Historical Perspectives on New York City Health

Historical Perspectives on New York City Health Author(s): David Rosner and Amy Fairchild Source: International Journal of Mental Health, Vol. 28, No. 4, The City and Mental Health: Interdisciplinary and International Perspectives (Winter 1999-2000), pp. 9-19 Published by: M.E. Sharpe, Inc. Stable URL: http://www.jstor.org/stable/41344912 . Accessed: 25/09/2014 15:29 Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp

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International JournalofMentalHealth, Vol.28,No. 4, Winter1999-2000,pp.9-19. О 2000 M.E. Sharpe,Inc.All rights reserved. ISSN 0020-7411/2000$9.50 + 0.00.

David Rosner

and Amy Fairchild

Historical

Perspectives

New

City

York

on

Health

ofNew Memoryplaysan immensetrickon mostofus whowriteaboutthehistory York.We oftendependon memoirsthatshrouditspastin a gloriousaurathatcontrastsdramatically withour view of today'scity.In thewritingsof politicians, and even thecityof thelast generationseems marvelously authors, historians, today'scityseems exciting, organized,and wholesome.In contrast, exhilarating, and burdened with and of dissolution.In overwhelmingly signs symptoms decay theearly1970s,OttoBettman, who collectedand cataloguedthousands ofphotothis as the creation of New characterized of graphs nineteenth-centuryYork, process a "benevolent carefree America."1 haze"thatleaves"uswiththeimageofanebullient, thereare aspectsof periodspast thatshouldbe recalledand even Certainly, celebrated. itis of diseasein thecityall too clearlyillustrates, But,as thehistory to lament and characterize the of eras to the dangerous passing supposedlygolden as a of decline and When we reflect on the present period disintegration. somberly alike that "The late historians and know world the nineteenth[of past, laypeople our century city]was in no way sparedtheproblemswe considerhorrendously own"whether most disease.2 be crime,or, they homelessness, poignantly, poverty, whenwe putasideourcurrent andveryspecificfearsofurbanviolence, Similarly, orAIDS, we can see sidesofthemoderncity homelessness, tuberculosis, poverty, thatreflectitscontinuing and vibrancy evenhope. The nineteenth-century urban environment The processof historicalreconstruction is sometimespartof a broaderpolitical tothecityas a cause,rather that can focus attention on newcomers thanthe agenda intheHistory Theauthors areassociated withtheProgram ofPublicHealth& Medicine: 100HavenAve.,Tower3, Suite17A, andSociety, ColumbiaUniversity, Ethics, Policy, NewYork,NY 10032. Thisarticle isadapted from D. Rosner InD. Rosner (1995)Introduction. (Ed.),Hivesof sickness: Publichealth andsickness inNewYork. NewBrunswick, NJ:Rutgers University Press(fortheMuseum oftheCityofNewYork). 9


