D. HEALTH HAZARDS OF URBAN CHILDREN

1. Human costs of urbanization and civilization, 1845

Griscom, Sanitary Condition of the Laboring Population of New York City, pp. 4-5, 21.

Griscom's study was inspired by Edward Chadwick's Sanitary Condition of the Labouring Population of Great Britain (1842) and was intended to promote a similarly comprehensive investigation of sanitary conditions in New York. For a summary of Griscom's efforts on behalf of sanitary reform a decade and a half after the 1845 study, see his Sanitary Legislation, Past and Future: The Value of Sanitary Reform, and the True Principles for Its Attainment (New York, 1861).

At all seasons of the year, there is an amount of sickness and death in this, as in all large cities, far beyond those of less densely peopled, more airy and open places, such as country residences. Even in villages of small size, there is an observable difference over the isolated country dwelling, in the proportionate amount of disease prevailing; proving conclusively that the congregation of animal and vegetable matters, with their constant effluvia, which has less chance of escape from the premises, in proportion to the absence of free circulation of air, is detrimental to the health of the inhabitants.

These circumstances have never yet been investigated in this city, as they should be. Our people, especially the more destitute, have been allowed to live out their brief lives in tainted and unwholesome atmospheres, and be subject to the silent and invisible encroachments of destructive agencies from every direction, without one warning voice being raised to point to them their danger, and without an effort to rescue them from their impending fate. . .

It is of course among the poorer labouring classes that such knowledge is most wanted. The rich, though they may be equally ignorant of the laws of life, and of the best means of its preservation, live in larger houses, with freer ventilation, and upon food better adapted to support health and life. Their means of obtaining greater comforts and more luxuries, are to them, though perhaps unconsciously, the very reason of their prolonged lives. Besides this, they are less harassed by the fears and uncertainty of obtaining for themselves and families a sufficiency of food and clothing. They are thus relieved of some of the most depressing influences, which tend to reduce the energy of mind and body in the poor, and render the latter more susceptible to the inroads of disease.

Sanitary regulations affect the pauper class of the population more directly than any other, because they live in situations and circumstances which expose them more to attacks of disease. They are more crowded, they live more in cellars, their apartments are less ventilated, and more exposed to vapours and other emanations, &c., hence, ventilation, sewerage, and all other sanitary regulations, are more necessary for them, and would produce a greater comparative change in their condition.

It is ascertained that in civilized communities, one-fourth part of all the human race who are born, die before attaining their first year; more than one-third before arriving at five years of age, and before the age of twenty, one half the human race, it is supposed, cease to exist. On referring to the last two annual reports of the mortality of this city, I observe that of the persons who have died, about the same proportion as is above stated, of all who are born, that is, about one-fourth died in the first year, about one-third before five years, but more than one half before twenty years of age.

No facts would speak in louder tones of the injurious operations of the circumstances of civilized life. That one-half should die before arriving fairly upon the broad platform of strength, usefulness, and hope in the world, is the significant finger pointing with unerring certainty to the sins of ignorance, and abuse of the bountiful and unfailing means of life and comfort lavished upon us by Providence, which lie at our doors. Can this ignorance of the laws of health be excused, or can this abuse of Heaven's bounties be defended? There can be no justification for either in the eye of the Creator and Giver of all things.

The savages who live in the caves of the earth, 'because they have neither the knowledge, nor means, to build houses, are pardonable; yet their natural instincts teach them the uses and necessity of fresh air and exercise. Yet we, who claim to be intelligent and civilized, who are taught the minutest particulars of nature's laws, suffer our numbers and strength, the bones, and sinews, and hearts of our people, to waste and die away in narrow and gloomy caverns of our own construction, with a rapidity surpassing that of the combined torrents of pestilence and war. Our sin is the greater that we permit these things in the midst of the light of science, and under the inspiring dictates of a religion, whose most prominent features are charity and love.

2. "This crowded mode of living," 1852

Philopedos, Sick Children in New York, pp. 3-10.

