Part 10

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 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 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 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

Min. Max. Av. London 20 24 22 Philadelphia 18 23 20 New York 28 41 33

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 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 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:

Average mortality of entire city 28 in 1,000 Mortality of better class 10 to 17 “ “ Mortality of tenant-house 50 “ 60 “ “

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 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. 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 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 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.