10 DAVIDROSNER ANDAMYFAIRCHILD in thelifeofthecommunity. imThisuse was particularly victims,ofdisruptions inthenineteenth as New YorkCityunderwent portant century changeas profound millionsofpeoplecame fromruralAmericaand Europeand as theenvironment and itseconomyweretransformed. racialstrife, class Despitewell-documented and theexploitation of womenin antebellumNew York, antagonisms, poverty, thatperiodcan all too easily appearto be an era of relativecohesivenessand disorder andpoverty ofthe salubrity, especiallywhencomparedwiththeapparent The industrial of the late nineteenth and century. city'sdemographic teeming city an transformation was hard to miss as Protesphysical English-speaking, largely tantcommunity became,bythe1880s,hometothousandsofCatholicandJewish The city,onlydecadesbeforea regionalcommercial hub,emergedas immigrants. thenation'sforemost centeroftrade,industry, and communication. finance, Along withthesechangeswenta profound in work,neighborhood, housreorganization and work and once clustered Homes, sites, offices, ing,family, transportation. aroundtheportsandcommercialsitesoflowerManhattan andBrooklyn'sshoreto areas of and Island Westchester.3 line,spread outlying Long Formanyinthemiddleandlatedecadesofnineteenth-century NewYorkwhose memoriesof thecitystretched back a fewdecades,recentchangeauguredboth andproblems.On theonehand,thecitywas obviouslyemerging as the possibility center of and in the nation. wealth Its culture, commerce, pre-eminent operahouse, to theculmuseums, plays,amusement parks,andmusichallswereall testimony turaldynamism On theotherhand,thepoverty, oftheCity.4 and illness,crowding, of the To Protestant New "foreignness" cityappearedfrightening. older,largely to denytheconnectionbetween"plaguesand people." Yorkers,it was difficult Norwas itpossibleto avoidincorporating nativist beliefsintoprograms aimedat disease. and a hostof intescontrolling Smallpox,cholera,typhoid, yellowfever, tinaldiseasesintheyoungandold alikeaccompaniedtherecognition ofpoverty, populationincrease,and immigrants. The fearsofan eliteclass ofantebellum New Yorkerswhobemoanedthepassof a in the ing "goldenage" city'shistorywas in largemeasurenostalgicand selective. death rates and pestilencehad longaffected richand poor highly High communities alike and longmarked"withshamethegreatCityof New York."5 of disease in recentdecadesappearedto contemporaries to confirm Yet,patterns thecommunity's New had York the worst health decay.By mid-century, among in thenation.Vitalstatistics statistics the showed that while one city gatheredby outofeveryforty-four in 1 in died 863 or New Boston York's people Philadelphia, ratewas one in thirty-six. Even whencomparedwithEuropeancenterssuchas Londonand Liverpool,New Yorkfaredbadly.In Londonand Liverpooldeath rateshoveredaroundone in forty-five aftertheintroduction of modernsanitary the fact that endemicconditionssuchas tuberculosis and diarpractices.Despite rhealdiseasesamongchildrenwereclearlymuchmoreimportant contributors to inthecitythanwereepidemicdiseases,theappearanceofscourgessuch mortality as cholerahad a veryreal significance as symbolsof theapparentrapiditywith


NEWYORKCITYHEALTH HISTORYII whichthecitywas beingtransformed. datawerecollectedandpresented Mortality in a waythathighlighted thecity'sapparentdecline.6 The attention ofthepoor"was notnewinNew Yorkin paid to the"conditions themiddlecentury. Butneverbeforehad therebeensucha generalizedsensethat of poorhealthwas becominga permanent aspectof thecity'slife.Investigations leaders as John the"conditionsof thepoor" had been conductedby such civic Griscomas earlyas the 1840s; butunderlying earlystudieswas thebeliefthat disease,poorhousing,and "immoral"conditionswerelargelyisolatedto certain In 1859reformers individualsand communities. orga"susceptible"orunworthy nizedtheNew YorkSanitaryAssociationin orderto agitateon behalfof a new to thecity'senvironmental administrative bodycapableofresponding permanent Associationjoined thereafter, crisis;andshortly duringtheCivilWar,theSanitary forceswiththenewlyformedNew YorkCitizens'Association.In 1864 theCitia CouncilofHygieneandPublicHealth,whosefirst zens'Associationestablished thecityin thehorrifying changesthathadovertaken agendaitemwas todocument blockthepreviousfewdecades.The associationorganizeda district-by-district, to-blockinspection of livingconditionsin Manhattan.7 In 1865just as theCivil Warwas endingand shortlyfollowingtheinfamous draftriotsof 1863, theNew YorkCitizens'Associationissued its finalreport, Sanitaryconditionofthecity.Dedicatedto thebenefitof"all classes inthecity," of thecity's thereportprovidedoverthreehundredpages of detaileddescription Comingat theendofa bloodywarthathad physical,social,andmoralcharacter. ofthecityas well,thereport cleavedapartnotonlythenationbutthecommunities leaderswho had commisreflected boththehope and thefearsof themerchant - a book,booklets,and pamin a varietyof forms sionedit.Widelydistributed - thereport thecityandthestatetoorganizea permanent wasusedtopressure phlets Board of Health the followingyear. Metropolitan In orderto accomplishtheenormoustaskof firstdocumenting thereasonsfor thehighdisease and deathratesin thecityand thendevelopinga planforpublic andprivateaction,thecouncilcalleduponNew York'sleadingphysicianstoparValentineMott,the"father ofvascularsurticipatein a fact-gathering expedition. American to remove an Willard the first Parker, successfully appendix;John gery"; of[NewYork's] theauthorofthefamous1845study"Sanitary conditions Griscom, laboringpopulation";StephenSmith,soontoheadNew York'snewMetropolitan Board of Healthand foundtheAmericanPublic HealthAssociation;and other inin a systematic prominent physiciansand civic leadersagreedto participate of the various districts. with the obcity's sanitary inspection Beginning spection servation that"pestilential diseases"laidbare"theimpotence oftheexisting sanitary that of the noted outbreaks disease paralyzedthecommercial system," physicians "Thepeoplearepanic-stricken andpoliticallifeofthecommunity: [and]theinterthe insensible and certain millions ." In a cityof estsofcommercesuffer loss by of less thatone millionpeople,fully7,000-10,000livescouldbe saved,itwas estimated,ifpropersanitary practicescouldbe developed.8Itwas clearthat"therela-


