Part 7

This is a perfectly truthful statement of the present condition of New York. Practically, it is a city without any sanitary government. In its growth it is developing the natural history of a city that utterly ignores all rules and regulations which tend to make the homes of its people pleasant and healthy. It is the only city in the civilized world which disregards the Platonic idea that in a model republic medical men should be selected to preserve and promote the public health. Its board of health, the mayor and common council, is an unwieldly body. Its commissioners of health have limited powers, and are equally incompetent.

[Sidenote: The City Inspector’s Department]

The City Inspector’s department, which alone has the machinery for sanitary inspection and surveillance, is a gigantic imposture. Of its forty-four health wardens, whose duty it should be to make house-to-house inspections, searching out the cause of disease, and using every known agency for the control and suppression of epidemics, many are liquor dealers, and all are grossly ignorant. Not one has any knowledge of medical subjects, nor dare they freely visit such diseases as smallpox, typhus, or cholera.

During this entire voluntary inspection, extending over six months, health wardens have rarely been known to visit infected quarters, although smallpox, fever, etc., etc., have been prevalent, and the city has been in a most disgracefully filthy condition. A single health warden recently ventured to visit a house where smallpox existed in an upper room; he sent for the attendant, and when she appeared, ordering her not to approach him, he gave the following as the best means of prevention: “Burn camphor on the stove, and hang bags of camphor about the necks of the children.”

To what depth of humiliation must that community have descended, which tolerates as its sanitary officers men who are not only utterly disqualified by education, business, and moral character, but who have not even the poor qualification of courage to perform their duties. But perhaps the most decisive proof of the utter and hopeless inefficiency of our multiform health arrangements is found in the fact that all the evils from which we now suffer have grown up under their care. A late City Inspector thus emphatically gave expression to the popular feeling in regard to existing organizations:

“With such a system, can there be a wonder that the sanitary condition of the city is not improved? * * * Nor must the consideration be kept from view, that the members of the common council, the board of health, and commissioners of health are all, from the manner of their appointment, subject to partisan influence. To expect a perfect sanitary system, under such a condition of things, is to expect an impossibility.”

[Sidenote: Sanitary Inspection]

The medical officer of health for the City of London, a gentleman of large experience, thus defines a health organization capable of answering the demands of a large and growing town: “The object of this organization lies in a word: inspection, inspection of the most constant, most searching, most intelligent, and most trustworthy kind, is that in which the provisional management of our sanitary affairs must essentially consist.” The results of this work of voluntary sanitary inspection which I have before me prove on every page the truth of the above statement. No health organization without daily inspection would have any efficiency.

Of the value of such thorough inspection in the suppression of epidemics, and in the prevention of disease, there are abundant examples. The people of a populous town of England, becoming alarmed at the approach of cholera in 1849, organized a corps of inspectors, whose duty it was to visit from house to house, and inquire for cases of premonitory diarrhoea, and when found to apply the remedy at once. The result was that cholera did not visit that town. The same systematic house-to-house visitation was adopted in some poor districts of London in 1854, and there was an almost complete exemption of those parts of the city, while some quarters of the wealthy, which were not under such surveillance, suffered severely.

[Sidenote: Inspection Must Be Thorough]

But it is essential that this inspection should be by thoroughly qualified medical men, and it must consist in a house-to-house visitation. Disease must be sought for, found, its incipient history completely made out, the causes upon which it depends reported, and its remedy suggested. Every case of death should be visited, and all the circumstances attending the development of the disease, if it belong to the preventable class, should be rigidly investigated and reported, in order that the central bureau may apply the proper remedy.

Striking examples of the value of medical sanitary inspection are furnished by this voluntary organization. One inspector found diarrhoeal affections very prevalent in a settlement in an up-town ward, and for a long time was baffled in his efforts to discover the cause. He was finally led to examine the water of a neighboring well, which the people used. This water appeared to be of an excellent quality, but on examination by Prof. Draper, it was found to contain a large amount of organic matter, derived either from a sewer or privy. Prof. Draper pronounced it liquid poison. The mystery was at once solved, and the proper remedy suggested.

In another instance a very contagious disease was found in a tenant-house, and after a long course of inquiry it was at length discovered that a washer-woman, living in the basement, had taken in sailors’ clothing. The sailors were found, the ship visited from which they came, and there the disease was found. None but medical men can prosecute such investigations with success, or suggest the proper remedy. If such a corps of sanitary inspectors were daily patrolling their districts, visiting from house to house, searching out sanitary evils, advising and aiding the people in the adoption of preventive measures, no epidemics of smallpox, typhus, scarlet fever, or cholera would ever gain more than a transient foothold. The sanitary inspector would truly become an officer of health and would be everywhere welcome.

