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.

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 Alarm of Medical
Men 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.

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 A Systematic
Investigation 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.

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 A House-to-House
Inspection 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.

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 The Medical
Experts 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.

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. Plan of
Inspection 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.

He entered each room, examined its means of ventilation and its contents, noted the number of occupants by day and by night, and carefully estimated the cubical area to each person. Whenever any contagious or infectious disease was discovered, as Each Room
Examined fever, smallpox, measles, scarlatina, the Inspector made a special report upon the dwelling. This report embodied specific answers to a series of questions, furnished in a blank form, requiring him 1. To trace and record the medical history of the sick person. 2. To ascertain and record facts relating to the family and other persons exposed to the patients and to the causes of the malady. 3. To report the sanitary condition of the domicil. 4. To report the statistics and sanitary condition of the population of that domicil. 5. To report upon the sanitary condition of the locality or neighborhood and its population. 6. To preserve and make returns of these records. 7. To prepare on the spot the necessary outlines or data for the sketching of a map or descriptive chart of the domicil, block, or locality.

Each Inspector was supplied with a notebook and a permanent record-book; in the first he constantly made notes as his examination proceeded, and in the latter these notes were expanded and put on permanent record. These permanent record-books are the property of the Association and embrace for the most part minute details concerning every building and tenement occupied by the laboring classes, as also, grog-shops, stables, vacant lots, slaughter-houses, etc.

Each Inspector was furnished with materials for drawing, and was directed to make accurate drawings of the squares in his district, locating each building, vacant lot, etc., and distinguishing the character and condition of each by an appropriate color. Many of these drafts of districts are beautiful specimens of art, and as sanitary charts enable the observer to locate infectious and contagious diseases, and with the aid of the permanent records, to determine the internal and external domiciliary conditions under which they occur.

I have been thus minute in specifying the details of the plan of inspection, the qualifications of the Inspectors, and the means employed, in order that the character of the work and the value of the results obtained may be properly appreciated.

Early in the month of May the work of thoroughly inspecting the insalubrious quarters, where fever and other pestilential diseases prevail, had been commenced, and the fact was soon ascertained that smallpox and typhus fever were existing and spreading Period of the
Inspection in almost every crowded locality of the city. It was not until about the middle of July that the entire corps of Inspectors was engaged. The work was then prosecuted with vigor and without interruption to the middle of November, when it was completed. The Inspectors met regularly every Saturday evening to report to a committee on the part of the Council the progress of their work, and to receive advice and instruction in regard to all questions of a doubtful character.

On the completion of the inspection each Inspector was required to prepare a final report embodying the general results of his labors. These reports have all been properly collated, under the direction of the Association, and are now passing through the press. They will soon appear in an octavo volume of about 400 pages, largely illustrated, with maps and diagrams. It will be the first interior view of the sanitary and social condition of the population of New York, and will abundantly demonstrate the fact that, though a great and prosperous commercial centre, she does not afford happy homes to hundreds of thousands.

Before proceeding to an analysis of this work, it will be necessary to notice the topographical peculiarities of our city, and the distribution of its population. New York is an island having an area of about thirty-four square miles, inclusive of its Distribution of
Population parks. Unlike Philadelphia, London, and most other large cities, which have a background of hundreds of square miles upon which to extend according to the exigencies of the population or of business, New York is limited in its power of expansion, and must accommodate itself to its given area. While it is true that a large business population will gather upon the adjacent shores, it is equally true that these non-residents will be of the better class. The laboring population will, for the most part, remain upon the island, and must be accommodated in the city proper, as they are compelled to live near their work.

New York has, thus far, grown without any control or supervision, until its population is estimated at 1,000,000 of persons. Of this number, at least one-half are of the laboring and dependant classes, compelled to live under such conditions as they find in their homes, without any power, either to change or improve them. Following the natural law which governs the movements of such a population, the wealthier or independent class spreads itself with its business arrangements over the larger proportion of the area, and the poorer or dependent class is crowded into the smallest possible space.

Already New York has covered about 8 of its 34 square miles with the dwellings of a population not far from 1,000,000, and all its commercial and manufacturing establishments. And the result is, as might have been anticipated, the dependent Tenant-House
Packing class, numbering fully one-half of the people, is crowded into tenant-houses which occupy an area of not more than two square miles. Such crowding amounts literally to packing.

For example, it is estimated that there are three contiguous blocks of tenant-houses which contain a larger population than Fifth Avenue; or, again, if Fifth Avenue had front and rear tenant-houses as densely packed as tenant-houses generally are, there would be a population of 100,000 on that single avenue. A single tenant-court in the Fourth Ward is arranged for the packing of 1,000 persons.