12 DAVIDROSNER ANDAMYFAIRCHILD tionof thehealthand vigorouslife of a people to the State,or to commercial in thedeveloping requiresno discussion."Disease was a commodity prosperity, that in and andan organized commercial could be measured dollars cents, capital the rates a and social to disease was necessity. high response political The recentwarhad illustrated onlytoo clearlythatlivingconditionsdirectly whether social or political affected efforts, well-beingand health."Reformatory as illustrated or exclusivelymoralandreligious"wereof "paramount necessity," the recent draft riots that had so traumatized the "The mobs thatheld city. by in violence in the month fearful our the memorable out-break of sway cityduring of July,1863,weregatheredin theovercrowdedand neglectedquartersof the thereader."The highbrickblocksandcloselycity,"thecouncilreportreminded seemedto be literally hivesofsickness houses where the mobs originated packed and vice." The reportwenton to pointoutthat: to believe,thatso muchmisery, It was wonderful to see,anddifficult disease, canbe huddledtogether andhiddenbyhighwalls,unvisited andwretchedness and unthought of,so nearourown abodes.Lewd butpale and sicklyyoung evwereimpudent andscattered women,scarcelydecentintheirraggedattire, and inthecrowd.Butwhatnumbers aremadehideousbyself-neglect erywhere inthosehoursofconflagra... To walkthestreets as wewalkedthem, infirmity! witheverywickedthing thedayofjudgment, tionandriot,was likewitnessing revealed,everysinandsorrowblazingly glaredupon,everyhiddenabominafire.. . . tionlaidbeforehell'sexpectant inthosewretchedly-constructed Theelements ofpopular discord aregathered wherepoverty, tenant-houses, disease,andcrimefindanabode.Herediseasein itsmostloathsomeformpropagatesitself.Unholypassionsrulein thedowithinand without, tendsto physicaland moral mesticcircle.Everything, degradation.9 The observation thathousing,politics,morals,andhealthwereall intertwined ofwhatneededto be doneforthecityinthe underscored thecouncil'sperception was theneed to documentand quantifythe comingyears.Of firstimportance ofurbanlife.Hence, theinadequacyofservices,andthehorrors degreeofsuffering, to repulsiveandnauseousscenesinthe thecouncilsetoutto expose"themselves localitiesand homesof disease abodesof miseryand want,and to theinfectious and death,in orderto be able to givean exactand completesurveyofthesufferwants."10 Witha voyeur'sacuity,an elite'ssenseof auings,perils,and sanitary thereportwas a remarkable ofmissionaries, andthemoralrighteousness thority, documentthatdetailedthephysicaland social life of mid-nineteenth-century New York. a citythatappearedto the The reportcan be used as a walkingguidethrough ofthevarious councilto be on thevergeof anarchyand collapse.In descriptions we find a wealth of about the infrastructure ofa city information neighborhoods, thatwas doublinginpopulation decade. The location of natusewers, nearlyevery ralsprings, and rock formation are detailed. We also can discern the enviponds,