[Sidenote: The Remedy]

The remedy for our evils must be apparent; and this remedy is suggested in such terse unqualified language by the City Inspector above quoted, that I call the attention of the committee especially to this remark, as a proper guide in your deliberations. In the City Inspector’s report for 1861 we find the following:

“The stay of pestilence, to be effectual, must be prompt, and equally prompt must be the interposition of barriers against the introduction of disease, which may be kept back, but, once introduced, can with difficulty be checked or extirpated. For these reasons, there should be a power existing in other hands that may be ready to be used at the moment the exigency may arise.” * * * “The remedy, apparent to every one, must consist in the adoption of laws transferring the power of sanitary regulations to some other authority of a different order of instruction in sanitary science.” * * * “The first groundwork of reform, in the opinion of the undersigned, is to bestow upon some other body, differently constituted, all power over the sanitary affairs of the city; and, until this is done, all other proposals of reform will be deprived of their essentially beneficial features. To escape present complications is the first great point to be gained; and this point secured, simplicity, promptness, and efficiency may be substituted for inefficiency, complication, and delay.”

Accepting this as the first step in reform, the practical question arises: How shall that body be constituted to which is to be confided the sanitary interests of New York?

[Sidenote: An Efficient Health Board]

If the experience of other large cities is of any value, or, indeed, if we rely simply on common sense, the following are indispensable prerogatives in any well-organized health board:

1. It should be independent of all political influence and above all partisan control.

2. It should combine executive ability with a profound knowledge of disease and the proper measures of prevention. To this end the board should be composed in part of men especially accustomed to the dispatch of business, and in part of medical men of great skill and experience.

3. It should have a corps of skilled medical officers as inspectors, which should be the eyes, the ears, in a word, the senses of the board, in every part of the city, searching out disease, investigating the causes which give rise to it, the conditions under which it exists, the means of its propogation, and the most effectual mode of its suppression.

4. It should have a close alliance with the police, which must be its arm of power in the prompt and efficient execution of its orders.

V

VICTORY

[Sidenote: Effect of the Hearing]

The effect of this startling exhibition of the horrible sanitary condition of New York, both upon the joint committees and the large audience, was evidently very profound. And this effect was heightened by the early denials by the then City Inspector and his followers of the truth of the description of the condition of special localities, and the immediate exhibitions by the speaker of the sworn statements of the Physician-Inspectors of the Citizens’ Association, with photographic illustrations. Pressed by members of the committee to state when he last had these places inspected, he admitted that they had never been inspected by his Department.

Intense interest was manifested in the custom of wholesale dealers in clothing of having their goods manufactured in tenement houses; in the fact that Inspectors had often found such clothing thrown over the beds or cradles of children suffering from contagious diseases, as scarlet fever, measles, smallpox; and in the evidence that these diseases were distributed widely over the country by this infected clothing. Several of the committee seemed much disturbed, as did the audience, during a recital of cases, and when the hearing closed, one of the committee said to me, in an excited manner, “Why, I bought underwear at one of those stores a few days ago, and I believe I have got smallpox, for I begin to itch all over!”

Indeed, the effect of the discussion before the joint committees was so favorable, that several members declared that the bill would immediately pass both Houses without opposition. But the City Inspector secured delay by requesting another hearing, in order to investigate the facts presented in my quotations from the report of our inspection. This delay gave him the desired opportunity to defeat the bill, by means at his command and by methods familiar to that class of politicians.

But the public, and especially the medical profession, both of the city and the State, had become so interested in the measure that at the next election it became a prominent issue and led to the defeat of seventeen candidates for the Legislature of 1866 who had voted in opposition.

[Sidenote: Triumph at Last]

It is said that epidemics are the best promoters of sanitary reform, and very opportunely cholera made its dread appearance in Europe late in 1865, and from its rate of progress it seemed likely to visit our shores early next year. These favoring conditions led to the passage of the “Metropolitan Health Law” among the first measures of the Legislature in 1866.

The struggle and final triumph of the people of New York, in their efforts to secure adequate health protection, were national in their influence. And this influence was emphasized by the first acts of the Metropolitan Board. Scarcely had it organized when cholera made its appearance in New York. There was the usual alarm among the people, and large numbers left the city. But the new health laws and ordinances, administered by an intelligent, scientific authority, demonstrated the _raison d’être_ of their existence.