A resident of the same Ward reports that: “On a piece of ground 240 feet by 150, there are 20 tenant-houses, occupied by 111 families, 5 stables, a large soap and candle factory, and a tan-yard, the receptacle of green hides. The filth and stench of this locality are beyond any power of description.” In general, it may be stated that the average number of families to a house among the poor is 7, or about 35 persons.

It is necessary also to make a single explanation, to render more apparent the bearing of the facts developed. For the purposes of sanitary inquiry, the causes of disease are divided into those which are inevitable, and those Avoidable and
Inevitable Disease which are avoidable or removable, and hence it follows that diseases and deaths are divided into those which are inevitable and those which are preventable. For example: Of unavoidable causes of disease, we have vicissitudes of weather, accidents, old age, physical degenerations, etc.

Of avoidable or removable causes of disease we have those conditions around or within our dwellings or places of business or resort, errors in our mode of living, etc., which vitiate health, or rather tend to diseases, and yet which can be removed or changed by human agency. For example, a country residence may be most favorably located for health, and yet decaying vegetable matter in the cellar, or a cesspool so situated as to allow the gaseous emanations to be diffused through the house, will expose all the inmates to fevers, diarrhoea and dysentery.

These would be preventable diseases, and all the deaths therefrom would be preventable, and hence unnecessary deaths. In like manner in cities, all diseases and deaths due to causes which human agencies can remove are preventable. And it is a melancholy fact that fifty per cent of the mortality of cities is estimated to be due to such causes, and is hence unnecessary.

In reviewing the result of this inspection, I shall call your attention only to the more patent causes of disease found existing, and to the preventable diseases discovered, and their relation to these causes. In this evidence you will find ample proof that radical reforms are required in the health organizations of New York.

I will first notice the causes of disease which exist external to our dwellings, and which are the most readily susceptible of remedy. The first that attracts attention in New York is the condition of the streets. No one can Filthy
Streets doubt that if the streets in a thickly populated part of a town are made the common receptacle of the refuse of families, that in its rapid decomposition a vast amount of poisonous gases must escape, which will impregnate the entire district, penetrate the dwellings, and render the atmosphere in the neighborhood in a high degree injurious to the public health. In confirmation of this statement, I will quote the City Inspector, who, in a former communication to the Common Council, says:

“As an evidence of the effect of this state of things upon the health of the community, I would state that the mortality of the city, from the first of March, has been largely on the increase, until it has now reached a point of fearful magnitude. For the week ending April 27th, there were reported to this department one hundred and forty more deaths than occurred during the same week of the previous year. Were this increase of mortality the result of an existing pestilence or epidemic among us, the public would become justly alarmed as to the future; but although no actual pestilence, as such, exists, it is by no means certain that we are not preparing the way for some fatal scourge by the no longer to be endured filthy condition of our city.”

The universal testimony of the sanitary inspectors is that in all portions of the city occupied by the poorer classes, the streets are in the same filthy condition as that described by the City Inspector, and, that street filth is one of the most fruitful causes of disease.

Says the Inspector of the Eighth Ward: “Laurens, Wooster, Clark, and Sullivan are in a most filthy condition, giving off insalubrious emanations on which depend the many cases of fever, cholera infantum, dysentery, and pulmonary diseases. I have Street Filth
and Disease observed that near where other streets cross the above-named streets there is a greater proportionate amount of sickness; and this fact I have shown by special reports of typhus and typhoid fever in Grand and Broome, and dysentery in Spring.”

The Inspector of the Sixth Ward says: “Domestic garbage and filth of every kind is thrown into the streets, covering their surface, filling the gutters, obstructing the sewer culverts, and sending forth perennial emanations which must generate pestiferous disease. In winter the filth and garbage, etc., accumulate in the streets, to the depth sometimes of two or three feet. The garbage boxes are a perpetual source of nuisance in the streets, filth and offal being thrown all around them, pools of filthy water in many instances remaining in the gutters, and having their source in the garbage boxes.”

The Inspector of the Seventh Ward says: “The whole most easterly portion of the district, the streets and gutters are very filthy with mud, ashes, garbage, etc.”

The Inspector of the Thirteenth Ward says: “The streets are generally in a filthy and unwholesome condition; especially in front of the tenant-houses, from which the garbage and slops are, to a great extent, thrown into the streets, where they putrefy, rendering the air offensive to the smell and deleterious to health. The refuse of the bedrooms of those sick with typhoid and scarlet fevers and smallpox is frequently thrown into the streets, there to contaminate the air, and, no doubt, aid in the spread of those pestilential diseases.”

Says the Inspector of the Ninth Ward: “The effect of dirty streets upon the public health is too well known, and too often insisted upon, to need any exposition in this report. The largest number of cases of cholera infantum, cholera morbus, and kindred disease, is always found in localities where the streets are dirtiest.”