HISTORY13 NEWYORKCITYHEALTH ronmental balancethathadbeendisrupted bytherapideconomicanddemographic of the Just north of development city. CityHall, forexample,intheareacurrently the Tombs and other layan areathat occupiedby cityandfederalofficebuildings, known as the"Colwater had been,in theearlynineteenth a pond century,pure lect."In 1800 it was the"largestpond on ManhattanIsland,"surrounded by a had been of Its waters and fields. hill from its sides,"groves, "high risingabruptly New Yorkers with and of unusual "greatdepth providingnearly10,000 purity," freshspringwaterwithwhichto maketea.11 Yet,beginningin theearly 1800s,theCollect was filledin, as its value for tenement housingbecame apparentto the emerginglandlordclass of thecity. Quickly,theCollectbecamea dumpinggroundfordead animalsandoffal,giving thearea "an insufferable stench."Then a canal was dug fromtheCollectalong Canal Streetto theHudson,and the area was gradedto allow forcommercial traffic its crowdedstreets.By theend of theCivil War,thetenements, through which"contained]4 to 8 familiesinas manyrooms,"coveredthearea.The lodgpersons. . . packedintoone small inghousesof thearea had "as manyas thirty as in thecase of one suchhouse on BaxterStreet,largeand room,"promoting, virulent outbreaks offever.12 The description of thearea providedthe SanitaryCommissionwitha vivid betweensocial and economicforces of theintimaterelationship understanding avenues The commercial thedistrict. thatcreateda slumand ill healththroughout oftheareawerepavedwithcobblestones, which,inturn,provideddeepcracksin withaccumulawhichrefusecollectedand rotted.The streetswere"veryfilthy" thearea,dead dogs,cats,and rats, tionsofmanurefromthehorsesthattraversed householdandvegetablerefusethatin winteraccumulatedto depthsofthreefeet withoffal,animalcarcasses, overflowed ormore."Garbageboxes,"rarelyemptied, watercollectedinthecarcassesofdead andhouseholdwaste."Pools" ofstagnant animalsand oversewerdrainsthatweregenerallyclogged."Filthof everykind intothestreets, obstructing [was]thrown coveringtheirsurface,fillingthegutters, and sendingforthperennialemanationswhichmustgenerate thesewerculverts, forthedisWilliamThorns,theSanitaryInspector diseases,"reported pestiferous thecourtyards trict."Drainageis generally being. . . belowthelevelof imperfect, at all timesofthe is thrownintothestreetandgutters thestreets" and"everything theregion, day."13 Although poorlydesignedsewershadbeeninstalledthroughout mostofthepopulationdependedupontheoutdoor"waterclosets"andpriviesin water. thecourtyards ofthetenement buildings,close to wellsused fordrinking oftenbecomthatwereprovidedweregenerally The fewamenities inadequate, The waterclosetsweregenerally"covered ingpublichealthhazardsthemselves. withfilth,so as notto be approachable."Otherswere "merely and surrounded trenches sunkenone ortwofeetintheground,thefluidsofwhich[were]in some instances allowedtorunintothecourts,stonesandboards. . . providedtokeepthe had no sewersconnectedto feetout of filth."Half of thehouses in thedistrict unbearableand them,makingthestenchthataroseduringthesummer"absolutely