The first case of cholera was promptly isolated, the house and its surroundings cleansed and disinfected, and rigid supervision established. The second case, which appeared in another part of the city, was treated in a similar manner and with the same results. A third, fourth, fifth, and finally many cases appeared in different parts of the city during the season, apparently brought from localities in the vicinity where the epidemic prevailed with its usual severity; but in New York no two cases occurred in the same place, so effectually was each case treated.

Within one month public confidence in the power of the board to control the spread of the disease was firmly established; people who had fled returned to their homes; business in commercial districts, which was at first suspended, was resumed; and the health department became the most popular branch of the city government, a position which it has maintained uninterruptedly for nearly half a century.

[Sidenote: The Reform National in Its Results]

This popular triumph of sanitation is largely due to the perfection of the original Metropolitan Law, which has been declared, officially and judicially, to be the most complete piece of health legislation ever placed on the statute books. From that fountain of legal lore the whole country has been supplied with both the principles and the details of sanitary legislation.

The agitation in New York rapidly extended over the entire country, and other cities secured the necessary authority, the Metropolitan Law being the basis of such health legislation. Within a decade nearly every municipality in the land had its health laws and sanitary ordinances and a competent authority to enforce them.

The enormous influence which this reform has had upon the health and domestic life of the people can never be estimated. A reference to the former and present sickness and death-rates of New York enables us to approximate the vast saving of life and consequent prevention of sickness and human misery that has resulted from health laws founded on the Metropolitan Law and intelligently but rightly enforced. Before the passage of that law the annual death-rate of the city fluctuated between 28 and 40 per 1,000 population; since that law went into effect it has steadily fallen until it has reached the low figure of fifteen to the thousand, or a saving of more than twenty thousand lives annually when the population of New York was only about one million, and of nearly 10,000 lives of the present population. If we extend this estimate to the whole country, of ninety-five million people, we may gain a faint conception of the inestimable benefits which the application of sanitary knowledge to the daily life of a people can accomplish.

VI

THE LEGAL WORK OF DORMAN BRIDGEMAN EATON

The following chapter consists of the address delivered by Dr. Stephen Smith on the occasion of the memorial service of Hon. Dorman B. Eaton, January 21, 1899. We have inserted it immediately following his historic review of the events which led up to the great public health reform of 1865–1866, not only because it is a fitting tribute to the memory of one to whom the citizens of New York are indebted for many improvements in the administration of the municipal government, but because it brings together in one compact perspective the legal and sanitary requirements of modern preventive medicine.--F. A.

[Sidenote: Unrecognized Pioneers]

The progress of the race is largely affected in each generation by a few pioneers who, with toil and sacrifice, prepare the way for the advance. Of these pioneers some blaze the future course in the unexplored and trackless forest; others remove the obstructions which impede the builders; while a few expert engineers bridge the rivers, tunnel the mountains and lay broad and deep the foundations of the great highway along which humanity passes to a higher civilization. Unfortunately these pioneers are not always known to public fame, and far too often, though benefactors of their race, pass away without a proper recognition of their services.

This apparent neglect is not due to a lack of appreciation of their work by the people, but rather to the fact that their labors are performed in obscurity, and hence are unknown. Far in the wilderness, or deep in the tunnel, or in the mire of the caisson, they toil all unseen by their generation, sacrificing health and often life while searching for the true pathway or laying its foundations. When the bridges are builded, the tunnels completed, and the broad highway is thrown open for travel and traffic, few or none of the passing throng give a moment’s thought to the labors and sacrifices of the builders, or the tribute of a sigh to the memory of those who perished at their work.

Impressed with a sense of public obligation and of a duty to the memory of a citizen with whose labors and sacrifices in the interests of this city I had great opportunities to become familiar, it has been a grateful task to place on record some of the incidents in the life of Hon. Dorman B. Eaton as they came under my personal observation. He was by nature, education, and association a reformer of the civil administration. Born and bred in the rural communities of Vermont, educated at Harvard, a partner of the famous Judge Kent, of this city, and an associate of men of the type of William Curtis Noyes, Charles O’Conor, and others of equal reputation, Mr. Eaton was admirably equipped for the great work to which he devoted so much of his life and energies.