The population of the city of New York in the year 1850, was 515,392, and the number of deaths was one in thirty-three. The same census gives one in sixty-seven as the proportion of the deaths to the living population in the other parts of the State. This difference in the rate of mortality, in the city and country, appears to indicate the prevalence of more health, and a far better prospect of longevity among the inhabitants of the rural parts of the State; and the difference between the two is a matter of surprise, and, by many, can scarcely be credited. It is, however, perfectly accurate, and, so far as the city is concerned, received its corroboration from the report of the City Inspector for that year. . . [The report] also supplies another species of information of considerable importance, in explanation of the difference, and which can be obtained by referring to the table containing the ages of the deceased. It will there be seen that 8,052, or 61 per cent. of these deaths, were children under the age of ten years. In the year 1851 there were 22,024 deaths reported; of which number 11,856, or 54 per cent., were children at the same ages. During the seven weeks of the present year (1852) ending on the 28th of August, there were reported 3,712 deaths, of which number there were 2,480, or 66.81 per cent. children under the age of ten years. On examining also these records for a number of years past, the fact of the immense mortality among them, is one of the most prominent there mentioned; 49 per cent. being the average number for a period of sixteen years. It is evident, therefore, that the excess in the number of deaths for the city, is made up exclusively of young children, to an extent that is truly alarming.

Not only is this mortality excessive, but it appears also to have been upon the increase. This will appear, by comparing the number of deaths with the population at the different census periods; thus, in 1835, the deaths were as 1 in 46.87; in 1840, 1 in 39.74; in 1845, 1 in 37.55, and in 1850, 1 in 33.52.

The causes of this fatality among the younger portion of the population, must be referred to the peculiar condition in which people live in cities, acting especially upon such as are most liable to receive physical impressions. This condition is that of crowding a vast number of people in comparatively a small space, and the effect is the deterioration of the air that they breathe.

In a city like ours, the air, in over-crowded houses, must. . . become exceedingly impure. In summer, such a state of living becomes almost insupportable, and in some of the poorer parts, the doors, windows and steps may be seen in the evening crowded with people endeavoring instinctively to obtain a little fresh air.

As was just remarked, children suffer most from this crowded mode of living, and it is the children of the extremely poor that die in such frightful numbers and swell so enormously our city bills of mortality.

Many persons are ignorant of the large number of people that are in one house among the poor. The average number in an ordinary sized house is about fifty; and it is by no means unusual to find six permanent occupants of one room, and it is known to have reached the number of twenty.

All this is bad enough where the houses stand side by side fronting the street with some space in the rear; but it is inconceivably worse where every available spot of ground is occupied by some kind of building, and where double or treble the proper number are crowded together with barely space enough among them to reach the different entrances.

A more particular sketch, however, may be necessary to give the reader some idea of the needs of those who suffer most in such habitations, and for whom all must feel some interest.

Go with me, therefore, kind reader, on a visit to some of my dispensary patients. The scenes will of necessity be for you but the pictures of the imagination; for me they will be the strong reminiscences of the truthful scenes of years now long past.

Here is my memorandum. In addition to the name and number of the street, it has this observation, "Chd. 3 f. f.," which, translated into English, means "child, 3d floor, front." Here it is: an old house, the "3 f. f.," proves to be the upper floor of the building, next to the roof. There is no plastering, and the sun's rays streaming upon it, produces a great intensity of heat, which rarifies the air beneath it, while from the construction of the house, and from its situation, closely surrounded by others, there can be no direct passage of air from without; what little arrives, there comes through the midst of a score or two of people below. Both these causes so affect the air as to make it impossible to receive at each inspiration a sufficiency of oxygen to satisfy the hungry lungs; we feel that we are on an allowance, and are suffering lassitude and even faintness, and that if such a state of prostration should continue, we could not retain vital energy enough to resist the invasion of disease.

There are three little people sweltering in this air, for whom I am expected to prescribe. To direct any kind of medicine to be given to them is positively absurd; it is disheartening to visit such a place, and to be required to relieve physical suffering when the first and indispensible pabulum of life is wanting. We must leave them for the present, and endeavor, before our next visit, to devise something that, professionally speaking, "will fulfil the indication."

