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History of Public Health in New York City, 1625-1866

History of Public Health in New York City, 1625-1866: Volume 1

John Duffy
Copyright Date: 1968
Published by: Russell Sage Foundation
Pages: 640
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  • Book Info
    History of Public Health in New York City, 1625-1866
    Book Description:

    Traces the development of the sanitary and health problems of New York City from earliest Dutch times to the culmination of a nineteenth-century reform movement that produced the Metropolitan Health Act of 1866, the forerunner of the present New York City Department of Health. Professor Duffy shows the city's transition from a clean and healthy colonial settlement to an epidemic-ridden community in the eighteenth century, as the city outgrew its health and sanitation facilities. He describes the slow growth of a demand for adequate health laws in the mid-nineteenth century, leading to the establishment of the first permanent health agency in 1866.

    eISBN: 978-1-61044-164-3
    Subjects: Health Sciences, Sociology

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-viii)
  3. Preface
    (pp. ix-xiv)
    George James
  4. Introduction
    (pp. xv-xx)

    In writing a history of public health the first problem is to decide precisely what is encompassed hy the term “public health.” There are few activities of organized society that do not have some bearing upon the health and welfare of a community, and it is easy for the historian of public health to wander far afield from those matters of direct concern. The elusive phrase, health-related, can lead him into investigating such diverse subjects as the history of tenements, immigration, urbanization, and of poverty itself.

    Long before health boards and formal governmental agencies came into existence, responsible citizens and...

  5. Part 1. From Frontier Post to Settled Community

    • 1 A Sweet and Wholesome Climate
      (pp. 3-21)

      To the English and Dutch, who viewed the New World from the standpoint of their well-tilled and comfortable homelands, the American scene was both strange and wonderful. It was a place of beauty and luxuriant fertility, and yet, at the same time, a land of savage inhabitants and forbidding wilderness. Game of all types abounded and the streams and coastal waters provided enormous quantities of fish, oysters, and clams. But special skills were needed to gather these harvests, and the early settlers often found themselves starving in the midst of plenty. The Indians, who could—and often did—help the...

    • 2 The Transition Years, 1664 to 1720
      (pp. 22-39)

      During the first forty years of its existence, the settlement of New Amsterdam had gradually made the transition from a fortified trading post into a relatively prosperous town. Dutch tolerance and the reluctance of the Hollanders to migrate had led to an influx of many nationalities, and New Amsterdam soon became the most cosmopolitan colonial town in the seventeenth century. Following the bloodless takeover in 1664, the large number of English inhabitants facilitated the change from Dutch to British administration. The process was further eased by the tact of Colonel Richard Nicolls, the first English governor.

      The incorporation of New...

    • 3 The Comfortable Town of New York, 1720 to 1776
      (pp. 40-72)

      As the eighteenth century drew on, New York continued to flourish. By 1731 the number of houses was estimated at 1,400 and the population had risen to about 8,600. Despite this growth, it remained a pleasant and clean little town, one which elicited many favorable comments from its visitors. One of them praised the healthful situation of the city, “the Clime temperate, the Air serene,” and added, possibly with tongue in cheek, “Here are no Physicians or Consumptions, and so very few Physicians and Apothecaries that Peoples live to a very great Age.” The well-built brick homes and the clean,...

    • 4 Revolution and Reconstruction
      (pp. 73-94)

      The years of growth and prosperity for New York City came to an abrupt halt late in the summer of 1776 with the British occupation. Even before this time, the gathering of the Revolutionary Army in and around the city had disrupted normal activities. As the British Army threatened, thousands of Americans fled their homes, reducing the population by almost half. In the eighteenth century armies normally lived off the countryside, and to professional soldiers it made little difference whether they were in friendly or enemy territory. To make matters worse, the bitterness between the Tories and Patriots had already...

  6. Part II. From Town to City, 1792–1825

    • [Part II. Introduction]
      (pp. 97-100)

      New York City’s progress from a frontier trading post to the present megalopolis has been one of steady and almost incredible growth. This phenomenon is by no means unique to New York, and the ultimate end to spreading urbanism is a matter of grave concern to all thoughtful men. The expansion of New York City, however, was a particular response to the peopling of the vast American continent. Thousands of immigrants poured into the city, many of whom lacked the resources to push on to the cheap land of the West. Despite the felicitous picture of the frontier draining away...