The Inspector of the Seventeenth Ward writes: “The two following localities present the appearance of dung-hills rather than the thoroughfares in a civilized city, viz.: Sixth Street, between Bowery and Second Avenue, and Eleventh Street, between First and Second Avenues.”

The Inspector of the Eleventh Ward says: “As a rule, the streets are extremely dirty and offensive, and the gutters obstructed with filth. The filth of the streets is composed of Animals
Dead house-slops, refuse vegetables, decayed fruit, store and shop sweepings, ashes, dead animals, and even human excrements. These putrifying organic substances are ground together by the constantly passing vehicles. When dried by the summer’s heat, they are driven by the wind in every direction in the form of dust. When remaining moist or liquid in the form of “slush,” they emit deleterious and very offensive exhalations. The reeking stench of the gutters, the street filth, and domestic garbage of this quarter of the city, constantly imperil the health of its inhabitants. It is a well-recognized cause of diarrhoeal diseases and fevers.”

The Inspector of the Eighteenth Ward reports: “The streets in the eastern part of the district, east of First Avenue especially, have, for the past six months, been in a most inexcusably filthy condition. The pavement here is uneven, there are deep gutters at either side of the streets, filled with foul slops, in which float or are sunk every form of decaying animal and vegetable matter. Occasionally, at remote and irregular intervals, carts come round, these stagnant pools are dredged, so to speak, and their black and decayed solid contents raked out. If there be anything on earth that is ‘rank and smells to heaven,’ these gutters do on such occasions, especially in the summer months. The streets in this part of the city are the principal depositories of garbage. In some instances heaped up at the sides of the streets, in others thrown about promiscuously, the event in either case is the same, if it be allowed to remain day after day, as it usually is. After having passed through every stage of decay, after having corrupted the surrounding air with its pestilential smell, it gradually becomes dessicated and converted into dust by the summer sun and the constantly passing vehicles. And now every horse that passes stirs it up, every vehicle leaves a cloud of it behind; it is lifted into the air with every wind and carried in every direction.

“Those who are directly responsible for this state of things suffer no more than the cleanly and thrifty who are so unfortunate as to live anywhere the wind, blowing from this quarter, reaches them. And what a pulvis compositum is it to breathe into the lungs! As we pass by, our mouths become full of it, we draw it in with our breath. It is swallowed into the stomach, it penetrates our dress and clings until it has covered our perspiring skin. Surely no dumping-ground, no sewer, no vault, contains more filth or in greater variety than did the air in certain parts of our city during the long season of drought the past summer. And wherever the wind blows, the foul corruption is carried; by a process as sure and universal as the diffusion of gases, is it conveyed throughout the city. Such, often, is the air drawn into the lungs with every respiration, of the poor sufferer stifled with consumption or burning with fever. No barrier can shut it out, no social distinction can save us from it; no domestic cleanliness, no private sanitary measures can substitute a pure atmosphere for a foul one.”

But I need not multiply these quotations. It will suffice to state that during the week ending August 5th, a special inspection of all the streets was made and they were found to be reeking, and, indeed, almost impassable, with filth. And to-day they are in, if possible, a still worse condition than ever before.

Closely allied to the streets are courts and alleys. These cul-de-sacs leading to, and adjoining the close and unventilated homes of the poor, are almost universally in a more filthy condition than the adjacent street. They are the receptacles of much of Filthy Courts
and Alleys the waste of the house, and are rarely cleaned. The air of these places during the summer is often the most stifling and irrespirable, and yet as it descends it enters the closely packed tenant-house and furnishes to the inmates the elements of disease and death. Says the Inspector of the Fourth Ward:

“Slops from rear buildings of such premises are usually emptied into a shallow gutter cut in the flagging and extending from the yard, or space between front and rear buildings, to the street. This is often clogged up by semi-fluid filth, so that the alley and those parts of the yard through which it runs are not infrequently overflown and submerged to the depth of several inches. There are more than four hundred families in this district whose homes can only be reached by wading through a disgusting deposit of filthy refuse. In some instances, a staging of plank, elevated a few inches above the surface, is constructed through the alleys.”

In the court is found generally that most pestiferous of all the sources of civic uncleanliness and unhealthiness—the privy and cesspool. These receptacles are rarely drained Cesspool
Abominations into the sewers, and consequently require for their cleanliness the frequent and faithful attention of the scavenger. The reports of the sanitary inspectors prove that this work is most irregularly and imperfectly done. Hundreds of places were found where these nuisances existed within, under or beside large tenant-houses, creating a vast amount of disease and death. Numerous instances of this kind are detailed in these reports, which are almost too revolting to be believed. I will quote but one or two illustrations:

“The privies (two in one) of Nos. — and — West Twenty-fourth Street need instant cleaning. They are overflowing the yard, and are very offensive. The privy No. — Seventh Avenue, as in the preceding two adjoining houses, is in the yard, and adjoins the house, and is on a line with the southerly wall of house No. — (the adjacent house), which has a back area; the wall of said area being part of the foundation of the privy. At times the fluid portion of the privy oozes through its own and the area wall.