Let us change the scene from the heat of our tropical summer to the intensity of our winter's cold. "3r. row b.," which means "3d house, rotten row-basement." Every city has its "rotten row," and doubtless dozens of them. It is a favorite term, and a highly expressive one. The one I now refer to, stood – if that term is a suitable one – precisely where the building of the Northern Dispensary now stands. It was a row of very old houses which cannot be better described than it is by the name that was given to it.

When it rained hard, the cellars were overflowed with water. The numerous crevices and openings caused but little difference in the winter's temperature outside or inside of some inhabited parts of "Rotten Row." One of these is the cellar which we are now to visit. There, upon a pile of shavings gathered for fuel, portions of which adhere in hard frozen lumps, lies the mother of the child I am to prescribe for. She is dead drunk. One of the children is clambering over the mother, making vain attempts to awake her. The sick child, a neighbor informs me, has been taken into temporary charge by her, as it appeared to be perishing with cold. The natural instinct to render assistance to the helpless, or perhaps the exercise of the Christian principal of benevolence, has been exerted to relieve this little child from present suffering.

Let us visit "Rotten Row" in summer. We will enter again one of these dilapidated cellars. Why, the floor is covered with water! True, it rained hard last night, and these places are generally so after a hard rain: the water is only about half an inch in depth, and you observe that bricks are placed at convenient distances for stepping to the bedside, that the feet may not get wet. It is of very little importance to know what form of disease it is that we see in the bed, or what description of person lies prostrated by it; whether the robust man or feeble woman – the aged, whose day is rapidly closing, or the young child, whose morning has but just dawned – all present a hopeless task for him who would relieve them by the resources of the medical art.

I once knew a pool of water, that was in an area, burst through the foundation of a house, and empty itself into a room where people were sleeping, carrying with it a quantity of mud and sand; it is even said that some have in this way been drowned. Besides the heavy rains that overflow these places, the water not unfrequently gets into them by the tide rising, and people living in them have barely escaped with their lives. In one instance, on the extraordinary rise of the tide in a cellar in Washington street, it disturbed thirteen people, four adults, and nine children, during their sleep.

With or without excessive rains or unusually high tides, these places are always damp, and are thereby a continued source of various inflammatory diseases, rendered more complicated and unmanageable by the positive deterioration of the air from want of ventilation; indeed, the occupants of cellars are always sick in a never-ending rotation. Sickness among the poor is always great, and in these damp and badly-ventilated places is more protracted, besides being more fatal, especially among children, than above ground. More than two-thirds suffer some lingering disease, existing among such as are almost constantly exposed to the causes that are always in action in such places, as women and children. They pass most of their time, both day and night, in the confined air of their abodes, while the men pass the day at their usual out-door work, and are under "home influences" only at night. In many of these places the floors are rotten, and impart an odor peculiar to decaying wood, while the whole has a chilly feeling, and yields a damp earthly odor, strongly suggestive of the odor of a vault. It cannot, therefore, be a subject for wonder that, in proportion to the number of inhabitants, the demands for medical services should be much more numerous by the inhabitants of cellars than by others.

Another memorandum indicates that I have been desired to call at No. – ––- street, "ch'd. f. b.," which means "child, front basement." Here is the house. The door is locked. Knock. No response. Knock again. Still no notice is taken of us; it is evident that we can not gain admittance. We will not go away yet. I have had some experience in these matters before. Sick people are not in the habit of being removed when the doctor is sent for. Yonder is a little window through which we may look, and perhaps learn something of the state of things within, and of the reason wherefore we could not be admitted. Let us look into the apartment. Every thing is rather obscure, but as the eye becomes accustomed to the gloom, objects gradually appear with more distinctness. There are evidently two children in that room; one lying on a bed, and the other sitting on the floor amusing itself with some uncouth playthings. Now the condition of things is better understood. The mother has left these children alone, while she has gone to earn a trifle by a day's work. This is the reason also that a request, of which I took no memorandum, was left that I would call at a designated hour, at which time she doubtless left her work, and went home to see her little ones and meet the doctor. My engagements not permitting me to call at the time desired, she had again locked them in and had gone to finish her day's work. We can see things in the room a little more clearly; the little one on the bed has a highly flushed cheek, and is, no doubt, burning with fever, while there is no one – nor will there be for many hours – even to give it a drink of water. God help you, my poor little creature, in your loneliness and suffering!

