Apathy in the United States

A great problem was left for the first civilized inhabitants of New
York to determine. Nature had made ample provision for the metropolis
of the western hemisphere. But two possibilities were attached to its
occupation by man–it could be healthy or unhealthy, at the option of
the people.

The conditions which made for health were: two large rivers of pure
water, from the mountains and the sea, flushed its shores, carrying the
outflow of its waste far away seaward; its soil could be thoroughly
drained; its sewerage could be so constructed as to convey to the
sea all forms of domestic waste and surface filth; its southern
exposure towards the ocean insured sunlight and sea breezes; its
inland situation supplied to its atmosphere the life-giving virtues of
abundant vegetation; the climate was temperate.

The conditions which made for unhealthiness were: large areas of sodden
marsh lands; a rock formation of shale, having a dip of the strata,
nearly perpendicular, admitting the flow of surface water to great
depths, thus poisoning springs and wells; numerous streams flowing into
the rivers; large ponds of stagnant water; fierce summer heat.

[Sidenote: Two Centuries and a Half Unhealthy]

From the year 1622 to the year 1866, a period of two hundred and
forty-four years, the people elected that the city should be unhealthy.
The land was practically undrained; the drinking water was from shallow
wells, befouled by street, stable, privy, and other filth; there were
no adequate sewers to remove the accumulating waste; the streets were
the receptacles of garbage; offensive trades were located among the
dwellings; the natural water courses and springs were obstructed in the
construction of streets and dwellings, thus causing soakage of large
areas of land, and stagnant pools of polluted water.

Later, in these centuries of neglect of sanitary precautions, came
the immigrants from every nation of the world, representing for the
most part the poorest and most ignorant class of their respective
nationalities. This influx of people led to the construction of the
tenement house by landowners, whose aim was to build so as to incur
the least possible expense and accommodate the greatest possible
number. In dark, unventilated, uninhabitable structures these wretched,
persecuted people were herded together, in cellars and garrets, as
well as in the body of the building, until New York had the largest
population to a square acre of any civilized city.

The people had not only chosen to conserve all the natural conditions
unfavorable to health, but had steadily added unhygienic factors in
their methods of developing the city.

[Sidenote: A Plague-Stricken Town]

The result was inevitable. New York gradually became the natural home
of every variety of contagious disease, and the favorite resort of
foreign pestilences. Smallpox, scarlet fever, measles, diphtheria,
were domestic pestilences with which the people were so familiar
that they regarded them as necessary features of childhood. Malarial
fevers, caused by the mosquitoes bred in the marshes, which were
perfect culture-beds, were regularly announced in the autumnal months
as having appeared with their “usual severity.” The “White Plague,” or
consumption, was the common inheritance of the poor and rich alike.

With the immigrant, came typhus and typhoid fevers, which resistlessly
swept through the tenement houses, decimating the poverty-stricken
tenants. At intervals, the great oriental plague, Asiatic cholera,
swooped down upon the city with fatal energy and gathered its enormous
harvest of dead. Even “Yellow Fever,” the great pestilence of the
tropics, made occasional incursions and found a most congenial field
for its operations.

[Sidenote: Enormous Sacrifice of Life]

Failure to improve the unhealthy conditions of the city, and the
tendency to aggravate them by a large increase of the tenement-house
population, offensive trades, accumulations of domestic waste, and the
filth of streets, stables, and privy pits, then universal, caused an
enormous sacrifice of life, especially among children. This fact is
strikingly illustrated by the following comparison of figures taken
from the official records.

The standard ratio of deaths to the total living in a community, where
the death-rate is normal under proper sanitary conditions, has been
fixed by competent authority at about 15 in 1,000 of population. The
death-rate in New York, in the five years preceding 1866, averaged 38
in 1,000 population, which is 23 in excess of the normal standard of 15
in the 1,000. In a city with a population of 1,000,000, the estimated
population of New York in 1865, a death-rate of 38 in the 1,000 means
23,000 deaths annually from preventable diseases.

