eloquently than words, of the unseen agencies which
are sapping the fountains of health. Vice, crime, drunkenness, lust,
disease, and death, here hold sway, in spite of the most powerful moral
and religious influences.

Religious teachers and Bible readers are beginning to give this class
over as past all remedy, until their physical condition is improved.
Their intellects are so blunted and their perceptions so perverted by
the noxious atmosphere which they breathe, and the all-pervading filth
in which they live, move, and have their being, that they are not
susceptible to moral or religious influences. In London, some of the
city missionaries have entirely abandoned the tenant-house class. There
is, undoubtedly, a depraved physical condition which explains the moral
deterioration of these people, and which can never be overcome until we
surround them with the conditions of sound health. A child growing up
in this pestilential atmosphere becomes vicious and brutal, not from
any natural depravity, but because it is mentally incapable of the
perceptions of truth. Most truly does the Inspector of the Fourth Ward

[Sidenote: Tenant-House Cachexy]

“There is a tenant-house cachexy well-known to such medical men as have
a practical acquaintance with these abodes; nor does it affect alone
the physical condition of their inmates. It has its moral prototype in
an ochlesis of vice–a contagious depravity, to whose malign influence
the youthful survivors of the terrible physical evils to which their
infancy is exposed, are sure to succumb. We often find in persons of
less than middle age, who have long occupied such confined and filthy
premises, a morbid condition of the system unknown elsewhere. The eye
becomes bleared, the senses blunted, the limbs shrunken and tremulous,
the secretions exceedingly offensive. There is a state of premature

“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

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.

STREET, 1865]

[Sidenote: Where Disease Flourishes]

Tenth Ward: The most prominent diseases during the past year have been
phthisis, typhoid and scarlet fevers, cholera infantum, dysentery,
smallpox, and diphtheria. They were most prevalent in the poorest part
of the district, having the lowest ground, the filthiest streets, and
the most dense population of poor and careless people, who are crowded
in the numerous tenant-houses, shanties, and small dwellings, which
were built for one or two families, but are now made to contain from
five to ten.

Nineteenth Ward: The diseases that have chiefly prevailed during the
past season are dysentery, diarrhoea, cholera morbus, cholera infantum
and the exanthematous fevers. They were of the most frequent occurrence
in the most crowded and insalubrious quarters.

Fifteenth Ward: Since the commencement of the survey, scarlet fever,
typhoid fever, smallpox, and cholera infantum have prevailed in the
tenant-houses of this ward. Six cases of smallpox occurred in one of
three thickly peopled rows of such dwellings, and the disease was
communicated to a child in an adjacent street, who had been playing in
the infected neighborhood. Seven cases of typhoid also occurred in a
court among children, and this was within a few doors of better class

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

At Mulberry Street, in a notoriously filthy house, it has existed
for more than four years. This house has a population of about 320,
which is renewed every few months. During the period alluded to, there
have been no less than 60 deaths by fever in this single house, and
240 cases. To-day this fever is raging uncontrolled in that house,
creating more orphans than many well-fought battles. Every new family
which enters these infected quarters is sure to fall a victim to this
pestilential disease.

[Illustration: PLAN OF FEVER-NEST, EAST 17TH STREET, 1865

_Here 85 Cases of Typhus Occurred in One Season_]

The tenant-house No. — East Seventeenth Street, which reaks with
filth, gives the same history; upward of 85 cases, with a large
percentage of deaths, occurred in this single house during the past
season. And still it remained unclean and open to new tenants. I
could mention scores of these houses in every part of the tenant-house
district where typhus has apparently taken up its abode, and from
whence it sends out in every direction its deadly streams.

Not only have single houses become centres of contagion, but this
fever has, in many instances, become localized in crowded streets,
which to-day are almost impassable on account of the heaps of garbage,
and the courts and alleys of which are reeking with filth, making
them great centres of pestilence. From many of these tenements whole
families have been swept away.


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

[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

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

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

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.

[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

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

The degree of public health of a town is therefore measured by its
cleanliness, and its capacity for health depends upon its capacity for

[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

[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

[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

[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.

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

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.

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

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