    • 5 Yellow Fever, the Number One Public Health Problem
      (pp. 101-123)

      From 1791 to 1822, a period of thirty-one years, the threat of yellow fever occupied much of the attention of health reformers, and, indeed, of the City Council itself. The disorder appeared first in 1791, raised serious apprehensions during the next three summers, and reached epidemic proportions in 1795. The following ten years mark the peak of the outbreaks, with the most serious attack in 1798. After striking in a desultory fashion in 1805, yellow fever disappeared for fourteen years. It returned in 1819, and then struck one last blow in 1822. Henceforth, although occasional cases were landed in quarantine,...

    • 6 The Beginnings of Organized Public Health
      (pp. 124-150)

      Since the occasional appearance of pestilence was still a strange and inexplicable phenomenon, even the best-intentioned municipal officials were never quite sure just what was the best method for preventing or fighting it. As already noted, the evidence clearly indicated that some diseases were contagious, that is, spread by direct contact, but it was equally clear that in the case of other disorders, most notably yellow fever and malaria, certain intangible factors were involved. In practical terms, officials had to decide whether to try to keep out the infection by means of a rigid quarantine, or whether to assume that...

    • 7 The First Board of Health
      (pp. 151-175)

      Almost every year for more than a decade committees to investigate the causes of epidemics had been established, and report after report had made the point that both quarantine and sanitary measures were needed. Even before adequate mortality statistics had been accumulated, it was evident that the disease centered in the damp, dirty, low-lying areas in the vicinity of the docks. This concentration of yellow fever cases lent credence both to the importationists and to those who ascribed the disease to dirt, dampness, and crowding. In attempting to deal with the sanitary and quarantine measures, the city had first sought...

    • 8 Street Sanitation and Nuisances: the Losing Battle
      (pp. 176-194)

      The 1790s were years of undoubted progress in civic administration. A rising consciousness of civic responsibilities was reflected in the emergence of effective quarantine measures and of a permanent health office, and in the efforts to remove accumulated filth, The first twenty-five years of the nineteenth century also witnessed marked advances, but in the general area of street cleaning, sewage removal, and general sanitation, the City Fathers fought a losing battle. Their failure can scarcely be attributed to oversight or lack of knowledge; complaints constantly poured into the City Council, and newspaper columns were filled with outraged editorials and indignant...

    • 9 Control of the Physical Environment
      (pp. 195-231)

      Although the yellow fever epidemics in the 17905 led to a temporary improvement in the a street-cleaning system and to some improvement in the city’s general sanitary condition, municipal authorities continued to lose ground in their fight for a clean and healthy city during the first quarter of the nineteenth century. As noted earlier, the explosive population growth created social, sanitary, and health problems which were far beyond the limited capacity of a local government designed to cope with the affairs of a relatively small town. In almost every aspect of sanitation, conditions were worse in 1825 than they had...

    • 10 Medicine and Hospitals
      (pp. 232-256)

      The practice of medicine changed relatively little in the thirty years prior to 1825, but notable strides were made toward the professionalization of its practitioners. In the city and the state at large, medical societies began blossoming and these organizations gained some control over the licensing of physicians and surgeons. The drive to raise professional standards was reflected in the fight to improve medical education and in the ever-increasing number of hospitals. Moreover, through their societies the doctors were able to influence local and state officials and play a greater role in developing public health policies.

      The Medical Society of...

    • 11 Health and Social Welfare
      (pp. 257-268)

      In the years from 1790 to I825, the population of New York City multiplied five-fold, jumping from 33,000 to 166,000. Although the city medical schools were totally inadequate for keeping pace with this dramatic population increase, the ratio of physicians to the population remained about the same. With a population of between 38,000 to 40,000, New York had 64 doctors in 1793. In I825 there were 430 physicians to serve a total of 166,000 residents. Since obtaining a medical degree was relatively easy, it is safe to assume that many practitioners had few formal qualifications. On the other hand, the...

  7. Part III. The City Overwhelmed

    • [Part III. Introduction]
      (pp. 271-278)

      It is difficult to determine the dominant public health theme in the forty-one years from 1825 to the passage of the Metropolitan Health Act of 1866. At first glance one might well assume that the recurrent epidemics of Asiatic cholera, beginning in 1832, supplied the main impetus to the public health movement. Without doubt, these epidemics made a tremendous impact upon New Yorkers. Their enormous toll in the more squalid tenement areas gave convincing proof of the relationship between dirt and disease and lent credence to the assertions of the sanitationists. In mobilizing the city’s resources to meet the threat...