[Sidenote: A Constructive Reformer]

Nor was he a reformer whose methods were simply destructive of what he regarded as wrong or evil in the municipal government; on the contrary, his mind was eminently constructive, and consequently he sought to remedy defects by substituting the new and best for the old and worst with as little friction and disturbance as possible. Thus he quietly and without observation, as a master builder, laid foundations and reared the massive superstructures of four of the best-organized and most efficient departments of our city government--viz., the Department of Health, the Fire Department, the Department of Docks, the Police Judiciary.

[Sidenote: Character of Previous Agitation]

My personal acquaintance with Mr. Eaton began in the year 1864, when we became associated in an effort to secure reforms in the sanitary government of the City of New York. Although prior to this date there had been periods of agitation in favor of a more efficient health organization, especially when epidemics, like cholera, visited the city and the utter worthlessness of our health officials became apparent, yet there had been no such organized effort as that of 1864. Previous agitation had, however, been very useful in preparing the way for the final struggle, by creating a popular interest in these reforms and in rendering the public mind both sympathetic and receptive.

[Sidenote: Incompetent Health Officers]

In 1855 the Academy of Medicine applied to the Legislature for relief from the evils of an insufficient health organization, and as a result a committee of that body investigated the sanitary condition of the city. It appeared that there were four separate departments devoted to the conservation of the public health. First, was the Board of Health, composed of the Aldermen and Mayor. When this body was organized as a Board of Health it had supreme power, both in the abatement of nuisances and the expenditure of money. So much and so justly was this board feared, that Fernando Wood, while Mayor, refused to call it into existence during an epidemic of cholera, declaring that the Board of Health was more to be feared than the pestilence.

Second, was the Commissioners of Health, composed of the Mayor and the Recorder, the City Inspector, the Health Commissioner, the Resident Physician, and the Port Health Officer. This body had no adequate power and was perfectly useless both for good and evil.

Third, was the Resident Physician, whose duties were limited to visiting the sick poor.

Fourth, was the City Inspector, a most formidable official politically, for he had the right to expend annually $1,000,000 without “let or hindrance.” His jurisdiction extended to the cleaning of the street, gathering vital statistics, and preserving the public health by the appointment of health wardens for each ward.

The investigation showed that this department, the only one which actually exercised public health functions, was permeated with corruption, ignorance, and venality. The City Inspector was the lowest type of ward politician, the vital statistics were crude and unreliable, there was no pretense of cleaning the streets, and the health wardens were for the most part keepers of saloons. It was shown in the evidence that no health warden ever dared to visit a house where there was a case of contagious disease. One, who was asked the best method of preventing smallpox, replied: “Burn sulphur in the room.” Another, asked to define the term “hygiene,” said: “It is a mist rising from wet grounds.”

[Sidenote: Reform Movement Born]

The report of this committee created a profound sensation and gave the first impetus to a reform movement. A number of prominent physicians and influential citizens became deeply interested in the subject and determined to secure proper legislation. Health bills were annually prepared and sent to the Legislature only to be rejected under the direction of the City Inspector, whose $1,000,000 was expended freely in the lobby at Albany. But the agitation increased in force with successive defeats, a large and still larger number of people were added to the ranks of the reformers of the Citizens’ Association in 1864, with Peter Cooper as President and upwards of a hundred of the leading citizens as members.

The moving spirit in organizing and managing this powerful body was Mr. Nathaniel Sands, an ardent and enthusiastic sanitarian. Two departments were created in the Association, through which the principal work was to be done; viz., a Council of Law and a Council of Hygiene. Mr. Eaton was an active member of the former, and I was for a considerable time Secretary of the latter. Thus we were brought into frequent consultation over a public health law, which the Association had determined to have prepared for the next Legislature.

It was decided that the Council of Hygiene should make a first draft of the bill in which should be incorporated the necessary sanitary provisions. This draft was then to be submitted to the Legal Council for completion in legislative form. As secretary of the Council of Hygiene I had to prepare the first draft of the bill, which was done along the lines of former bills and seemed to the members to be a very perfect piece of work. When, however, the bill came from the Legal Council, scarcely a shred of the original draft was recognizable.

[Sidenote: The Right Man]

Though the Legal Council was composed of the leading lawyers of the city at that time, the revision and completion of the health law was committed to Mr. Eaton, a junior member. This selection proved to be of immense importance to the immediate sanitary interests of this city, and secondarily to the creation and administration of the health laws of the United States. The field of sanitary legislation was entirely uncultivated in this country at that time, and the principles on which health laws should be based were unrecognized, except by the more advanced students.