Mortality statistics computed on a scale of forty years, the period
during which New York has been under an intelligent sanitary
government, still more impressively show the former waste of life
through municipal neglect of the elementary principles of public
hygiene. The lesson which these figures teach should be engraven on
the memory of every man, woman, and child. Our authority is the annual
report of the Department of Health of the City of New York, for the
year 1908, in which appears the following statement.

“A remarkable decrease in the death-rate has taken place within the
past forty years, a decrease comparing each decennial rate with the one
immediately preceding represented by seven, seven, and eighteen per
cent respectively, and comparing that of the first decennium with the
individual year under review, a decrease of forty-seven per cent.”

Cholera was approaching the shores of England. The alarm of the people
was intense. The enormous devastations of that pestilence on its
first and only previous visit to that country, in 1832, were vividly
recalled by the elder people. The only known preventive measures were
“flight, fasting, and prayer.” As the pestilence was believed to
be a “visitation of God” on account of the sins of the people, the
clergy petitioned the Prime Minister to proclaim a day of “fasting and
prayer,” with many expressions of sorrow at the prevailing national
vices which had finally provoked the wrath of the Almighty. The Prime
Minister replied in substance as follows:

“Do works meet for repentance. First make your homes and their
surroundings clean and wholesome; then you may with propriety
ask Almighty God to bless your efforts at protection against the
approaching epidemic.”

This response of the highest official of the Kingdom to the usually
humble and devout petition of the clergy, when the people were
threatened with an epidemic, was received with profound astonishment
by the religious classes, with ridicule by the masses of the people,
but with commendation by sanitarians. The popular agitation was great.
The clergy protested with solemn asseverations their belief that
pestilences were always indications that national sins had become
intolerable to the Almighty, and only fastings and prayers could
appease His wrath.

The people at large gave no heed either to the clergy’s admonition to
fast and pray, or to the Prime Minister’s advice to clean their homes
and their surroundings; but, with their usual disregard of the domestic
diseases with which they were constantly familiar, gave no thought to
approaching danger. But the sanitarians very earnestly urged the people
of their respective localities to act upon the advice of the Prime
Minister, assuring them that cholera was a disease which prevailed more
generally and severely in localities and homes where there was the
greatest amount of “filth.”

The epidemic of 1849 came and went with its apparent usual great
disturbances of the people. “Flight” and “fasting and prayers” had
their natural results, the former being effectual when undertaken in
time, and the latter without sensible influence over the mortuary

[Sidenote: Can Diseases Be Prevented?]

Then the net results of this visitation of cholera were officially
determined by the Registrar-General, one fact attracted wide attention
and created a profound and lasting impression on the minds of the
common people. A town in the interior of England reported no case of
cholera, though the epidemic had prevailed with great virulence in the
communities surrounding it.

On inquiry as to the cause of this remarkable feature of a pestilence
that hitherto had shown no respect for persons or localities, it was
learned that certain citizens of this town were deeply impressed
with the reasonableness of the Prime Minister’s suggestions, and had
organized and taken action accordingly. Volunteer committees composed
of the leading men and women were selected. One was to secure thorough
cleaning of the streets and public places; another was to cause an
inspection of every residence and its surroundings and secure complete
cleanliness; a third was to obtain reports of all cases of sickness and
require immediate isolation and treatment when there was the slightest
symptom of cholera.

This town had its “fastings and prayers,” but not until its citizens
had done works meet for repentance; and then it asked the divine
blessing on its efforts to protect itself–and its prayers were
abundantly answered.

But there was another phase of this place’s experience not less
impressive than its escape from cholera. There was a great diminution
of such diseases as diphtheria, typhoid, erysipelas, scarlet fever,
measles, and other low forms of sickness, so fatal in the homes of the
poor, during the period that the citizens exercised so much care in
securing cleanliness.

[Sidenote: The Word Fitly Spoken]

“A word fitly spoken is like apples of gold in pictures of silver.”
A word fitly spoken broke the spell of centuries, and completely
revolutionized human history. That word was spoken, not at the
suggestion of science, nor by a scientist, but, at the dictation of
common sense, by a layman who happened to be in authority. It was
a plain, simple word, which was understood by the people and which
appealed to their common sense.