14 DAVIDROSNER ANDAMYFAIRCHILD 43 stables,and406 "dramshops"addedto the brothels, perilous."14 Twenty-nine thatseventy-five generalizeddecayof a district yearsbeforeboastedthepurest waterin thecity. Most obviousto thevariousinspectors thatwrotethedistrict reportswas the stenchthatcharacterized thepoorsectionsofthecity.In district afterdistrict, the detailed the smell of that "sewer from the sewinspectors gas" escaped inadequate thepollutedwatersupply,thefilthy theoverflowing streets, age system, garbage, thecollapsingtenement firetraps.Inspechouses,andotherairless,overcrowded torafterinspector worriedthatthe"miasmas"createdby rotting foodsand filth threatened theneighborhood andthelargercityas well.Theyfearedthatthewortheyoungandtheold,andrichandpooralikeall weresuscepthyandunworthy, tibletothefeversandplaguesthatwerecarriedthrough theair,fromwhichno one was trulyprotected. "Familiarwiththehauntsof feverand otherpestilential disthe have the dismal and unwholeeases, Sanitary Inspectors fearlessly penetrated somequarters whereinfectious poisonsand deadlymaladiesmenaceinhabitants andvisitants, and fromwhenceemanatethemostdreadeddiseasesthatfindtheir to the more favoreddistricts of thecity."15 In New York,"Disease, debaseway and ... are found allied" and "seriouslyendangerthe ment, pauperism closely of all other classes."16 sanitary safety Remakingthecity The council's reportacceptedthatthe "fever-nests and small-poxfieldsthat the were neither nor "natural." inevitable disRather,infectious infest[ed] city" ease was controllable social and action.The through reordering administrative observedthat"comewhateventstheremaybe toaffect thephysical,social, report ofthecity,letitbe bornein mindthatSanitary political,or commercialinterests Scienceanditspreventive skillareofmorevalueto ourfellowbeingsandto this The reportproposeda citythanall thecurativeartsof medicineand surgery."17 of street the of sewers and program cleaning, building purewatersupplies,garand meat and milk bage collection, inspection. the Despitetherelativeabundanceof land acrosstheHudsonin New Jersey, EastRiveron Long Island,andto thenorthinWestchester, orwhatwe nowknow as theBronx,thepatternof building,economicdevelopment, and land use had createdin New Yorksome of theworld'sworstcrowdingand mostdepressing healthstatistics. In part,theextraordinary thecityin crowdingthatcharacterized themiddleof thenineteenth was its century producedby uniqueeconomyand built as a and locatedon an islandwithoutbridgesor tunnels, topography: port efficient or thecity'spopulationoriginallycontransportation,communication, centrated in therelatively narrowbandof landbetweenthetworivers.Yet,more economicandtopographic forcesplayeda rolein creatingmid-nineimportantly, New York's wretched The commercialcityhad teenth-century livingconditions.


NEWYORKCITYHEALTH HISTORY15 for createda skewedmarketforlandandhousingthatprovidedenormousprofits landlordsand absenteeownersbutdeniedwholesomelivingquartersto workers andtheirfamilies.18 In responseto thistransformation ofthehousingmarketandphysicalenvironinstituthecitycreateda permanent mentand to theresulting social disruption, to a of the a of as Public tion, Department Health, city'sattempt regulate part meatand milkinspection, conditionsthatcaused disease. Housinginspections, and sewerageservices garbagecollectionand streetcleaning,waterdistribution, thatsoughtto controlthe would all be organizedthrougha healthdepartment ofPublicHealthwouldbeenvironment. Soon,thenewlyorganizedDepartment whatwas considthenation,employing comea modelforothercitiesthroughout advancesin bacteriology. eredthelatest"scientific" But althoughthecouncil'sreportplayeda crucialrole in thepoliticaldrama theconditions thecreationofNew York'spublichealthdepartment, surrounding of lifeformanyNew Yorkerscontinuedto remainmarginalat best.In theyears wouldfocuson cleaningthestreets, thehealthdepartment followingitscreation, tenement reforms suchas sewerageandwastedisposal,andmandating regulating Itwould tosewersystems. thedevelopment ofindoorpriviesanddirectconnections base todevelopa scientific also seektobecomea leaderintheevolvingmovement New Yorkwould forpublichealthpractice.By theturnofthetwentieth century, notions in thedomainofpublichealth.Oldersanitarians' emergeas pre-eminent wouldslowlybe suppleofthecause ofdiseaseas residinginfilthandimmorality mentedwithnewer,ostensiblyscientific views,thatdiseasewas caused by specificpathogens,by bacteriaresponsibleforspecificdiseases. By attackingthe thanengaginginwhatcameto meansbywhichparticular pathogensspreadrather ofstreet be considered offumigation orexpensiveprograms meaningless programs couldbecomebothmoreecoclean-ups,itwas believedthatpublichealthefforts incontrolling andmoreeffective disease.Isolationofdiseased nomicallyefficient and laboratory vaccinationofpotentialvictimsof infection, individuals, analysis sanitarian of milksuppliesslowlygaineda place alongsidethemoretraditional theseolder,traditional, focusof thepublichealthdepartment.19 Simultaneously, and weremovedtonewdepartments ofsanitation, charity, publichealthprograms welfare. A half-century aftertheCitizens'Associationreport,thecity'spublichealth officialswerecontinuing to adjustto new ideas and incorporate themintoolder of practice.Further, it was incorporating thegermtheoryintooldernopatterns theinfluenceofthechangingurbanenvironment on thehealthof tionsregarding itspeople.In largemeasurebecause of theefforts of theorganizersof the 1865 of Health,whichwas report,thecitynow had in place a permanent Department forcontrolling someof thecity'sworstenvironmental responsible problems.Garhad meatandmilkinspections, andpurewaterandseweragesystems bagecollection, beeninstalled thecity.Dead animalswerenowregularly throughout pickedupoffthe andfiresafety stricter enforcement ofhousinglaws. codes augmented streets,