“The privy of the rear tenant-house No. — West Twenty-second Street is used by 42 persons; it has five subdivisions, one for every two families. The compartments are so small that a person can scarcely turn round in them, and so dark that they have to be entered with an artificial light. The cellar itself, as has been stated, is damp, dark, and without ventilation. Under such circumstances the emanations of the excrementious matter of 42 persons can find no escape; thus this privy-cellar is worse than a Stygian pit.”

The Inspector of the Fifth Ward says: “Very few tenements have water-closets in the house; they have privies in the yards, which, as a rule, are insufficient for the accommodation of the numbers crowded into the houses; many are not connected with the sewers; are seldom cleaned, being allowed to overflow in some cases, rendering the neighborhood offensive with insalubrious emanations.”

The Inspector of the Fourteenth Ward states that: “The water-closets are nearly all in the yards—but few being in the houses—and connecting with the sewers. The greater number of these sewers are in a filthy condition, being but seldom emptied. Many of those which communicate with the privies are choked up by all sorts of offal being thrown into them, thereby producing a very bad condition.”

The Inspector of the Seventeenth Ward reports: “The privies of East Eleventh Street, rear, are beneath the floored alley-way leading to the building. Large holes in this floor allow ocular inspection from above, and admit rain and dirt. These nuisances Unbelievable
Vileness are almost always overflowing, and the passage leading to them is full of fÆcal matter. It would seem impossible for human beings to create or endure such vileness. The cellar is used by children and others as a privy; the foul air there seems never to change.”

The Inspector of the Sixteenth Ward says: “The privies form one end of the chief features of insalubrity. Nearly all of them are too small in size and too few in number, and without ventilation or seat-covers. About twelve were found locked securely, and on procuring the key and inspecting the privy, such masses of human excrements were found on the seats and floors as would justify the locking of the door to protect unwary persons from injury. Occupants of rear buildings are the principal sufferers from this insalubrity. The proximity of privies is in some cases eight feet from the windows of rear houses; the odor in these is, especially at night, intolerable. Instances of the kind are to be found at Nos. —, — and — West Seventeenth Street, and others. They are also too few in number; for example, No. — West Nineteenth Street, where in the front and rear buildings more than one hundred persons live who have one common privy, with a single partition dividing it, and but four seats in all. Twenty-five persons are expected to use one seat-opening.”

The Inspector of the Twentieth Ward says: “During my inspection I reported a number which were filled, and at the same time in such need of repair as to hazard the lives of those who entered them. The proximity of these places to the houses in many cases is a fact to which I would call your attention. One instance of this kind I may state: At a house in Fortieth Street, between Broadway and Seventh Avenue, the privy is situated about 10 feet from the door, and there is another on a line 10 feet from the first, and still another within 10 feet of the last mentioned, making three privies within 30 feet, and two of these belong to houses fronting on Broadway. The offensive odor arising from these places contaminates the air of the houses in the vicinity. This house, in Fortieth Street, is actually unfit to live in. At the time of my inspection the noxious gases from these privies were strongly perceptible in every part of the house.”

The Inspector of the Seventeenth Ward reports: “The privies are in most cases in the rear court-yard. In about two-thirds of the houses the privies are connected with the sewer. Overflowing privies are frequently found. Sometimes they are located in a dark place, which in all cases must be considered an evil. Such is the case in some houses in Rivington, Stanton, Ninth and Eldridge streets. All these places are filthy, and exceedingly offensive and dangerous to the whole neighborhood; in some places the foundation of the privies being rotten and broken, and fÆcal matter runs into the cellar, as in No. — ‘Extra Place,’ where diseases and deaths have occurred. The contents of a privy in a court at No. — Fifth Street have, from a similar cause, saturated the yard of premises on the Bowery, where several children died during the summer.”

I will at this point simply allude to special nuisances. New York has within the narrow limits of its present occupied area of about eight square miles, in addition to its one million of people, and all its commercial and manufacturing Special
Nuisances establishments, a vast number of special nuisances, which are, to a greater or less degree, detrimental to its public health. There are nearly 200 slaughter-houses, many of which are in the most densely populated districts. To these places droves of cattle, hogs, and sheep are constantly driven, rendering the streets filthy in the extreme, and from them flow blood and refuse of the most disgusting character.

In certain populous sections are fat-boiling, entrails-cleansing, and tripe-curing establishments, which poison the air for squares around with their stifling emanations. To these must be added hundreds of uncleaned stables, immense manure heaps, etc., etc. But I shall not dwell further on these subjects, and the evidence regarding them.

