Health and Disease

• Cholera and Understandings of Disease in 19th Century New York
  
• The Citizen's Association Report on Hygiene and Public Health and the Metropolitan Board of Health
  

Cholera and Understandings of Disease in 19th Century New York
Today, we understand that diseases are caused by microbes. For much of the 19th century, however, both medical professionals and the lay public held different beliefs about what caused people to become sick.

When New York City was struck by epidemic cholera in 1832, ordinary citizens pointed to the prevalence of sinful behavior, as the cause of this latest malady. The men and women of New York, they believed, had infringed upon the laws of God, and cholera was his judgment. Medical opinion concurred, agreeing that those who were intemperate, imprudent, and filthy were predisposed to this most dreadful disease. Lacking a specific cause, cholera, like other diseases, was an influence in the atmosphere that threatened with death only those who had somehow weakened themselves through wicked and immoral deeds. As historian Charles Rosenberg has written, "Cholera was a scourge not of mankind but of the sinner… [and m]ost Americans did not doubt that cholera was a divine imposition."1

But cholera in 1832 was not only a disease that afflicted the sinner, it was also one that struck the poor in disproportionate numbers. In the minds of wealthy and middle-class New Yorkers, the same vices that condemned a man to poverty also predisposed him to disease. When the poorest Irish and African-American residents of the Five Points neighborhood fell to cholera in alarming numbers, it was not surprising as they were considered the most intemperate, imprudent, and filthy New Yorkers.2

When cholera again visited New York in 1849, ordinary residents continued to hold that the disease represented retribution for sin. Most New Yorkers also continued to believe that poverty was likewise a moral failing, and that the vices that produced disease also produced poverty. But stronger in 1849 was the notion that something more than morality determined sickness and health-lay people as well as medical men began to more and more recognize disease as a product of environment, "the city and the tenement assumed leading places in the list of cholera's predisposing causes."3

In the minds of observers, cholera and similar diseases did not affect the poor equally. The vicious, sinful, intemperate and unworthy poor were cholera's appropriate victims, not the prudent and industrious workman. For nativists, it was no coincidence that 40 percent of those who died of cholera in New York were of Irish birth. Irish homes were the filthiest, most crowded, and least well ventilated, conditions no doubt originating in poverty, but a poverty rooted in obvious moral shortcomings.4

By the end of the Civil War in 1865, most Americans had accepted cholera and other diseases as social problems rather than moral ones. During the Civil War, public health workers or sanitarians observed that there appeared to be something connecting dirt and disease-the cleaner the camp the healthier the soldiers. Indeed, when the third cholera epidemic threatened New York City in 1866, both physicians and sanitarians had confidently accepted the link between dirt and disease. Health inspectors applied the same logic to the rear yards of tenements-the cleaner the yard the healthier the residents.5

By 1866, the majority of physicians believed that decaying human and animal waste produced an indistinct poison or chemical substance responsible for causing diseases such as cholera. Most had yet to subscribe to the theory of disease specificity, the notion that each illness had a distinct and identifiable cause. Even in 1866, however, a small but growing number of physicians and public health workers were beginning to believe that microorganisms and not "poisons" were the true danger to the health of city residents.6

While sanitarians and doctors believed that filth caused disease, ordinary people, especially in the 1860s, would not have made as strong a connection between dirt and illness. During the mid 19th century, most ordinary Americans showed little concern for how they cooked or stored food, where they went to the bathroom, and where they got their drinking water from. 7

Yet moralism continued to inform understandings of disease despite a more earnest recognition of the link between unsanitary conditions and disease. Predisposing causes remained a significant underpinning onto which a greater awareness of the importance of sanitation was grafted. Dirty water and foul tenements might be responsible for contracting cholera, but so too were intemperance and immorality. Poverty might not be entirely one's own doing, but it was a condition still distrusted by city leaders.8

Despite a greater understanding of the connection between dirt and disease, physicians and public health workers could do little to protect city residents from the threats posed by illness. Cleaning streets, emptying privies, disinfecting tenement buildings, and inspecting food and beverage manufacturing all helped to mitigate the dangers posed by unsanitary conditions, but microbes can and do flourish even in clean environments, and sanitarians were not always completely successful at eradicating disease.9

