Part 6

Thus it appears that while the average death-rate of the city is very high, it is principally sustained by those Wards where the tenant-house population is the most numerous. We find this excess of mortality just where we found the causes of diseases existing most numerously. And when we sift the matter further, we find that the excess of mortality is not even equally distributed over these populous poor Wards, but is concentrated upon individual tenant-houses. For example, while the mortality of the Sixth Ward is nearly 40 in 1,000, the mortality of its large tenant-houses is as high as 60 to 70 in 1,000. The following is a recent census of a large but not exceptional tenant-house of that Ward: Number of families in the house, 74; persons, 349; deaths, 18, or 53 in 1,000; constant sickness, 1 in 3; deaths of children, 1 in 6, or at the rate of 16 in 1,000.

The following table illustrates the distribution of the mortality of New York among the different classes of inhabitants at the last census:

Average mortality of entire city 28 in 1,000 Mortality of better class 10 to 17 “ “ Mortality of tenant-house 50 “ 60 “ “

[Sidenote: Some Scapegoats--Foreign Immigration]

But I should not do justice to this branch of inquiry without noticing the alleged causes of the high mortality of New York. The first is the large foreign immigration. The reliance to be placed upon that scapegoat may be readily shown. Emigration occurs to this country under two conditions: 1. The emigrant is driven from home by famine, in which case the poorer class emigrate, or, 2, he is allured by advantages for labor or business, when the middle classes principally emigrate.

Now, it is under the latter circumstances that emigration generally takes place to the United States. This is seen in the vast sums of money which the emigrants now annually bring, and the amounts which they return to their friends as the result of their labor. This class is always very hardy and healthy, as is proved by the small mortality that occurs _in transitu_ being but 4.31 per cent for ten years. Besides, we have the official statements of the Commissioners of Emigration that but 3 per cent remain in the city.

But the City Inspector himself shows the utter fallacy of this alleged cause of excessive mortality in his report for 1860, in which he makes the true explanation, and attributes to its proper cause whatever increased mortality arises from emigrants. He says:

“Most of the children who arrive in this city from foreign ports, although suffering from the effects of a protracted voyage, bad accommodations, and worse fare, do not bring with them any marked disease beyond those which, with proper care, nursing, and wholesome air, could not be easily overcome. The causes of this excessive mortality must be searched for in this city, and are readily traceable to the wretched habitations in which parents and children are forced to take up their abode; in the contracted alleys, the tenement house, with its hundreds of occupants, where each cooks, eats, and sleeps in a single room, without light or ventilation, surrounded with filth, an atmosphere foul, fetid, and deadly, with none to console with or advise them, or to apply to for relief when disease invades them.”

[Sidenote: The Floating Population]

Again, it is alleged that the floating population causes the excess of deaths. But it has been established by Dr. Playfair that the floating population is the most healthy. The same is true of wandering tribes, of a moving army, and equally of individuals. But when they fix their habitations or encamp, that moment the causes of disease begin to gather about them, and unless sanitary regulations are carefully observed, diseases, such as fever, diarrhoeal affections, etc., begin to prevail.

The poor population of New York is to-day but an immense army in camp, upon small territory, crowded into old filthy dwellings, and without the slightest police regulation for cleanliness. If this army should abandon its camp and begin a roving life in the country, all the diseases now prevalent would disappear. And it must be added, that if these deserted and uncleaned tenements should immediately be filled by healthy people from the country, the new tenants would at once begin to suffer from all the pestilential diseases now indigenous to that part of the city.

I have now laid before you, as briefly as possible, the accumulated evidence that New York is to-day full to repletion with all the causes which originate and intensify the most loathsome and fatal diseases known to mankind.

This evidence proves that at least half a million of its population are literally submerged in filth, and half-stifled in an atmosphere charged with all the elements of death. I have demonstrated that the legitimate fruits of her sanitary evils is an excessively high death-rate and a correspondingly large sickness rate.

[Sidenote: Can the Causes of Disease Be Removed?]

The all-important question which now concerns us as citizens, and you as practical legislators, is, can these evils be remedied? We answer, yes. In the first place the streets can be kept clean. Other cities accomplish this object, and therefore New York can, and we have striking illustrative examples. In certain portions of the city the streets are as clean as this floor. They are swept daily, and scarcely a particle of dust is left in the streets or gutters the year round. But they are cleaned by private contract of the people residing upon them. What individual enterprise can do for whole squares, surely a corporation so lavish in money as New York ought to be able to do for the city at large.