    • 12 The Administration of Public Health
      (pp. 279-296)

      As of 1825 the tide of immigration had only begun, yellow fever still threatened but the danger seemed to be receding, and the only diseases winnowing the population were familiar ones, such as the respiratory ailments, various enteric disorders, and the rather vague and amorphous group known as “fevers.” All of these were familiar complaints and aroused no undue public alarm. The mortality statistics collected by the City Inspector’s Office showed a steady climb in the number of deaths from tuberculosis, leading a few of the physicians to issue warnings, but city officials considered that they had more pressing problems....

    • 13 The Office of City Inspector
      (pp. 297-329)

      From the standpoint of health and sanitation, the Office of City Inspector was one of considerable importance. Throughout the first half of the nineteenth century, the duties remained much as they had been defined by a state law in 1807 to investigate nuisances and prepare corrective ordinances for the City Council; to collect mortality and business statistics; to carry out instructions from the Board of Health; to inspect buildings and properties; and to enforce fire regulations. The City Inspector had little power in his own right, but the more able occupants of the office often served as gadflies, prodding the...

    • 14 The Health Office: Chief Quarantine Agency
      (pp. 330-355)

      Unlike the City Inspector’s Office and the Board of Health, the third administrative unit concerned with city health matters, the Health Office, was a semi-independent agency whose officials were appointed by the state. The duties and perquisites of its three chief officers, the Resident Physician, the Health Officer, and the Health Commissioner have already been touched upon in a previous chapter.¹ Suffice it to say that the fees which these officials were permitted to collect provided them with a lucrative income, while at the same time their control over all shipping offered unscrupulous office-holders even greater opportunities for graft. Fortunately...

    • 15 The Lucrative Business of Not Cleaning the Streets
      (pp. 356-375)

      The Same factors which had brought a steady deterioration in the sanitary condition of New York streets during the first quarter of the century continued to operate for the next forty years. The mushrooming of the city vastly increased the sanitary problems, and a steady influx of newcomers conditioned by a rural environment made the existing sanitary laws almost unenforceable. A city-operated street-cleaning system alternated with one run by private contractors, but neither proved effective for any sustained period. The appearance of Asiatic cholera periodically brought a major cleanup, but once the danger was past, the streets soon became the...

    • 16 Noisome Substances and Public Nuisances
      (pp. 376-390)

      Probably no single subject occupied the attention of city officials, newspapers, and citizens in general as did that of public nuisances. This rubric encompassed manure piles, slaughterhouses, dairies, stables, burial grounds, obnoxious trades, overflowing privies, cesspools, stagnant pools, filthy gutters, and a wide range of annoyances which were offensive to the nose and the eye. To recreate the atmosphere of old New York, one has to visualize a good sized city in which horses supplied the chief motive power for transporting men and goods. They hauled the garbage and night soil, delivered both milk and water, and were omnipresent in...

    • 17 The Advent of Sanitary Engineering: Croton Water and the Sewerage System
      (pp. 391-404)

      The brief flurry of activity over the city water supply from 1822 to 1825 had produced a number of sound proposals, but, unfortunately for New Yorkers, little came of them. The Manhattan Company, still recognizing that the operation of a water system for the city was essential to maintaining its lucrative banking privileges, continued to render an absolute minimum of service. The quality of this service was well matched by the quality of the water supplied from its shallow wells, a water so thoroughly contaminated that it was as unpleasant to taste as it was unsafe to drink. The collapse...

    • 18 Sewerage and Drainage
      (pp. 405-419)

      During the first quarter of the nineteenth century, the subject of an underground drainage and sewerage system had been thoroughly explored by several New Yorkers and had aroused considerable public interest. Men such as Edmond Genêt and Drs. Sabatier and Edward Miller had set forth the concept of a graded, integrated sewerage system, consisting of round or elliptical-shaped pipes to facilitate water flow, and the use of steam engines for pumping a continuous stream through the sewer lines. While the project was technologically feasible, it was too far ahead of the social thought of its day. In 1826 the city...