A new era now dawned upon the domestic life of the English people.
Every household learned that cleanliness had not only saved a town
from a visitation of cholera, but had reduced the contagious and
infectious diseases always present in their homes. The Health Officer
of England gave tremendous force to the revelation that had been made
by officially characterizing and classifying cholera and the whole
brood of domestic scourges as “filth diseases.” This was a most happy
term, because it suggested not only the source of these diseases, but
the simple and effectual remedy that every householder could apply.
It became popular in the sanitary literature of the period, and thus
permeated all classes, until the most humble family knew its import and
complied with its suggestion.

The next visitation of cholera to England was met by the simple remedy
of domestic and civic cleanliness; and so manifestly effectual was
this measure that the pestilence lost its former terrors. But the
great and lasting gain to the people, which grew out of the original
proclamation of the Prime Minister that cleanliness of the home and its
surroundings was the best preventive of cholera, was the discovery of
the fact that nearly all diseases which afflict the individual family,
and in a larger sense the whole community, have their origin in or are
intensified by decomposing waste matter, the “filth” of the sanitarian,
in and around their homes.

So profoundly impressed with this fact were the laboring classes,
and so earnest did they become in their zeal for sanitation, that
sanitary measures entered into the political campaign. On one occasion
a prominent candidate was so disturbed by the numerous inquiries which
the audience made as to his views in relation to current questions of
local sanitation, that he cried out in despair, “_Sanitas sanitatum, et
omnia sanitas!_”

During the score of years that the great awakening of the people of
England to the value of cleanliness of the individual, the home, and
the municipality, as the true remedial measure against foreign as
well as domestic pestilences was in progress, extending from 1846 to
1866, the people of the United States remained profoundly apathetic
in relation to all questions of improvement of the public health and
the prevention of epidemics. Cholera ravaged their cities in 1849, and
again in 1854, without meeting other obstruction than the occasional
fumes of sulphur. Days of fasting and prayer were religiously observed;
but, for the most part, the terror-stricken people fled to the country
to escape what they believed to be inevitable death if they remained in
their town homes.

The object lesson which the people of England had learned from the
experience of one town, and had so successfully applied in several
visitations of epidemics, was known to a few students of sanitary
science and administration in different parts of this country and
efforts had been made by them, from time to time, to awaken public
interest in sanitation of the home and the municipality, but very
little progress was made. A few cities had health organizations which,
for the most part, were devoted to political schemes and purposes, with
no pretense to knowledge of the objects or methods of sanitation.

[Sidenote: An Incident That Counted]

As the simple suggestion of the Prime Minister, that cleanliness of the
home and its surroundings was the best measure of protection against
cholera, contained the germ of practical sanitary reform in England, so
an incident in the writer’s experience became the potential force that
gave to New York a most complete system of health laws and ordinances,
and an efficient administrative department of health. In a larger sense
it may, with justice, be claimed that this incident contained the germ
of health reform that has given to this entire country the most perfect
system of municipal, state, and national health administration in the
civilized world.

The incident referred to occurred in the fifties of the last century.
New York was in the grip of the deadly typhus. This was sometimes
called the “Spotted Fever,” from the dark spots which appeared on
the body of its victims, and also “Emigrant Fever,” because it was
brought to this country by the immigrants, especially by those who
came from Ireland. Indeed, the Irish immigrants suffered so generally
and severely that the disease was sometimes called the “Irish Fever.”
Immigration from Ireland was at that time at its flood and the typhus
was so prevalent among these poverty-stricken people that the hospitals
were overcrowded by them and large numbers were treated in tents, both
on Blackwell’s Island and at the quarantine grounds on Staten Island.

Having completed a two years’ term of service on the interne medical
staff of Bellevue Hospital, where large numbers of typhus cases were
treated, I was placed in charge of the tents on Blackwell’s Island by
the Commissioner of Charities. Soon after entering upon the service, I
noticed that patients were continually admitted from a single building
in East Twenty-second Street.