Still another memorandum to visit a cellar. This one is in a rear building. The house is one of those that has been built on the rear of a lot of ground, even after it would appear that every spot on it had already its house. It is completely hemmed in, and as we descend, observe how extremely dark it is. In addition to the want of ventilation so common to all such places, there is a remarkable absence of light. From the position of the room the rays of the sun have never reached it, and it appears doomed to uninterrupted murkiness and gloom. Notice the inmates, how pale they are! what a waxen, cadaverous complexion these children have! the very lips are pale and the whole face is puffy and destitute of expression. The father and one child died about a month since, and the entire family appear to have been always sick.

Go with me now, after the lapse of a fortnight, to the New York Hospital, whither these children with their mother were sent. I must repeat the remark that this is no picture drawn by the imagination, but a simple truth. They begin to look as children should look. The first tinges of the ruddy hue of health have already appeared. They are cheerful and playful. What has brought about all this change? Not a particle of medicine has been given, but they have been placed in a large, light, and well-ventilated ward, while they have been supplied with ordinary healthy nourishment.

We may form an idea from this sketch of the causes of some of the sufferings of the poor, and learn also that those who have the least to do with the production of these causes and with any arrangement necessary for their physical comfort – such as can have no thought whatever upon the subject – are the principal victims.

It is certainly a remarkable fact, that those who could have had no agency whatever in causing the evils they suffer, should be among those that are first and the most grievously punished. . .

3. Tenements and health, ca. 1866

Stephen Smith, The City That Was (New York 1911), pp.18-21.

Stephen Smith (1823-1922), surgeon and pioneer in public health, was principal author of New York City's Metropolitan Health Law of 1866 and commissioner of the Board of Health, 1868-1875. The City That Was describes the sanitary condition of New York before 1866.

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, 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 by 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 tile favorite resort of foreign pestilences. Smallpox, scarlet fever, measles, diphtheria, were domestic pestilences with which the 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 typhoid 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 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 estimated population of New York in 1865, a death-rate of 38 in the 1,000 means 23,000 deaths annually from preventable diseases.

. . . The lesson which these figures teach should be engraven on the memory of every man, woman, and child.

1. Dairies and distilleries, 1842

Robert M. Hartley, An Historical, Scientific, and Practical Essay on Milk, as an Article of Human Sustenance; with a Consideration of the Effects Consequent upon the Present Unnatural Methods of Producing it for the Supply of Large Cities (New York, 1842), pp. 139-143.

Hartley (1796-1881) was one of the founders (1843), and for many years secretary, of the New York Association for Improving the Condition of the Poor.

Is anyone. . . still skeptical as to the pernicious quality of the milk with which he is supplied, or as to the patronage he is indirectly giving the distiller, though he uses not a drop of alcohol in any form as a beverage, let him accompany his milkman to his dairy, and, nineteen chances out of twenty, his doubts will be removed by a full demonstration of the facts insisted upon. If the wind is in the right quarter, he will smell the dairy a mile off; and on reaching it, his visual and nasal organs will, without any affectation of squeamishness, be so offended at the filth and effluvia which abounds, that still-slop milk will probably become the object of his unutterable loathing the remainder of his life. His attention will probably be first drawn to a huge distillery, sending out its tartarian fumes, and, blackened with age and smoke, casting a sombre air all around. Contiguous thereto, he will see numerous low, flat pens in which many hundreds of cows, owned by different persons, are closely huddled together, amid confined air, and the stench of their own excrements. He will also see the various appendages and troughs to conduct and receive the hot slush from the still with which to gorge the stomachs of these unfortunate animals, and all within an area of a few hundred yards. He will discern, moreover, numerous slush-carts in waiting and in motion, for the supply of distant dairies; empty milk-wagons returning, and others with replenished cans, as constantly departing. Moored off in the distance, he will, perhaps, discover a schooner discharging her freight of golden grain into huge carts, each drawn by four oxen, employed to convey it to the distillery mill, which, grinding at the rate of one hundred bushels per hour, rapidly converts the nutritious substance into slop and whisky, to "scatter firebrands, arrows and death," through the community.