16 DAVIDROSNER ANDAMYFA1RCHILD Yet,seriousandpervasiveproblemspersisted;andthetypesofdiseasesthecity facedappearedtobe changing. Neithersmallpox,theclassicepidemicdiseaseof theeighteenth andnineteenth norpolio,a twentieth-century would centuries, terror, be completely controlled untilafterWorldWarII. Despitedecadesofagitation and a rapidlyevolvingviewofdiseasecausation,aftertheturnofthecentury theDeofHealthstillfaceddaunting environmental hazards. partment In 1912thedepartment issuedan annualreportthat,indispassionate language, detailedthecontinuing environmental problemsthatNew Yorkersfaced.The DeofHealthpickedup over20,000dead horses,mules,donkeys,andcattle partment fromthecity'sstreets fromcitiduringtheyearandrecorded343,000complaints andofficials aboutproblemsrangingfrominadequateventilation zens,inspectors, andleakingcesspoolsandwaterclosetstounlicensedmanuredumpsandanimals Italso removedfromthestreets keptwithout permits. nearlyhalfa millionsmaller animalssuchas pigs,hogs,calves,and sheep.Furthermore, itsmeatinspection unitremoved5,669,470poundsofspoiledpoultry, fish,pork,andbeefand carted 1,946 cubic yardsof nightsoil fromthe backyardsand priviesof the city's tenements.20 The department's hadexpandedenormously overthecourse scopeofactivities of theprevioushalf-century, and itsbudgetnow amountedto nearly$4 million. a "remarkable andcontinuous decreaseinthedeathrate. . . accomSignificantly, ... of publicsanitation," theannualreportstated."In paniedthedevelopment 1866,theyearinwhichthedepartment was organized, thedeathrateofNew York Buttheratehaddeclined,decadeafterdecade,until Citywas 36.31 perthousand." ithadrecently fallentobelow 16.The department was justifiably proud,forover thecourseofjust forty-five years,therehad beendecreaseofover50 percent.21 Somewhatstartling, was theemergence ofchanging ofdeath however, patterns in thecity.The report'sauthorwonderedwhether thenatureofdiseasein thecity was undergoing a perceptibleshift:"An enormousreductionin mortality [has] takenplace in all age groupsbelow forty-five, whiletherehas [been]an actual increaseinthemortality atall ages overforty-five." The infectious diseasesofthe nineteenth and pulmonary centurysuch as smallpox,typhoidfever,diphtheria, tuberculosis appearedto be claimingfewerand fewerof thecity'schildrenand youngadults.Butcancer,heartdisease,andpneumoniawereclaiminglargerand largernumbersof theelderly."Withoutexception,"thereportpointedout,"the diseasesinwhicha reduction ofmortality has beeneffected belongto theclass of infectious diseases,whileofthosediseasesinwhichtherehasbeenincreaseinthe mortality onlyone,pneumonia, belongsto thatgroup."To thepublichealthofficialswriting theannualreport, "thesefacts[were]doublysignificant." On theone mannerthe success of publicsanitary hand,theyshowed"in an unmistakable administration whichhas heretofore directeditsefforts almostentirely againstinfectiousdiseases."On theotherhand,thereport"point[ed]withequal clearness towardthefieldin whichpublichygienemust[focus]in thefuture, namely,the reduction ofmortality fromthediseasesofmiddleandold age."22Whatnewtech-