I pass from the consideration of the external to the internal domiciliary conditions. The poorer classes of New York are found living either in cellars or in tenement houses. It is estimated by the City Inspector that 18,000 persons live in cellars. This Cellar Population—
Dens of Death is also about the estimate of the police. The apartments of these people are not the light and airy basement rooms of the better class houses, but their homes are, in the worst sense, cellars. These dark, damp and dreary abodes are seldom penetrated by a ray of sunlight, or enlivened by a breath of fresh air. I will quote several descriptions from these reports. In the Fourth Ward many of these cellars are below tide water. Says the Inspector of that district:

“This submarine region is not only excessively damp, but is liable to sudden inroads from the sea. At high tide the water often wells up through the floors, submerging them to a considerable depth. In very many cases the vaults of privies are situated on the same or a higher level, and their contents frequently ooze through the walls into the occupied apartments beside them. Fully one-fourth of these subterranean domiciles are pervaded by a most offensive odor from this source, and rendered exceedingly unwholesome as human habitations. These are the places in which we most frequently meet with typhoid fever and dysentery during the summer months. I estimate the amount of sickness of all kinds affecting the residents of basements and cellars, compared with that occurring among an equal number of the inhabitants of floors above ground, as being about a ratio of 3 to 2.”

The Inspector of the Fifteenth Ward reports: “In a dark and damp cellar, about 18 feet square and 7 feet high, lived a family of seven persons; within the past year two have died of typhus, two of smallpox, and one has been sent to the hospital with erysipelas. The tops of the windows of this abode are below the level of the surface, and in the court near are several privies and a rear tenant-house. Yet this occurred but a short distance from the very heart of the city.”

The Inspector of the Ninth Ward writes: “At Nos. —, —, — and — Hammond Street, and also at No. — Washington Street, are inhabited cellars, the ceilings of which are below the level of the street, inaccessible to the rays of the sun, and always damp and dismal. Three of them are flooded at every heavy rain, and require to be baled out. They are let at a somewhat smaller rent than is asked for apartments on an upper floor, and are rented by those to whom poverty leaves no choice. They are rarely vacant.”

The Inspector of the Seventeenth Ward states that: “In 17 squares 55 houses contain 246 persons living in cellars entirely underground. As a matter of course such cellars are unhealthy dwelling apartments. Stanton Place has some of these miserable cellar-apartments, in which diseases have been generated. These cellars are entirely subterranean, dark and damp.”

The Inspector of the Sixth Ward says: “There has been some improvement within the last few years—the cellar population having been perceptibly decreased, yet 496 persons still live in damp and unwholesome quarters under ground. In some of 496 Persons
Under Ground them water was discovered trickling down the walls, the source of which was sometimes traced to the courts and alleys, and sometimes to the soakage from the water-closets. The noxious effluvia always present in these basements are of a sickening character. Many of the cellars are occupied by two or three families; a number are also occupied as lodging-houses, accommodating from twenty to thirty lodgers. One, near the corner of Elm and Worth streets, is now fifteen or sixteen feet below the level of the street (the street having been raised ten feet). The lodging-house keeper complained to the Inspector that her business had fallen off some since the street was raised. As might be expected, the sickness rate is very high; rheumatic disease, fevers, strumous diseases, cholera infantum, etc., etc., running riot among the population. Indeed, in nearly every basement disease of some kind has been found peculiarly prevalent and fatal.”

Another Inspector says: “At No. — West Sixteenth Street, two families, in which are thirteen persons, occupy the basement. It is so dark that ordinary type can be seen with difficulty. In the other case the people were healthy before entering the basement; since, however, they have been ill; the mother has phthisis. Of twenty-four cellars, note of which has been made, four only were in good sanitary condition. The rest were more or less filthy, some indescribably so. One contained urine, bones, and soakage from the privy.”

The Inspector of the Eighteenth Ward writes: “There are a few cellars so dark that one cannot see to read in them, unless by artificial light, except for a few hours in the day, by sitting close to the window; and there are many basement rooms into whose gloomy recesses not a single direct ray from the sun ever shone. The latter are, as a rule, by half their depth below the level of the street. Dark and damp, with very little chance for circulation of air, it would be difficult to imagine a human being more completely beyond reach of sanitary provisions. And when we consider that four large families often crowd this subterranean floor, no words are needed to show their condition deplorable. That a generally impaired vitality is promoted by living in this unnatural way, ‘a nameless, ever new disease,’ there can be no question; that these people will be especially prone to whatever form of prevailing sickness may be about in the community, no one can doubt; but whether there is any specific cause involved, capable of producing definite forms of disease, is more difficult to determine.”

