“Great Centers of Pestilence”: Public Health in Civil War New York

Series historical adviser, Daniel Czitrom, discusses the death and disease that were caused by contaminated water and other health hazards in 19th century New York City.

Dr. Freeman doesn't think that the other doctor's diagnosis of cholera is accurate.

Dr. Freeman with a sick child effected by contaminated water.

Dr. Matthew Freeman struggles to treat victims of a mysterious disease afflicting large numbers of Five Points children, an outbreak he eventually traces to tainted neighborhood well water. Freeman advocates a more scientific approach to public health problems, based on direct observation of actual conditions.  New Yorkers  in this era suffered from unusually high rates of death and disease. In 1863 over 25,000 New Yorkers died out of a population of some 900,000, for an annual mortality rate of 1:35 (one death for every thirty five inhabitants). In the more crowded tenement districts the death rate approached 1:20, and for children under five, death rates of 1:5 or worse were not uncommon. These numbers were far higher than those found in English and French cities, or in Boston or Philadelphia. Baxter and Mulberry Streets, with their large piles of garbage and filth strewn alleys, were especially singled out as “great centers of pestilence.” One Mulberry Street tenement, housing 320 people, had 240 cases of typhus over three years, of whom 60 died. In another, 78 people shared one outdoor privy.

As a response to the Draft Riots, a group of doctors formed the Citizens’ Association of NY to address public health and related social problems. In 1865 it published the Report of the Council of Hygiene and Public Health, a landmark in the history of the nation’s public health movement. Performed mostly by young physicians, the Report provided an extraordinarily detailed, block-by-block overview of  New York’s sanitary conditions, It emphasized the city’s fearfully high death and disease rates, singling out several causes: overcrowded tenements; filthy streets; overflowing and neglected privies; lack of running water, proper sewerage, and drainage; nuisance industries, such as slaughtering, bone-boiling, and fat-melting, operating right next to tenements and schools; offal dumps and manure yards near populous streets.

Tenement House 1865 (via http://www.loc.gov/pictures/resource/cph.3c21734/)

An illustration of a funeral at a tenement house in Five Points.
Frank Leslie’s Illustrated Newspaper, 1865.

The Report helped propel two ground breaking laws through the New York State legislature. In 1866 the state created the Metropolitan Board of Health, with the power to make laws and regulations, and to enforce them through the work of fifteen professional sanitary inspectors and the city police. The act offered the first comprehensive health legislation of its kind in the U.S., and it established, in principle at least, the state’s inherent right to actively protect the public health and to challenge private property rights if necessary. The Tenement House Law of 1867 buttressed the Board’s authority to regulate tenement conditions and, as with the health legislation, it established the principle of the state’s power to curb the property rights of landlords and builders in the interest of the common good.