NEWYORKCITYHEALTH HISTORY17 niquescouldbe employedto addressthesenew challenges?Werethetraditional toolsofenvironmental clean-uporthenewertechniquesofvaccinationandmedical interventions adequate? of thesanitary Unlikethemoralundertone reportof 1866,whichhad laid the the health for the creation of forty-six yearslaterthe department, groundwork the to describe 1912 annualreportused decidedlydifferent language progressof ofsanitary scienceoverthediseasetollofpovthepastfivedecades.The victory development pointedto somelessonsthatappearedself-eviertyandcommercial America: dentin earlytwentieth-century a study ofthevitalstatistics ofNewYorkoranycommunity Generally speaking, failtoindicate theenormous advancesachievedbysanitary science canhardly in thepastfifty Since the full benefits of the methods and years. practiceof andwell-organized scienceareavailableto anyintelligent community sanitary it maybe trulysaid thatwithin whichwillmakethenecessary expenditures, P certain limits publichealthispurchasable The moraltoneofthe1866 Citizens'Associationreportwas replacedbynew, diseases.Cleanandtechnocratic infectious professional, approachestocontrolling the streets and ing improving seweragesystems, providingpurewater,and quarthe sick became administrative and antining organizationalfeats thatwere without the moral and fervor thathad markedearlierrepolitical accomplished and formefforts. Formanyinthecity,infectious diseasesbecameless ofa threat; in NewYorkersundoubtedly terms of both and lowbenefited, decliningmortality environments. Publichealthsupplemented itsorigieredcosts,fromtheimproved nalmissiontopreventdiseasewitha newmissionto attackthespecificsourcesof diseasethrough theuse of thelaboratory, medicalscience,individualtreatment, andtheidentification, and sometimestheisolation,ofpersonscapableofspreadingdisease.24 Conclusion:Disease as an indicatorofcommunityand social relations The culmination offifty toestablishtheDepartment of yearsofpoliticalstruggles Healthas an important armoftheNew YorkCity'sadministration had leftitwith a newmandateanda changingsetofproblems.No longerwouldpublichealthbe In future limitedtoenvironmental andfoodinspection. engineering yearsitwould finditselfcomingintoconflictwithprovidersof medicalcare as prevention of diseasethrough andvaccination, inoculation prenatalandwell-babycare,factory and thetreatment of communiinspectionand occupationaldisease prevention, cablediseasessuchas syphilisandgonorrhea wouldforcepublichealthtoventure intoareaspreviously thepreserve ofthephysician. theemergence ofchronic Further, diseasesand theapparentdeclineof infectious illnesschallengedthedepartment to redefine itsmissionand elaboratea newpurposeand role. thehealthproblemswe faceas a cityarelargelyof As inthenineteenth century,


