Part 5

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

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

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

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

Eighth Ward: The prevailing diseases of the past season have been fevers of the typhus, typhoid, remittent and intermittent types, cholera infantum, scarlatina, dysentery, and diarrhoea, all confined to densely populated tenements. The typhus and typhoid fevers have been of a malignant type in two houses, twelve out of eighteen cases proving fatal.

Ninth Ward: The prevailing diseases during the past season have been typhoid fever, dysentery, diarrhoea, scarlet fever, measles, and a few cases of variola.

[Sidenote: Seeds of Disease Uncontrolled]

Sixth Ward: The seeds of disease exist everywhere, and although removable and susceptible of sanitary control, they are yet uncontrolled, and at any time may spring into activity and a terrific life, that shall only have the power and effect of death. Cholera, when it visits these shores again, will first break forth here, if proper sanitary measures be neglected. Typhus fever nests exist in all parts of the district; and it has been traced from these nests to every ward in the city, spreading the disease not only in the worst localities, but into the homes of the industrious, the wealthy, and the highest classes of society. This disease is now on the increase, and if proper sanitary measures are not adopted to remove the predisposing and the infecting causes, we may again have an epidemic of that scourge.

Fourteenth Ward: There have been attended in this district, during the last year, over 200 cases of typhoid and typhus fever by one dispensary physician; also, 70 cases of dysentery, and 50 cases of smallpox. There is one particular locality which has contributed to the spread and intensity of the fever contagion, viz.: the little street known as Jersey Street. It is always filthy, and the effluvia arising therefrom is extremely offensive. The privies are generally full nearly to overflowing, and the yards are also in a dirty condition, heaps of refuse matter being allowed to remain and to accumulate continually in many of them. There is no sewer in this little street, though the streets at each end are sewered.

[Sidenote: Where Disease Flourishes]

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

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

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

Eleventh Ward: Typhus and typhoid fevers have been found prevailing in all sections of this district. Smallpox, scarlatina, measles, and pulmonary diseases are met with in almost every street. Typhus is the most typical of the preventable diseases that abound in the Eleventh Ward. Cholera infantum and obstinate diarrhoeal maladies were prevalent in the rear tenements and throughout the lowest streets during the summer and autumn.

To give you an idea of the wide prevalence of these diseases, I will notice one or two more in detail.

[Sidenote: Smallpox]

Smallpox is the very type of preventable diseases. We have a safe and sure preventive in thorough vaccination. And yet this loathsome disease is at this moment an epidemic in New York. In two days’ time, the inspectors found 644 cases, and in two weeks, upward of 1,200; and it was estimated that only about one-half were discovered. In many large tenant-houses, six, eight, and ten cases were found at the same time. They found it under every conceivable condition tending to promote its communicability. It was in the street cars, in the stages, in the hacks, on the ferry-boats, in junk-shops, in cigar-stores, in candy-shops, in the families of tailors and seamstresses, who were making clothing for wholesale stores, in public and in private charities. I hold in my hand a list of cases of smallpox found existing under circumstances which show how widespread is this disease. Bedding of a fatal case of smallpox was sold to a rag-man; case in a room where candy and daily papers were sold; case on a ferry-boat; woman was attending bar and acting as nurse to her husband who had smallpox; girl who was making cigars while scabs were falling from her skin; seamstress who was making shirts for a Broadway store, one of which was thrown over the cradle of a child sick of smallpox; tailors making soldiers’ clothing, have their children, from whom the scabs were falling, wrapped in the garments; a woman selling vegetables had the scabs falling from her face, among the vegetables, etc., etc. Instances of this kind can be quoted at any length, but these examples are sufficient to show that smallpox spreads uncontrolled throughout our city. And they show, too, how this disease is disseminated abroad. Says the Inspector of the Fourth Ward:

[Sidenote: Smallpox in Tailored Garments]

“In localities where smallpox prevailed I found, in some instances within a few feet of the patients, tailors at work for our best clothing establishments. Such infected vestments--worse than the tunic of the Centaur--bring disease and death not only to the wearers, but to many others. The occupant of the crowded tenant-house procures from such a source a coat or a blanket, and soon a loathsome pest attacks the young and unprotected members of his family, and ultimately spreads through the entire quarter, destroying life after life and endangering the health of a whole community.

“Smallpox, suddenly breaking out in some secluded rural district, often owes its unsuspected origin to the above causes. In the remote solitude of the ocean the seaman opens the chest in which he has deposited such obnoxious apparel, and from this Pandora’s box scatters the seeds of pestilence among his comrades, which, ripening, shall spread its germs to distant ports.”

Or, what is more striking, take the following from the report of the Inspector of the Fifth Ward:

“The largest wholesale establishments for the sale of dry goods on this side of the Atlantic Ocean are in immediate contact with the tenant-houses of the worst class, and which are infested with smallpox and typhus fever. The two freight depots and the principal passenger depot of the Railroad Company are in the same close association with these nests of infection. In the region immediately surrounding are also situated several hotels, and a large number of boarding-houses, whose inmates are thus in danger of personal contact with these diseases any moment. West Broadway, running through the very centre of the district, is traversed by five different lines of railway cars, with an average of five cars passing every minute, and carrying millions of passengers yearly by the very doors of these houses. Broadway, at but a short distance removed, is the principal thoroughfare of the city. Hudson Street on the west is also a leading route for city travel; and the cross streets of the district are traversed daily by multitudes to reach various lines of steamboats, cars, and steamships, which leave the city opposite this point.