[Sidenote: A Fever Nest]

Impressed with the importance of closing this fever-nest, I visited the
tenement and was not surprised at the large number of cases of fever
which it furnished our hospital. It is difficult to describe the scene
that the interior of the house presented to the visitor. The building
was in an extreme state of dilapidation generally; the doors and
windows were broken; the cellar was partly filled with filthy sewage;
the floors were littered with decomposing straw, which the occupants
used for bedding; every available place, from cellar to garret,
was crowded with immigrants–men, women, and children. The whole
establishment was reeking with filth, and the atmosphere was heavy with
the sickening odor of the deadly typhus, which reigned supreme in every

The necessity of immediately closing this house to further occupation
by immigrants, until it was thoroughly cleansed and made decently
habitable, was imperative, and I made inquiries for the responsible
owner. I found that the house was never visited by anyone who claimed
to be either agent or owner; but that it was the resort of vagrants,
especially of the most recent and destitute immigrants; that they came
and went without let or hindrance, generally remaining until attacked
by the prevailing epidemic of fever, when they were removed to the
fever hospital.

[Sidenote: The Unknown Owner]

After considerable inquiry in the neighborhood I found a person who
was the real agent of the landlord; but no other information could be
obtained than that the owner took no interest in the property, and
that the agent was under instructions not to reveal the owner’s name.
A suggestion to this agent, to have the house vacated and put in good
condition for tenants, was refused with a contemptuous remark as to the
absurdity of furnishing such vagrants and immigrants better quarters in
which to live.

As there was no Health Department to which an appeal could be made, the
Metropolitan Police Department was visited and the matter laid before
its president, Mr. Acton. He directed the secretary, Mr. Hawley, a
lawyer, to examine the health laws and ordinances to determine what
measures were in the power of the police to enforce. A search was
made, and the result was that neither law nor ordinance under which
the police could take action was found. Mr. Acton advised that the tax
lists be examined, to find who paid taxes on the property, and thus
discover the responsible party to its ownership, and then that appeal
be made directly to him to authorize the necessary improvements. An
examination of the tax list revealed that the owner was a wealthy man,
living in an aristocratic neighborhood, a member of one of the most
popular churches of the city.

The condition of his tenement house was brought to his attention, and
its menace to the public health as a fruitful fever nest was explained.
He was very angry at what he declared was an interference with the
management of his property, and asserted, in the most emphatic manner,
that as the house yielded him no rent, he would not expend a dollar for
the benefit of the miserable creatures who had so wrecked the building.

With the failure of this appeal to the owner, I had exhausted,
apparently, every legal and moral means of abating a nuisance dangerous
to life and detrimental to health.

[Sidenote: Fear of Publicity]

In this extremity I visited the office of the _Evening Post_ and
explained the matter to Mr. William Cullen Bryant, then editor of that
newspaper. He was at once interested in the failure of the power of
the City Government to remedy such a flagrant evil. In the absence of
laws and ordinances, Mr. Bryant proposed to make the case public in all
of its details, and for that purpose suggested that the police should
cause the arrest of the delinquent owner, and he would send a reporter
to make notes of the case. A charge was made against the landlord, and
he was required to appear at the Jefferson Market Court. On entering
the court he was confronted by the reporter, pad and pencil in hand,
who pressed him with questions as to his tenement house.

Greatly alarmed at his situation, the owner inquired as to the purpose
of the reporter, and was informed that Mr. Bryant intended to publish
the proceedings of the court in the _Evening Post_, and to expose
his maintenance of a fever nest of the worst description. He begged
that no further proceedings be taken, and promised the court that he
would immediately make all necessary improvements. He promptly vacated
the house, and made such a thorough reconstruction of the entire
establishment that it became one of the most attractive tenements in
that East Side district. For many years that house continued to be
entirely free from the ordinary contagious diseases of the tenement
houses of the city. It is an interesting fact that the landlord
subsequently thanked the writer for having compelled him to improve his
tenement house; for he had secured first-class tenants who paid him
high rents.