ANDAMYFAIRCHILD 18 DAVIDROSNER fatalism underourowncontrol.Ourcurrent ourownmakingandalso potentially and diseases associatedwithpovertyand AIDS, tuberculosis, notwithstanding, andtherefore canbe addressed areina veryrealwaysocialcreations homelessness andhence real we create our environment In a social decisions. way, very through disease in theninetheconditionsin whichdiseasesthrive.Whetherinfectious teenth cholera,silicosis,oryellowfeverinearliertimes,orAIDS, cancer, century, heartdisease,or tuberculosis today,themannerin whichwe addressdiseasebemomentin history. ofa specificsocietyat a particular comesemblematic life in America's and marked disease shaped premiercityformuch Epidemic the Fora fewdecadesmidwaythrough and twentieth centuries. ofthenineteenth that infectious disbelieved most health twentieth analystsoptimistically century, ofvirueases were"conquered,"wereproblemsofthepast.Yet,thereappearance ofcholerain thepandemicofAIDS, andtheoutbreaks lentstrainsoftuberculosis, assessSouthand CentralAmericaforceus to wonderwhethersuch optimistic inthe faith a unbridled reflections of mentswereephemeral, generation's passing of curative medicine. potential diseases in their on thesocial responsesto infectious Focusingourattention ofcuringdiseases variousformscan helpus balanceourbeliefinthepossibilities themby improvingthe city's infrastructure, withthe necessityof preventing and hospitalsystem. and educational social services,and primary-care economy, andtyphus, were as such Acuteinfectious cholera,yellowfever, diseases, typhoid, we as a culturecreatedinthenineteenth as muchpartofthespecificenvironments as arechronicillnessessuchas heartdiseaseandcancer,AIDS, andtubercentury as culosistoday.Specificdiseases,and ourresponsesto them,can be understood well as discrete bioas andsocial relationships ofcommunity concreteindicators entities. logicalor sociallynegotiated Notes - Theywereterrible ! NewYork:Random 1. OttoBettman (1974)Thegoodolddays "thefresh andselectively remembered havefondly others House.Pp.xi-xii.Morerecently, ofNewYorkofthe1920sandhow"muchofNewYork"ofthatera"hasbeenwildly spirit" 's NewYork. NewYork:Fordham See:William S. Hall(1988)inChristopher Morley changed." Press. P. xvi. University 2. OttoBettman (1974)Ibid. which Wiebe(1966)Thesearch Richard 3. See,forexample, , 1870-1920, fororder lifeinthelate ofAmerican ofthetransformation stillranksas oneofthebestoverviews nineteenth century. 4. See DavidNasaw(1993)Goingout. NewYork:BasicBooks. andPublicHealth condition 5. Sanitary , Report oftheCouncilofHygiene oftheCity NewYork,1865.P.xii. Association ofNewYork. oftheCitizens' reaction ofthecityto oftheshifting 6. Ibid.P.xi.Forwhatis stillthebestdescription see also Charles thecourseof thenineteenth thisrecurrent century, epidemicduring ofChicagoPress. (1964)Thecholera Rosenberg years.Chicago:University A history 7. John Urbana: (1990)Thesanitarians: Duffy ofAmerican publichealth. ofIllinoisPress.Pp. 118-19. University


NEWYORKCITYHEALTH HISTORY19 8. Sanitary condition oftheCity.Op.cit.(note5). P.xii. 9. Ibid.P.xvi. 10.Ibid.P.xvii. 11.Ibid.P. 75. 12.Ibid.P.77. 13.Ibid.P. 76. 14.Ibid.P. 80. 15.Ibid.P.xxxiv. 16.Ibid.P.cxliii. 17.Ibid. 18.Thesignificance andsocialrelationships in ofthesechanging economic aredetailed Elizabeth Blackmar 1785-1850. Ithaca: Cornell Press. (1989) Manhattan forrent, University 19.Judith Leavitt back.Bacteriological andprac(1992)"Typhoid Mary"strikes theory ticeinearlytwentieth ISIS,83,608-629. century publichealth. 20. AnnualReport oftheDepartment ofHealthoftheCityofNewYork fortheYears 1910-1911.Pp.31-33. 21. Ibid.P. 11. 22. Ibid.P. 12. 23. Ibid. 24.SeeJohn inNewYork (1990)Op.cit.(note7);A history ofpublichealth Duffy City, vol.1,1625-1866;vol.2, 1866-1966);andJudith Leavitt (1992),Op.cit.(note19).