The courts, alleys, cesspools, and privies can be cleansed and kept in good condition. There are tenant-houses which are as clean in all their alleys, courts, and cellars as the best-kept private houses. These are dwellings for the poor in which the landlord takes especial interest. What is done for the surroundings of one of these houses, may be done for all. But the tenant-houses of the worst class may be quickly placed in a good sanitary condition.

[Sidenote: Improvements During the Inspection]

The inspectors furnish many examples of this fact. They were frequently mistaken in their inspection for an official, and when their visit to the tenant-houses was reported to the landlord, he hastened to renovate the building. Some of the most filthy quarters were so completely changed within forty-eight hours that the inspectors could scarcely recognize the locality. The Inspector of the Eighth Ward says:

“The sanitary improvement in my district during the progress of my inspection was plainly visible. Exceedingly filthy places, overflowing cesspools, and privies, which were numerous in my first visit, were suddenly cleaned. Often upon my second visit, with paper and pencil in my hand to sketch the filthy scene, I would find the quarters cleaned and whitewashed, and the air, instead of being laden with disagreeable odors, would be comparatively pure and wholesome. Many of these sudden transitions were from fear of the presumption that my inspection had some official authority; but the greater part were brought about by explaining to the people the necessity of cleanliness.

“Pools of filthy water from obstructions at the street corners, and accumulated along the gutters, would quickly disappear, when the people would be convinced of the deleterious effect upon the public health. It will be well for the inhabitants of New York City, and especially for those of this section, when there shall be laws not only to compel them to keep their houses and surroundings clean and free from the effluvia resulting from vegetable and animal decomposition, but to prevent the overcrowding of tenant-houses, where fatal diseases are generated, and where death walks around.”

[Sidenote: How to Improve the People]

The tenant-house population is susceptible of infinite improvement, when once rescued from the reign of filth, and restored to a pure atmosphere and clean homes. The poor live in these wretched tenements because they are compelled to, and not from choice. They universally complain that they cannot escape from domestic and street filth. It surrounds and pervades their habitations, always accumulating, and never diminishing. The most tidy house-wife, compelled to live in the midst of this ocean of rubbish, with all its degrading associations, soon finds the same level, and from this she can be rescued only by giving her again a clean and well-ordered home. And such a home every municipal government is bound to secure to the poorest and humblest citizen.

Let the landlord be compelled to keep his house in good repair, supply it with an abundance of pure water, connect the privy with the sewer, open free ventilation, afford means for removal of garbage, and then keep a careful oversight of his tenants, enforcing cleanliness. If this were done, the tenant-house people would immediately improve, and the death-rate, if we may judge from other cities, would fall one-fourth.

Again, the cellar population can be removed from their subterranean abodes, and placed in better homes. Liverpool has solved this problem for us.

In 1847 that city had a cellar population of 20,000; an ordinance was passed forbidding the occupation of underground rooms as residences, with certain restrictions, and within three years the great mass of people in these subterranean haunts were removed to better tenements, with a great reduction of the mortality of the city.

That city, formerly the most unhealthy in England, has continued the reforms thus inaugurated by compelling landlords to improve their tenant-houses, and the result is that it has become one of the healthiest towns of Europe. London has recently taken similar action in regard to cellar tenements. What these cities have done, New York can and ought to do for her public health.

[Sidenote: A Town That Was Immune]

What the diseases which prevail with such fatality in the uncleaned tenant-houses are for the most part preventable, we have the most undoubted evidence. That smallpox is preventable is known to every school-boy, and yet that loathsome disease to-day prevails throughout all the tenant-house districts of New York, without the slightest restraint on the part of our local authorities. Typhus is to-day ravaging the homes of the poor without “let or hindrance,” and yet cleanliness and pure air are sure preventives. Of this truth these reports furnish many examples.

The fever-nest--West Thirty-third Street--is one of a row of tenant-houses five stories high, and contains 16 families. It was in a filthy condition, without Croton water, waste-pipes stopped, sinks overflowing and emitting offensive odors; fever had prevailed all winter, nearly every person in the house having had an attack, four having died. It was never inspected by a city official. The owner was induced to clean the house, and from that date not a case of fever has occurred. The inspector who reports this case very justly adds: “If, when the first case of fever occurred in this building, the owner had been compelled to put it in a good sanitary condition, six human lives would undoubtedly have been saved, besides a great amount of sickness.”

Cholera infantum and diarrhoeal affections are found in their greatest intensity where putrescible animal matter and domestic filth exist. Remove these causes, or remove the patients from the neighborhood, and these diseases generally disappear at once. Diphtheria is found to be most intense in the vicinity of unclean stables. It is, therefore, with great propriety, that the entire class of zymotic diseases are now called “filth and foul air” diseases by the English sanitary writers. Remove the filth and foul air, and these diseases disappear as effect follows cause.