In the early 1880s, for example, Martha B. Roosevelt, mother of Theodore Roosevelt, died from typhoid, a disease that had by then been labeled by public health experts a "filth disease." While today it is clear that she could have contracted typhoid from eating contaminated food outside of her home or by coming into contact with a person carrying the typhoid germ, as of 1884 these means of infection had yet to be discovered. Physicians and public health workers had to ask themselves: how could the family home, a mansion on West 57th St., equipped with the latest in plumbing, be contaminated by a "filth disease?" How could such a scrupulously clean woman, as Mrs. Roosevelt was purported to be, contract a disease spread by fecal contamination? Such instances confirm that, before knowledge of the microbial origins of disease were known and understood, not even the most fastidious of individuals was safe from the invisible carriers of disease. 10

The Citizen's Association Report on Hygiene and Public Health and the Metropolitan Board of Health
In 1865, the Citizen's Association of New York Council on Hygiene and Public health released its Report on the Sanitation of the City of New York. While civic leaders such as John Griscom had previously set out to document the living conditions of the working-class and poor, these early studies were rooted in the notion that disease, poor housing, and immoral and intemperate behavior for the most part affected certain predisposed individuals and communities. During the last years of the Civil War, the New York Citizen's Association, comprised of wealthy merchants and city leaders, organized to address what they considered to be indicators of the community's decay including political corruption and poor health.11

The Citizen's Association's action was fueled as much by self interest as by a concern for protecting the city's poorest residents against disease. Some of the city's leaders feared the rapid spread of epidemic disease from poor to elite neighborhoods. In the wake of the 1863 Draft Riots, many feared an equally violent uprising at the hands of a diseased immigrant population. Both of these exaggerated fears helped motivate public health reformers to action.12

Along these lines, in 1864 the association organized a ward-by-ward, block-by-block survey of the housing and sanitary conditions of Manhattan neighborhoods. Commencing just as 97 Orchard Street was completed, it paints an important picture of housing and sanitary conditions in New York at the time. For the first time, most city leaders and physicians believed that environmental conditions rather than a predisposition to intemperance, immorality, and squalor were responsible for the poor health of the city's population.13

Dr. J.T. Kennedy was the inspector for the Eight Sanitary Inspection District, an area coterminous with the 10th Ward, bounded by Rivington Street to the north, Division Street to the south, Norfolk Street to the east, and the Bowery to the west. Despite the ward's rapidly increasing German immigrant population, Kennedy found the area to be relatively sanitary, a finding he attributed in art to native German habits. For example, he praised the notable presence of sewer-connected privy for helping to maintain the "salubrious" living conditions here in New York's 10th Ward. Unlike many other tenements, the privies at 97 Orchard Street were connected to the sewer, suggesting that human waste was regularly carried away from the premises and that there may have been less of a risk of disease here than in other tenements. But as microbes can and do flourish even in clean environments, the presence of relatively healthy sanitary conditions in this part of New York failed to successfully eradicate disease.14

Widely distributed in a variety of forms, the 1865 Citizen's Association report laid bare the links between poverty, unsanitary living conditions, and ill health, and was used to compel city and state governments to create a permanent health department. As the threat of cholera again loomed, the New York State Assembly established the Metropolitan Board of Health in 1866. In part, the newly created Board of Health represented an effort by the New York State Assembly to wrest control of the City's existing health department from a corrupt City government controlled by the Democratic Party political machine, Tammany Hall. Equipped with police powers to a degree that until now was unheard of in any American city, the Board of Health set out to prevent the repeat of yet another cholera epidemic in the city of New York.15

Through its newfound authority to order quarantines and disinfection of unsanitary houses and rear yards the Metropolitan Board of Health successfully turned away a cholera epidemic from a city that by 1865 had become the largest and most crowded in America. City streets were cleaned, some 160,000 tons of manure was removed from vacant lots, over 4,000 yards were cleaned and disinfected, 771cisterns were emptied and 6,418 privies cleaned. Throughout the nation, communities large and small moved to create similar boards of health endowed with equally effective powers.16

Despite good Intentions, however, the Metropolitan Board of Health enjoyed a relatively short life. In 1870, New York passed the "home rule" charter, replacing the state commission with a municipal health department. Unfortunately, the New York City Department of Health was likewise plagued by corruption and a lack of adequate manpower.17