A great problem was left for the first civilized inhabitants of New York to determine. Nature had made ample provision for the metropolis of the western hemisphere. But two possibilities were attached to its occupation by man—it could be healthy or unhealthy, at the option of the people.

The conditions which made for health were: two large rivers of pure water, from the mountains and the sea, flushed its shores, carrying the outflow of its waste far away seaward; its soil could be thoroughly drained; its sewerage could be so Healthy or Unhealthy:
Which? constructed as to convey to the sea all forms of domestic waste and surface filth; its southern exposure towards the ocean insured sunlight and sea breezes; its inland situation supplied to its atmosphere the life-giving virtues of abundant vegetation; the climate was temperate.

18 The conditions which made for unhealthiness were: large areas of sodden marsh lands; a rock formation of shale, having a dip of the strata, nearly perpendicular, admitting the flow of surface water to great depths, thus poisoning springs and wells; numerous streams flowing into the rivers; large ponds of stagnant water; fierce summer heat.

From the year 1622 to the year 1866, a period of two hundred and forty-four years, the people elected that the city should be unhealthy. The land was practically undrained; the drinking water was from shallow wells, befouled by street, stable, Two Centuries and
a Half Unhealthy privy, and other filth; there were no adequate sewers to remove the accumulating waste; the streets were the receptacles of garbage; offensive trades were located among the dwellings; the natural water courses and springs were obstructed in the construction of streets and dwellings, thus causing soakage of large areas of land, and stagnant pools of polluted water.

Later, in these centuries of neglect of sanitary precautions, came the immigrants from every nation of the world, representing for the most part the poorest and most ignorant class of their respective nationalities. This influx of people led to the construction of the tenement house by19 landowners, whose aim was to build so as to incur the least possible expense and accommodate the greatest possible number. In dark, unventilated, uninhabitable structures these wretched, persecuted people were herded together, in cellars and garrets, as well as in the body of the building, until New York had the largest population to a square acre of any civilized city.

The people had not only chosen to conserve all the natural conditions unfavorable to health, but had steadily added unhygienic factors in their methods of developing the city.

The result was inevitable. New York gradually became the natural home of every variety of contagious disease, and the favorite resort of foreign pestilences. Smallpox, scarlet fever, measles, diphtheria, were domestic pestilences with which the A Plague-Stricken
Town people were so familiar that they regarded them as necessary features of childhood. Malarial fevers, caused by the mosquitoes bred in the marshes, which were perfect culture-beds, were regularly announced in the autumnal months as having appeared with their “usual severity.” The “White Plague,” or consumption, was the common inheritance of the poor and rich alike.

With the immigrant, came typhus and typhoid20 fevers, which resistlessly swept through the tenement houses, decimating the poverty-stricken tenants. At intervals, the great oriental plague, Asiatic cholera, swooped down upon the city with fatal energy and gathered its enormous harvest of dead. Even “Yellow Fever,” the great pestilence of the tropics, made occasional incursions and found a most congenial field for its operations.

Failure to improve the unhealthy conditions of the city, and the tendency to aggravate them by a large increase of the tenement-house population, offensive trades, accumulations of domestic waste, and the filth of streets, stables, and privy Enormous Sacrifice
of Life pits, then universal, caused an enormous sacrifice of life, especially among children. This fact is strikingly illustrated by the following comparison of figures taken from the official records.

The standard ratio of deaths to the total living in a community, where the death-rate is normal under proper sanitary conditions, has been fixed by competent authority at about 15 in 1,000 of population. The death-rate in New York, in the five years preceding 1866, averaged 38 in 1,000 population, which is 23 in excess of the normal standard of 15 in the 1,000. In a city with a population of 1,000,000, the estimated21 population of New York in 1865, a death-rate of 38 in the 1,000 means 23,000 deaths annually from preventable diseases.

Mortality statistics computed on a scale of forty years, the period during which New York has been under an intelligent sanitary government, still more impressively show the former waste of life through municipal neglect of the elementary principles of public hygiene. The lesson which these figures teach should be engraven on the memory of every man, woman, and child. Our authority is the annual report of the Department of Health of the City of New York, for the year 1908, in which appears the following statement.

“A remarkable decrease in the death-rate has taken place within the past forty years, a decrease comparing each decennial rate with the one immediately preceding represented by seven, seven, and eighteen per cent respectively, and comparing that of the first decennium with the individual year under review, a decrease of forty-seven per cent.”