[Sidenote: Can Populous Towns Be Improved?]

But while it is admitted that the streets of a town may be cleaned, the condition of the poor improved, and diseases, under the most favorable circumstances, prevented, it may be doubted whether the sanitary condition of populous towns can be materially changed, and the death-rate greatly reduced. Yet in England, where sanitary science is enthusiastically cultivated, there is not only no doubt that large towns can be thus improved, but that the mortality of London itself may be no greater than that of the country.

Already, indeed, the London _Times_ boasts “that the average of health throughout the City of London is higher than the average of health throughout all England, taking town and country together. The mortality in all England is at the rate of 22.8 in every 1,000 of the population; in the City of London it is at the rate of 22.3 for every 1,000 inhabitants! The improvement has been progressive; it has been slow, but steady and sure. Gradually the mortality has decreased, until the yearly death roll of 3,763 has been reduced to 2,904 within a period of nine years, during which the city has been under the rule of the Sanitary Commission. The deaths this year--22.3 per 1,000, or one in every forty-five of the inhabitants--are nine per cent below the general average, and represent a saving of 286 lives. And secondly, this gratifying result has been obtained in the face of obstacles which seemed to be almost insurmountable.”

Liverpool affords a striking example of the power of sanitary measures, rigidly enforced to improve the public health. It was formerly the most unhealthy city of England, being the very home of typhus, smallpox, and allied preventable diseases. But it adopted vigorous measures of reform, improving its poorer districts, and the death-rate has fallen eight in 1,000. Macclesfield, Salisbury, and many other English towns have had their mortality reduced 8, 10, and 15 in 1,000 by the vigorous prosecution of sanitary improvements. All the populous towns of that country are moving in this reform, and, as a result, the general death-rate of towns is approximating that of the country.

[Sidenote: Cleanliness Preserves from Epidemics]

The Health Officer of London announced that cleanliness would preserve a town from the visitations of epidemics. But there must be cleanliness of the streets, cleanliness of the courts, cleanliness of the apartments, and cleanliness of the person. On the approach of the cholera in 1849 the town of Worcester, England, determined to test the theory, and set vigorously to work and cleaned the town thoroughly, removing everything of an offensive nature, and adopting the most stringent regulations against the accumulation of filth about or within the homes of the people. The result was that this “destroyer” of unclean cities made a Passover with the people of Worcester, for on every lintel and door-post was written--Cleanliness, Cleanliness. Not a house was entered, and the town was saved in the midst of the most frightful desolation.

New Orleans is another striking example of the value of civic cleanliness. Since, by military regulations, it is kept constantly in a cleanly condition, it has had no visitation of its old enemy, yellow fever.

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

[Sidenote: Importance of Sanitary Government]

There is scarcely a city which has such absolute need of an efficient and intelligent sanitary government as New York. On its small territory three, four, or five millions of people are yet to be accommodated with houses. Already there are crowded upon less than eight of its thirty-two square miles all of our commercial, business, and manufacturing interests, and the houses of nearly 1,000,000 of people. And in the natural relations of the poor and rich, the former consisting of more than half of the entire population, are crowded into less than a fourth of this area. Of what vast importance is it that a wise and intelligent authority be vigilantly exercised, so that in its future growth and expansion every condition pertaining to health shall be secured to its inhabitants!

It is universally conceded that New York has in the highest degree all the natural advantages of salubrity. Its climate is the mean between the extremes of heat and cold; its topographical peculiarities are admirably adapted for drainage and sewerage; its exposure is southern; its shores are swept by two rivers, which bear seaward everything that enters them beyond the power of the flowing tide to return it; its rural surroundings are of the most healthful. In every respect it is regarded by competent observers as most favorably located for cleanliness, and the highest degree of public health. And there can be no doubt, that should New York be placed under a wise sanitary government, which would improve all its natural advantages for health, it would become the cleanest and healthiest city in the world, and one of the most delightful places of residence.

[Sidenote: The Entire Country Concerned]

But this is not a matter which concerns the citizens of New York alone. The people of the State have a vital interest in the public health of our city. Connected as it is by means of rapid inter-communication with all parts of the country, there is every facility offered for the wide diffusion of the seeds of contagion. It is estimated by accurate statisticians that no less than 250,000 persons pass in and out of New York daily over the ferries and railroads. It could not fail to happen that if any contagious disease prevailed in this city, it would be carried into the country and widely disseminated. And such is now a matter of daily occurrence. There is no doubt that nearly all the epidemics of smallpox in country towns, and much of the typhus and similar diseases, have their origin in New York. I have in my hand letters from all parts of the State confirming this statement. They strikingly illustrate the want of a good sanitary police in New York, and the power of a great commercial centre to scatter disease broadcast over the country.