“All this large amount of daily travel passes through a region always containing cases of typhus fever, and largely infected with smallpox. Is it any cause of surprise that cases of these diseases are here contracted, to be carried to distant sections of the country, there to develop themselves, to the surprise and alarm of whole neighborhoods? It is also well to remember that several large livery stables are located in the immediate neighborhood, whose vehicles, it is well-known, are frequently employed to carry persons, suffering from these diseases, to hospitals, or to attend at funerals. These vehicles are, perhaps, immediately afterward driven to the various car and steamboat lines to secure passengers, who are thus exposed in the most dangerous manner to these diseases.”

[Sidenote: Typhus Fever]

Second only to smallpox as a preventable disease, but of a more fatal character, is typhus fever. Typhus is greatly aggravated by domestic filth, and by overcrowding, with deficient ventilation. The inspectors found and located by street and number no less than 2,000 cases of this most contagious and fatal disease. Commencing in a large tenant-house in Mulberry Street, it was traced from locality to locality, in the poorer quarters, until it was found to have visited nearly every section of the city. It became localized in many tenant-houses and streets, where it still remains, causing a large amount of sickness and mortality.

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

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

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

Jersey Street, a short but uncleaned avenue, adjacent to a fashionable part of Broadway, is another great depot of fever, which, according to these records, frequently contained upward of thirty cases in progress at one time. East Eleventh Street, between First and Second Avenues, now, as all the past summer, in a horribly filthy condition, is a local habitation of fever of the worst type. The same statement may be made of nearly every district where the tenant-houses are especially crowded, and the streets, courts, and alleys are unusually filthy.

[Sidenote: Intestinal Affections]

Intestinal diseases, as cholera infantum, diarrhoea, dysentery, typhoid fever, etc., which arise from, or are intensely aggravated by the emanations from putrescible material in streets, courts, and alleys, or from cesspools, privies, drain pipes, sewers, etc., were prevalent in the tenant-house districts, creating, as usual, a vast amount of sickness, and a large infant mortality. Very generally these diseases were directly traceable to the decomposing filth, and in some instances were stopped by the removal of the nuisance.

The Inspector of the Eighth Ward reports: “Cholera infantum has probably consigned many more to the grave during the past summer than all other diseases in my inspection district. In every case examined I have found it associated with some well-marked course of insalubrity; vegetable and animal decomposition have been the most prominent causes. That fifty per cent die from preventable causes in my inspection district I do not doubt.”

The Inspector of the Sixth Ward says: “The mortality among children is fearfully high, many families having lost all their children; others four out of five or six.”

[Sidenote: Living at a Sewer’s Mouth]

The Inspector of the Ninth Ward says he found among the people living near the mouth of an open sewer: “That no less than twenty-nine cases of dysentery and diarrhoea, five of which had terminated fatally, had occurred during the three weeks immediately preceding his inspection.” He adds: “Now, when we take into consideration the fact that there are only twenty-two dwellings on this square (a considerable portion of it being occupied by a large lumber-yard), and that all these cases had occurred within a period of about twenty-one days, the ratio becomes appalling. How many cases may have occurred subsequently, I have not sought to ascertain, my time being fully occupied in the inspection of the other parts of my district. But a still more direct and specific action of the poisonous emanations proceeding from this obstructed sewerage, manifested itself in the dwelling on the corner of West and Gansevoort streets, which is in the closest proximity to the outlet of the sewer. Here I learned, upon inquiry, that typhoid fever had prevailed almost continuously during the preceding winter, and I found three severe cases of dysentery at the time of my visit.”

But I will not occupy time with further details of the evidence which this inspection furnishes of the vast accumulation of the causes of unhealthiness which exist in New York, and of the wide prevalence of contagious diseases arising therefrom or aggravated thereby.

The next point of inquiry is as to the effect of these conditions upon the public health of the city. Our constituted health authorities claim that notwithstanding this excessive concentration of the causes of disease around and in the homes of half of our population, the death-rate of New York is very low. To properly understand this statement, we must inquire what is the rate of death from inevitable causes.

[Sidenote: The Normal Death-Rate]

It has been estimated by careful writers on vital statistics that 17 in 1,000 living persons annually die from inevitable causes. That is, in a community of 1,000 persons living under circumstances such that persons die only from old age, cancer, casualties, etc., 17 will die annually, and no more. And this number is the maximum that will die without the occurrence of some disease due to a removable cause. Taking this standard as the absolute necessary death-rate, we can readily estimate the number of unnecessary or preventable deaths which occur in any community.