An Inspector thus describes a visit to one of these subterranean abodes: “We enter a room whose low ceiling is blackened with smoke, and its walls discolored with damp. In front, opening on a narrow area covered with green mould, two small windows, A Visit to the
Cave-Dwellers their tops scarcely level with the court-yard, afford at noonday a twilight illumination to the apartment. Through their broken panes they admit the damp air laden with effluvia, which constitutes the vital atmosphere inhaled by all who are immured in this dismal abode. A door at the back of this room communicates with another which is entirely dark, and has but this one opening. Both rooms together have an area of about eighteen feet square.

“The father of the family, a day laborer, is absent. The mother, a wrinkled crone at thirty, sits rocking in her arms an infant whose pasty and pallid features tell that decay and death are usurping the place of health and life. Two older children are in the street, which is their only playground, and the only place where they can go to breathe an atmosphere that is even comparatively pure. A fourth child, emaciated to a skeleton, and with that ghastly and unearthly look which marasmus impresses on its victims, has reared his feeble frame on a rickety chair against the window sill, and is striving to get a glimpse of the smiling heavens, whose light is so seldom permitted to gladden its longing eyes. Its youth has battled nobly against the terrible morbid and devitalizing agents which have oppressed its childish life—the poisonous air, the darkness, and the damp; but the battle is nearly over—it is easy to decide where the victory will be.”

But I need not multiply the evidences that 18,000 people, men, women, and children (a goodly-sized town), are to-day living in our city in a condition the most destructive to health, happiness, and morals that could possibly be devised. As you look into these abodes of wretchedness, filth and disease, the inmates manifest the same lethargic habits as animals, burrowing in the ground. They are, indeed, half narcotized by the constant inhalation of the emanations of their own bodies, and by a prolonged absence of light and fresh air. Here we never find sound health, while the constant sickness rate ranges from 75 to 90 per cent.

Now, as to the second condition under which we find the laboring classes. It is estimated by the police that the tenant-house population of New York reaches the enormous figure of 500,000 or about half of the total number of inhabitants. Tenant-House
Population The great and striking fact in regard to the domiciliary condition of the tenant-house class is overcrowding and deficient sunlight and fresh air. The landlord of the poor tenant-house has two principal motives—first, to pack as many people as he can in a given space, and second, to make as few improvements and repairs as possible.

The tenant-houses are of two classes, viz., the front and the rear. The latter is closely allied to the cellar; being shut out from air and sunlight, it is generally damp, gloomy, and filthy. The space between the front and rear house, familiarly called the “well hole,” contains the privy and cesspool, the emanations from which are closely confined to this space, and slowly but constantly pervade with their disgusting odors all the rooms and recesses.

The tenant-house has frequently been described by sensation writers, with all its miseries, its diseases and its deaths. But no pen nor pencil can sketch the living reality. It is only by personal inspection that one can learn to what depths of social and physical degradation human beings can descend. Said a committee appointed by your body to investigate the condition of the tenant-houses of New York:

“Sitting together upon the same broken box, lying together upon the same dirty straw, covered by the same filthy shreds, vieing with each other in the utterance of foul obscenities, you have a picture of the mass of corruption and squalid misery gathered inside the walls of that unventilated building in Mission Place. In that single house there was that which made the soul sicken and turn in horror from the sight. Vice, with its pretentious brow, and wretchedness, with hollow cheek and sunken, glazed eye, were there; hunger and lust stood side by side, petit larceny and cold-blooded murder were holding converse.”

The inspectors describe more or less minutely a large number of tenant-houses, and also of groups:

“‘Cat Alley’ is the local designation of a group of dilapidated tenant-houses in an alley on Cannon Street. The alley is unpaved, and is Cat
Alley excessively filthy. The privy is a small and broken-down structure, covering only a part of the vault, which is now full almost to overflowing. The inhabitants are degraded, both physically and socially. In several of the domiciles, at the time of our last inspection, there was neither bedstead nor table. Twelve of these families were found in a wretched condition, and all the children we saw were covered with dirt, and presented the intensest aspects of scrofulous disease; their sore eyes, encrusted heads, and dehumanizing appearance, told the story of want and neglect, and of greater evils to come.

“Five small houses, two and a half stories in height, including the basements, each containing apartments for six families, front on an alley called Rivington Place. This alley is always in a filthy condition. The houses on it are small and overcrowded. The 30 families that reside in these five houses have no other water supply than that which two hydrants furnish in the exterior courtyard; while for this population of nearly 200 persons, of all ages, there are but two privy vaults, and, at the time of the last inspection of the quarters, these vaults were filled nearly to the surface. In the year 1849, 42 individuals died here in three weeks of cholera, and not one recovered that was taken sick. The reasons are plain: they have no ventilation, and the houses being double, the exhalations from one apartment are inhaled by the other.