A few of these cases will abundantly illustrate the point:

Dr. J. S. Sprague, of Cooperstown, Otsego County, reports the occurrence of twenty-six cases of smallpox in that town, communicated by one person in October, 1860, who took the disease at a hotel in our city, in which a person with the disease had recently died. He was a merchant, and came to the city on business.

Dr. C. C. F. Gay, of Buffalo, reports the case of a female, who arrived from New York in November, 1860, and was removed from the cars of the Erie Railroad to the State Line Road, and proceeded westward. As was afterward ascertained, she had smallpox, and communicated the disease at Columbus, Ohio, where there were three deaths produced by it. Four deaths were directly traceable to this exposure, viz.: three milkmen and one baggage man, all of whom came in contact with the sick woman.

W. T. Babbitt mentions the case of a young man who took the disease in this city at a hotel where it was prevailing, at which he stopped while on a visit here, in whom the disease appeared after his return to Olean, in Cattaraugus County.

Dr. M. Jarvis, of Canestota, Madison County, relates the case of a man who visited this city with horses for sale, and was attacked with symptoms of smallpox some ten days after his return to Smithfield, in that county, who communicated the disease to his family, from whom it spread to others in that and, also, in a neighboring town.

[Sidenote: Smallpox in a Hotel Bedroom]

Dr. C. M. Noble, of Waverley, Delaware County, mentions the case of a merchant of that place, who came to this city with his wife, and went to one of our most frequented hotels. Being very much fatigued, they retired to the room provided for them without any particular examination of it--but found in the morning that they had been put in a room from which a patient with smallpox had just been removed, without its having been cleansed. The gentleman was seized with a malignant form of that disease after his return home. Two deaths and six cases of smallpox and varioloid resulted from this case.

Dr. S. W. Turner, of Chester, Connecticut, gives also two cases, one of smallpox and one of varioloid, in that and a neighboring place, which could be traced to this city.

Dr. Snow, the vigilant Health Officer of Providence, R. I., states that smallpox is rarely known in that city, except when imported from New York.

[Sidenote: New York Inoculates the Nation]

I could repeat these details until it was shown that nearly every town in the State, and nearly every city in the country, has been inoculated by New York with this most loathsome disease. The most striking and most melancholy instances of the free dissemination of contagion are found in the army, where whole regiments have been stricken with smallpox through infected clothing manufactured at the homes of the poor, where the disease was prevailing. But these are facts too well known to every medical man, and even to the community, to require further illustration.

What terror smallpox creates in country towns when it attacks its first victim, you very well know. The house where it occurs is quarantined, and not unfrequently the sufferer is deserted by his friends, and left to recover or die, as the case may be. Business with the country is often suspended by the placards posted upon the highways, with the terrifying word “Smallpox” upon them, and a finger pointing ominously to the town. In nine cases out of ten, another finger should point toward New York, as the source of the pestilence.

It has been estimated by a competent observer, that every case of smallpox in a country town costs, by derangement of business alone, more money than is annually expended upon its public schools. If we add to this pecuniary loss the feverish excitement and popular apprehension, and the sufferings and probable death of the victim from want of proper care, we may but indifferently estimate the cost to the country of the prevalence of this disease.

Now, this diffusion of contagion from New York, we contend, is unnecessary. Every well-informed medical man knows that we may have a sanitary police so vigilant, so efficient and so powerful, that it will not only preserve the public health, but prevent the spread of disease therefrom. We hold, therefore, that you are not only called upon to protect the people of the City of New York from contagious disease, but equally that you are bound to protect the people of the State from dissemination of pestilence by every legislative safeguard which sanitary science can suggest.

[Sidenote: Inefficiency of Health Organizations]

The Sanitary Committee of the Board of Health, during the prevalence of cholera in 1849, remark in their report:

“The labors of your committee, during the past appalling season of sickness and death, and the awful scenes of degradation, misery, and filth developed to them by their researches, have brought into full view the fact that we have no sanitary police worthy of the name; that we are unprotected by that watchful regard over the public health which common sense dictates to be necessary for the security of our lives, the maintenance of the city’s reputation, and the preservation of the interests of the inhabitants.”

[Sidenote: Without Sanitary Government]