[Sidenote: Agitation for Reform]

This incident came to the attention of several prominent citizens,
physicians, lawyers, and clergymen, who became profoundly impressed
with the revelation that there were no laws under which such a glaring
violation of the simplest principles of health, and even of common
decency, could be at once corrected.

For many years there had been a growing sentiment in favor of a reform
of our health regulations, stimulated by the writings of Dr. John H.
Griscom, Dr. Joseph M. Smith, Dr. Elisha Harris, and others, and the
Academy of Medicine had occasionally passed resolutions favoring
adequate health laws; but no results had been secured.

It was now resolved to organize a society devoted expressly to sanitary
reform, and the “Sanitary Association” came into existence. For several
years this body annually introduced a health bill into the Legislature,
but the measure was regularly defeated through the active opposition of
the City Inspector, whose office would be abolished if the bill became
a law.

[Sidenote: The Citizens Association]

In the early sixties the famous “Citizens Association” was organized,
with Peter Cooper as President, and a membership of one hundred of the
most prominent citizens. This was in the days of the Tweed régime, and
at a period when the City Government was most completely in his power.
The objects of the Association were reform in all branches of the
Municipal Government, the promotion of wise legislation, and the defeat
of all attempts to subordinate the city to the schemes for control by
Tweed and the coterie of politicians who were under his directions.

The friends of sanitary reform decided to attempt to secure proper
legislation through the Citizens Association. The application, by a
delegation, for the aid of this Association was well received and a
plan of procedure adopted. The secretary of the Citizens Association,
Mr. Nathaniel Sands, had been a member of the Sanitary Association, and
as an enthusiastic sanitarian had been disappointed at its repeated
failure to secure legislation. At his suggestion, it was decided to
create two committees, one on health and another on law, and through
these agencies to have the Citizens Association accomplish its work.
The first committee eventually came under my direction, while the
second was directed by Dorman B. Eaton, Esq.

In the Committee on Public Health were many of the more prominent
medical men of that period, as Dr. Valentine Mott, Dr. Joseph M. Smith,
Dr. James R. Wood, Prof. John W. Draper, Dr. Willard Parker, Dr. Isaac
E. Taylor. The Committee on Law was equally distinguished for its
membership, having on its list the names of William M. Evarts, Charles
Tracy, D. B. Silliman.

[Sidenote: A Health Bill]

It was determined, as a preliminary step, to prepare a “Health Bill”
and introduce it into the Legislature, which was that of 1864, and thus
learn the obstacles to be met; for efforts had repeatedly been made to
pass health bills without success. The bill was drawn along the lines
of previous bills, and was altogether inadequate in its provisions to
effect the required reforms. The effort, however, developed the fact
that the real opposition to health legislation was the City Inspector’s
Department. As that department exercised all of the health powers, any
proper health bill would abolish it altogether.

The City Inspector, at that time, was a grossly ignorant politician,
but as he had upwards of one million of dollars at his disposal, he
had a prevailing influence in the Legislature when any bill affected
his interests. At the hearing on the Association’s bill, the City
Inspector’s agents denied every allegation as to the unsanitary
condition of the city, and as the Association had no definite
information as to the facts asserted, the bill failed, as had all the
bills of the Sanitary Association during the previous ten years.

[Sidenote: Sanitary Inspection of New York]

In conference it was now decided to make a thorough sanitary inspection
of the city by a corps of competent physicians, draft a new and much
more comprehensive measure, and thus be prepared to confront the City
Inspector with reliable facts in regard to the actual condition of the
city. The Citizens’ Association consented to bear the expense of the

Under the auspices of the Association, and in the absence of the
secretary of the Committee on Health, Dr. Elisha Harris, who was at
that time in the service of the United States Sanitary Association,
I organized and supervised the inspection. The corps of inspectors
consisted of young physicians, each assigned to one of the districts
into which the city was divided. The work was completed during the
summer months of 1864, and the original reports of the inspectors
were bound in seventeen large folio volumes. These reports were
afterwards edited by the secretary, Dr. Elisha Harris, and published
by the Association in a volume of over 500 pages. The total cost to
the Association of this inspection and publication was $22,000; but it
richly repaid the Association, for it accomplished the object for which
it was undertaken.