Says the Registrar-General of England (Twentieth Annual Report): “Any deaths in a people exceeding 17 in 1,000 annually are unnatural deaths. If the people were shot, drowned, burnt, poisoned by strychnine, their deaths would not be more unnatural than the deaths wrought clandestinely by diseases in excess of the quota of natural death--that is, in excess of seventeen in 1,000 living.”

[Sidenote: Death-Rate of New York]

Taking this as the standard, let us see how the death-rate of New York compares with it. It is claimed by the city officials that notwithstanding the vast accumulation of the universally-recognized causes of disease, New York has a low death-rate. It is not reasonable to suppose this statement true, nor is it true, as will presently appear. It is stated very truly in the City Inspector’s Report for 1863, that “it is only by taking a connected view of a period of years that a correct judgment can be formed of the state of health of a city,” and upon this basis let us determine what is the mortality of New York.

Take the 11 years preceding the last census, viz., 1860, excluding, however, 1854, the year of the cholera. I select this period because it includes the three last census returns, and it is only where we have the census returns with the mortality records that we have accurate data for our estimates. Now, the City Inspector’s own records (reports of 1863, page 192) show that during the period referred to, the death-rate of New York City was never below 28 in the 1,000, and twice exceeded 40 in the 1,000, the average being as high as 33 in the 1,000. These deductions are made directly from the City Inspector’s Reports, and, as they are claimed to be infallible, these conclusions cannot be controverted.

Now, when you remember that the highest death-rate fixed by sanitary writers for inevitable deaths is 17 in 1,000, and that all deaths above that standard are considered preventable, it is apparent what a fearful sacrifice of life there is in New York. Estimated at the very minimum death-rate of the last decennial period, viz.: 28 in 1,000, New York annually lost 11 from preventable deaths in 1,000 of her population, or upwards of 7,000 yearly, on an average, giving the enormous sum total for this period of 77,000 preventable deaths.

It may be urged that cities never can attain to this standard of healthfulness, but English writers maintain that the rate of 17 in the 1,000 is the true measure of the public health, and that even the most populous towns may yet be brought up to it. Nor can we doubt that there is much plausibility in the assertion, when we find the mortality in Philadelphia fall to 18 in 1,000, and that of London gradually descend from 30 in 1,000 to 22 in 1,000.

[Sidenote: New York, London, and Liverpool Compared]

It is maintained, also, that New York has a lower death-rate than London or Philadelphia. Let us see how far this assertion is sustained by the records of the health authorities of those cities. During the decennial period preceding, but including 1860, and excluding 1854, as in the former comparison, the minimum mortality in London was 20 in 1,000, the maximum 24 in 1,000, the mean about 22 in 1,000. These figures are from the Registrar-General Reports.

The rate of mortality of Philadelphia for the same period was as follows: Minimum 18 in 1,000, maximum 23 in 1,000, mean about 20 in 1,000. These figures are from the report of Dr. Jewell, long the able Health Officer of that city. Placed in their proper relation, these mortality statistics read as follows: The number of deaths to the 1,000 living for the ten years, 1850–60 inclusive, but exclusive of 1854, is for

Min. Max. Av. London 20 24 22 Philadelphia 18 23 20 New York 28 41 33

If, then, New York had as low an average death-rate as Philadelphia, she would have saved 13 in 1,000 of her population during that period, or in 1860, 10,577. These figures may seem excessive, but they are careful deductions from the annual returns of the several cities. And yet it is reiterated year after year by the City Inspector, that “New York City, at this day, can lay claim to the privilege of being numbered with the most healthy in the world.”

With what consummate justice did Dr. Jewell administer this withering rebuke to our pretentious official. “It is unnecessary,” he says, in his report of 1860, “to comment upon this extraordinary statement, when the above figures contradict so positively the assertion. It is to be regretted that the inspector had not availed himself of the above statistical information, which would have obliged him to have presented a widely different statement, although one indicating a more severe pressure of sanitary evils, upon the health of their population, than his report develops.”

[Sidenote: Constant Sickness]

But excessive as is this death-rate, it is not the full measure of the penalty which we pay to the demon of filth. A high death-rate from the diseases which it engenders or intensifies, always implies a large amount of sickness. It is estimated by competent authority that there are 28 cases of sickness for every death. On this basis of estimate what an enormous amount of unnecessary sickness exists in our midst! Nor is this a mere supposition. I have an accurate census of many groups of families of that portion of our population who live immured in filth, and here we find the constant sickness-rate excessive. It is no uncommon thing to find it 50, 60, and 70 per cent.

[Sidenote: Where the Death Pressure Is Greatest]

I wish now to call your attention to the fact that great as is our mortality and sickness rate, its excess is not equally distributed over the entire population, but falls exclusively upon the poor and helpless. One-half, at least, of the population of New York have a death-rate no higher than the people of a healthy country town, while the death pressure upon the other half is frightfully severe. For example, the Seventeenth Ward, which is inhabited principally by the wealthy class and has but few tenant-houses, has a death-rate of but 17 in 1,000, or only the death-rate from inevitable causes; but the Sixth and Fourth Wards, which are occupied by the laboring classes, have a death-rate varying from 36 to 40 in 1,000.