“At No. — West Twenty-fifth Street, a wretched tenement of two apartments, the rooms occupied by one family. The sitting-room is about 10×12 feet, and the bedroom about 5×12, without a single window or air hole. These rooms were occupied in the hot month of July by a colored female, having pulmonary consumption, and her two children. Here she died, shortly after we made the inspection of her domicilium; having no money nor friends, a Christian burial was denied her for four days, although the neighbors acquainted the police of the fact, and they the Health Warden.”

“Rag Pickers Row” is thus described: “The houses are of wood, two stories, with attic and basement. The attic rooms are used to deposit the filthy rags and bones as they are taken from gutters and slaughter-houses. The yards are filled with Rag Pickers
Row dirty rags hung up to dry, sending forth their stench to all the neighborhood, and are exceedingly nauseous, operating upon me as an emetic. The tenants are all Germans of the lowest order, having no national nor personal pride; they are exceedingly filthy in person, and their bed-clothes are as dirty as the floors they walk on; their food is of the poorest quality, and their feet and heads, and doubtless their whole bodies, are anasarcous, suffering from what they call rheumatism, but which is in reality a prostrate nervous system, the result of foul air and inadequate supply of nutritious food. They have a peculiar taste for the association of dogs and cats, there being about 50 of the former and 30 of the latter. The whole number of apartments is 32, occupied by 28 families, number 120 in all, 60 adults and 60 children. The yards are all small, and the sinks running over with filth.”

Says a visitor in the Eighth Ward: “The instances are many in which one or more families, of from three to seven or more members, of all ages and both sexes, are congregated in a single and often contracted apartment. Here they eat, drink, Tenant-House
Degeneration sleep, work, dress and undress, without the possibility of that privacy which an innate modesty imperatively demands. In sickness and in health it is the same.

“What is the consequence? The sense of shame—the greatest, surest safeguard of virtue, except the grace of God—is gradually blunted, ruined, and finally destroyed. New scenes are witnessed and participated in, with a countenance of brass, the very thought of which, once, would have filled the sensitive heart of modesty with pain, and covered its cheek with burning blushes. The mind of one thus brought in daily and nightly contact with such scenes must become greatly debased, and its fall, before the assaults of vice, rendered almost certain.”

Another writes: “These houses seem to be always open to newcomers, and, in some way or other, they can accommodate them. I have found three families, of men, women, and children, in one room; there they lived and there they slept. Can any one doubt that there must be a rapid declension of morals in both parents and children, or that a bar is here opposed to moral and religious instruction, or that this state of things is consequent on the circumstances and condition of life?”

I could give you many details of other tenant-houses, the reputation of which is a reproach to any city in the civilized world. Such is “Gotham Court,” “Rotten Row,” “The Great Eastern,” “Sebastopol,” “Quality Row,” “Bummer’s Retreat,” etc. Speaking of the tenant-house, the Rev. Dr. Muhlenburg says:

“‘Their homes!’ that cold and damp cellar, about as tenantable as your coal vault! Do you call that a home for the distressed body, crowded in one corner there, swollen with the pains of rheumatism? Or that close apartment, heated or stifling in preparing the evening meal, on the shattered stove—that suffocating room, where you would not stop within for a moment—is that the home which you think so favorable for the worn asthmatic, catching every breath as if the last? Ask any clergyman, he will tell you with how little satisfaction he makes his visits among the poor, when they are laboring among disease; how he never has the heart to speak of comfort for the soul, when discomforts of the body call so loudly for relief, and for which the scanty aid he can minister seems akin to mockery!”

Mr. N.P. Willis who witnessed the “draft” riots thus truthfully and graphically describes the inmates of tenant-houses:

“The high brick blocks and closely packed houses where the mobs originated, seemed to be literally hives of sickness and vice. The
Rioters It was wonderful to see, and difficult to believe, that so much misery, disease and wretchedness can be huddled together and hidden by high walls, unvisited and unthought of, so near our own abodes. Lewd, but pale and sickly young women, scarce decent in their ragged attire, were impudent and scattered everywhere in the crowd. But what numbers of these poorer classes are deformed—what numbers are made hideous by self-neglect and infirmity! Alas! human faces look so hideous with hope and self-respect all gone! And female forms and features are made so frightful by sin, squalor, and debasement! To walk the streets as we walked them, in those hours of conflagration and riot, was like witnessing the day of judgment, with every wicked thing revealed, every sin and sorrow blazingly glared upon, every hidden abomination laid bare before hell’s expectant fire? The elements of popular discord are gathered in these wretchedly constructed tenement houses, where poverty, disease, and crime find an abode. Here disease in its most loathsome forms propagates itself. Unholy passions rule in the domestic circle. Everything, within and without, tends to physical and moral degradation.”

