Part 2

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 room.

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 undertaking.

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 populations.

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 health.

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.

IV

NEW YORK, THE UNCLEAN

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.

[Sidenote: Alarm of Medical Men]

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 proposed.

[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 them.

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]