This volunteer sanitary inspection of a great city was regarded by
European health authorities as the most remarkable and creditable in
the history of municipal reform. Too much credit can not be given to
the President of the Association, Peter Cooper, and to the Secretary,
Nathaniel Sands, for the constant support which they gave the Committee
on Health in the prosecution of this great undertaking.

Meantime the Committee on Law perfected a bill to be introduced at the
coming session of the Legislature, 1865. It was the joint product of
the Medical and Law Committees, and was made the subject of extensive
study and research, in order to embody in it every provision essential
to its practical operations.

At the request of the Committees I made the first draft for the purpose
of embodying the sanitary features as the basis of the bill. Former
health bills were restricted in their operations to the city of New
York, and the officers were appointed by the Mayor. As the government
of the city was dominated in all of its departments by Tweed, it was
decided to place the proposed new health organization under the control
of the State, by making a Metropolitan Health District, the area of
which should be co-extensive with that of the Metropolitan Police
District. This feature of the bill was also important because the
protection of the city from contagious diseases in outlying districts
required that the jurisdiction of the Board should extend to contiguous

The original draft having been approved by the Committee on Health, Mr.
Eaton was requested to perfect the bill by adding the legal provisions.
As he had recently made a study of the English health laws, he
incorporated many items especially relating to the powers of the Board
which were quite novel in this country.

[Sidenote: An Anomaly in Law]

One feature of the bill deserves mention; for it is an anomaly in
legislation and apparently violates the most sacred principle of
justice; viz., the power of the courts to review the proceedings
of a health board. The Committees concluded that a board which was
authorized to abate nuisances “dangerous to life and detrimental to
health” should not be subjected to the possible liability of being
interrupted in its efforts to abate them by an injunction that would
delay its action. Accordingly the law as so drawn that the Metropolitan
Board was empowered to create ordinances, to execute them in its own
time and manner, and to sit in judgment on its own acts, without the
possibility of being interrupted by review proceedings or injunctions
by any court.

Its power was made autocratic. The language of that portion of the bill
conveying these powers was purposely made very technical, in order
that only a legal mind could interpret its full meaning, it being
believed that the ordinary legislator would not favor the measure if
he understood its entire import. It is an interesting fact that the
first case brought into court under the law was an effort to prove the
unconstitutionality of this feature; but it was carried to the Court of
Appeals, and its constitutionality was sustained by a majority of one.

[Sidenote: Introduction of an Epoch-Making Bill]

On the assembling of the Legislature of 1865 the Metropolitan Health
Bill was formally introduced into both houses, and preparations made to
secure its passage. Mr. Eaton was selected by the Citizens’ Association
to advocate the legal provisions of the bill at the hearings before
the committees of the Legislature, and I was delegated to explain the
sanitary requirements of the measure. The first hearing occurred on
the thirteenth of February, before a joint committee of both houses,
Hon. Andrew D. White, senator, presiding. A large audience was present,
including the City Inspector and the usual retinue of office holders
in his department. The Citizens Association was represented by Rev.
Henry W. Bellows, Dr. James R. Wood, Dr. Willard Parker, Prof. John W.
Draper, and several other prominent citizens, in addition to Mr. Eaton
and myself.

Mr. Eaton first addressed the committee, and made an admirable
presentation of the legal features of the bill. He eloquently appealed
for its enactment into law, in order to create in New York a competent
health authority, with power to relieve the city of its gross sanitary
evils and adopt and enforce measures for the promotion of the public

I followed him, my task being to show, from the existing condition of
the city, the imperative need of such legislation. My remarks on the
occasion were published in _The New York Times_ of March 16, 1865.