Such, Mr. Chairman, is the external and internal sanitary condition of the homes of 500,000 people in the City of New York to-day, as revealed by this inspection. It requires no extraordinary amount of medical knowledge to determine the physical condition Tenant-House
Rot of this immense population, living under such circumstances. Even though no devastating epidemic is found ravaging the tenant-house, yet the first sight of the wretched inmates convinces you that diseases far more destructive to health and happiness, because creating no alarm, are wasting the vital energies, and slowly but surely consuming the very tissues of the body.

Here infantile life unfolds its bud, but perishes before its first anniversary. Here youth is ugly with loathsome diseases and the deformities which follow physical degeneracy. Here the decrepitude of old age is found at thirty. The poor themselves have a very expressive term for the slow process of decay which they suffer, viz.: “Tenant-house Rot.” The great majority are, indeed, undergoing a slow decomposition—a true eremacausis, as the chemists term it. And with this physical degeneration we find mental and moral deterioration. The frequent expression of the poor, “We have no sickness, thank God,” is uttered by those whose sunken eyes, pale cheeks, and colorless lips speak more eloquently than words, of the unseen agencies which are sapping the fountains of health. Vice, crime, drunkenness, lust, disease, and death, here hold sway, in spite of the most powerful moral and religious influences.

Religious teachers and Bible readers are beginning to give this class over as past all remedy, until their physical condition is improved. Their intellects are so blunted and their perceptions so perverted by the noxious atmosphere which they breathe, and the all-pervading filth in which they live, move, and have their being, that they are not susceptible to moral or religious influences. In London, some of the city missionaries have entirely abandoned the tenant-house class. There is, undoubtedly, a depraved physical condition which explains the moral deterioration of these people, and which can never be overcome until we surround them with the conditions of sound health. A child growing up in this pestilential atmosphere becomes vicious and brutal, not from any natural depravity, but because it is mentally incapable of the perceptions of truth. Most truly does the Inspector of the Fourth Ward say:

“There is a tenant-house cachexy well-known to such medical men as have a practical acquaintance with these abodes; nor does it affect alone the physical condition of their inmates. It has its moral prototype in an ochlesis of vice—a contagious Tenant-House
Cachexy depravity, to whose malign influence the youthful survivors of the terrible physical evils to which their infancy is exposed, are sure to succumb. We often find in persons of less than middle age, who have long occupied such confined and filthy premises, a morbid condition of the system unknown elsewhere. The eye becomes bleared, the senses blunted, the limbs shrunken and tremulous, the secretions exceedingly offensive. There is a state of premature decay.

“In this condition of life the ties of nature seem to be unloosed. Maternal instinct and filial affection seem to participate in the general decay of soul and body. A kind Providence, whose hand is visible even here, mercifully provides that the almost inevitable decay and death which man’s criminal neglect entails on the offspring of the unfortunate who dwell in these dreary mansions, shall elicit comparatively feeble pangs of parental anguish. To the physical and moral degradation, the blight of these miserable abodes, where decay reigns supreme over habitation and inhabitant alike, may be plainly traced much of the immorality and crime which prevail among us. The established truth, that, as the corporeal frame deteriorates, man’s spiritual nature is liable also to degenerate, receives its apt illustration here.”

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 Prevailing
Diseases 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.

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 Seeds of Disease
Uncontrolled 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.

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 Where Disease
Flourishes 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.

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, Smallpox 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:

“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 Smallpox in Tailored
Garments 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.”

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 Typhus
Fever 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.

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, Intestinal
Affections 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.”

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, Living at a
Sewer’s Mouth 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.

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 The Normal
Death-Rate 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.”

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 Death-Rate of
New York 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.

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 New York, London, and
Liverpool Compared 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

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.”

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 Constant
Sickness 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.

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 Where the Death Pressure
Is Greatest 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.

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:

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 Some Scapegoats—
Foreign
Immigration 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.”

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. The Floating
Population 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.

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 Can the Causes of Disease
Be Removed? 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.

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 Improvements During
the Inspection 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.”

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 How to Improve
the People 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.

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 A Town That
Was Immune 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.

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 Can Populous Towns
Be Improved? 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.

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 Cleanliness Preserves
from Epidemics 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.

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 Importance of Sanitary
Government 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.

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 The Entire Country
Concerned 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.

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 Smallpox in a
Hotel Bedroom 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.

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 New York Inoculates
the Nation 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.

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 Inefficiency of
Health Organizations 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.”

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 Without Sanitary
Government 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.

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 The City Inspector’s
Department 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.”

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 Sanitary
Inspection 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.

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 Inspection Must
Be Thorough 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.

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. The
Remedy 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?

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 An Efficient
Health Board 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.