    • 19 Food and Market Regulations
      (pp. 420-439)

      New York City, had a long tradition of regulating the sale of all foods, but meat and fish, the items most likely to spoil, were the chief concern of the authorities. Under the terms of its charter, the city was permitted to operate public markets and to license butchers and fishmongers. Meat could he sold only in the public markets by licensed butchers. The intent of low was to guarantee quality food at a fair price. The market inspectors were responsible for preventing the sale of unwholesome food, and for seeing that the stalls and aisles were kept reasonably clean....

    • 20 Epidemic and Endemic Diseases
      (pp. 440-460)

      During the eighteenth century New York had been scourged by many epidemic diseases, yellow fever, smallpox, measles, diphtheria, and recurrent outbreaks of respiratory and enteric disorders. The relatively small size of the city, the vast ocean which separated it from Europe, Africa, and Asia, and the limited communication between American towns and villages all contributed, however, to reducing the incidence of major communicable diseases. Contradictory as these two statements may seem, they are not mutually exclusive. When smallpox or measles, for example, was introduced in New York during colonial days, the large number of nonimmunes guaranteed that the disease would...

    • 21 Medicine and the Medical Profession
      (pp. 461-480)

      The years from 1825 to 1866 were interesting ones for American medicine. Old theories were being discarded, but as yet the profession had evolved no satisfactory rationale to replace them. The biological and physical sciences were still not at a point where they could contribute to medicine, and many physicians felt they were caught between the Charybdis of pure theories and the Scylla of pure empiricism. As the profession groped for an answer to the intangibles of disease, bitter professional debates turned into equally bitter clashes of personality. The self-doubts of the profession were all too well known to the...

    • 22 The Rise of the Hospital
      (pp. 481-514)

      In 1825 hospitals were still places of refuge for the sick or for homeless strangers. Operating rooms were a rarity, and on the few occasions when surgery was deemed necessary, it was usually performed in open wards without benefit of anesthesia. The largest hospital in the city as the second quarter of the century opened was the oldest institution, the New York Hospital. Although a major hospital with over 2,000 admissions, it largely provided custodial care. In the year 1825 a total of 2,139 patients were admitted; 270 of these were insane who were treated at Bloomingdale. Of these patients,...

    • 23 Immigrants, Tenements, and General Mortality
      (pp. 515-539)

      New York, like all American port cities, was profoundly affected by the growing stream of immigrants. From 1825 to the mid 1850s, with a few minor fluctuations, the trend of immigration was steadily upward. Immigrants who arrived with some resources were in a position to move west, but the remainder were compelled to settle in the crowded city and seek employment where they could. Prior to 1847, the date when the immigration commission was established, no precise records were kept of the yearly inflow, and the estimates vary widely. For example, William J. Bromwell in his 1856History of Immigration...

    • 24 The Fight for Reform
      (pp. 540-572)

      In the mid-nineteenth century, with so many technological problems still unresolved and no trained personnel, the sheer size of New York’s mounting sewerage and sanitary problems would have tested the managerial skills of the best administrators operating under a well-organized municipal government. Unfortunately, neither of these conditions existed: the structure of the city government hodgepodge of patchwork, and intelligent and honest administrators were the exception rather than the rule. The caliber of civic officials had steadily deteriorated as the flood of immigrants pouring into the city overwhelmed the existing political order and replaced old voting patterns with new political machines....

  8. Appendices

    • Appendix 1 Mortality Statistics of New York City, 1804–1865
      (pp. 575-577)
    • Appendix 2 Infant Mortality, New York City, 1804–1865
      (pp. 578-579)
    • Appendix 3 Negro Mortality, New York City, 1821–1865
      (pp. 580-580)
    • Appendix 4 Mortality of the Foreign-Born Population, New York City, 1835–1865
      (pp. 581-581)
    • Appendix 5 Mortality of the Irish and German Foreign-Born Population, New York City, 1835–1865
      (pp. 582-582)
    • Appendix 6 Deaths from Specified Causes, Average Annual, New York City, 1804–1865
      (pp. 583-584)
    • Appendix 7 Deaths from Consumption of Negro and Foreign-Born Population, New York City, 1821–1865
      (pp. 585-586)
    • Appendix 8 Consumption Death Rate per 1,000 for Native White, Negro, and Foreign-Born Population, New York City, 1821–1865
      (pp. 587-587)
    • Appendix 9 Deaths from Asiatic Cholera by Nativity Status, New York City, 1832–1854
      (pp. 588-588)
  9. Bibliography
    (pp. 589-606)
  10. Index
    (pp. 607-619)