This sketch, though drawn from actual observation, very inadequately represents one of the still-slop milk and whisky manufactories, in the vicinity of New-York. Description, to be effective, must be more minute. . .

The situation of Johnson's distilleries, and the manner of feeding the cattle with hot slop by means of gutters, etc., has already been given. The dairies have been formed around the distilleries, for the purpose of consuming on the spot the slop refuse of this extensive concern, which, as we were informed, distills about one thousand bushels of grain daily. The cowpens are rude, unsightly wooden buildings, varying from fifty to two hundred feet in length, and about thirty feet in breadth. They are very irregularly arranged, so as to cover the entire ground, excepting narrow avenues between; and appear to have been temporarily constructed, as the arrival of new dairies required enlargements for their accommodation. It is said they will contain about two thousand head of cattle, but this estimate, we would judge, is an exaggeration. The stalls are rented by the proprietor of the distilleries to the different cow owners, at from four to five dollars a year per each head of cattle, while the slop is furnished at nine cents a barrel. Slop constituting both food and drink, water and hay or other solid or gramineous fodder, supply no part of the wants to these abused animals. The fluid element, indeed, appears not to be in request for purifying purposes. Fountains of pure water, extensive hay-ricks, capacious out-houses, and similar conveniences, which are ordinarily deemed so important for the feeding and watering so large a stock, are here dispensed with as unnecessary appendages to a city dairy.

The interior of the pens corresponds with the general bad arrangement and repulsive appearance of the exterior. Most of the cattle stand in rows of from seven to ten across the building, head to head and tail to tail alternately. There is a passage in the rear for cleaning, and another in front which gives access to the heads of the cattle. The floor is gently inclined, but no litter is allowed. The stalls are three feet wide, with a partition between each, and a ceiling about seven feet high overhead. But the chief and most inexusable defects are the want of ventilation and cleanliness, though in the latter respect, since public attention has been called to their vile condition, they are somewhat improved. There appears, however, no contrivance for washing the pens, or by which a circulation of air can be produced. .

Such, then, as described, is the barbarous and unnatural treatment of this docile, inoffensive and unfortunate animal, that is destined to supply us with nutriment, both when living and dead, and which is one of the most valuable gifts of Providence to ungrateful men. Here, in a stagnant and empoisoned atmosphere that is saturated with the hot steam of whisky slop, and loaded with carbonic acid gas, and other impurities arising from the breath, the perspiration, and excrements of hundreds of sickly cattle, they are condemned to live, or rather to die on rum-slush. For the space of nine months, they are usually tied to the same spot, from which, if they live so long, they are not permitted to stir, excepting, indeed they become so diseased as to be utterly useless for the dairy. They are, in a word, never unloosed while they are retained as milkers. In some few cases the cattle have stood in the same stalls for fifteen or eighteen months; but so rapid is the progress of disease under this barbarous treatment, that such instances are exceptions to the general rule, and of very rare occurrence. Facts show that all the conditions necessary to the maintenance of health and life, are recklessly violated to an extent which, if not well authenticated, might appear incredible in a Christian community. Of course, by a law of physical nature, the digestion of the animals becomes impaired, the secretions vitiated, loathsome and fatal diseases are engendered, and if not seasonably slaughtered, and eaten by our citizens, the abused creatures die, and their flayed carcases are thrown into the river.

2. Effects of swill-milk diet on child health, 1858

Letter from Dr. John H. Griscom in New York City, Board of Health, Majority and Minority

Reports of the Select Committee of the Board of Health Appointed to Investigate the Character and Condition of the Source from which Cow's Milk is Derived for Sale in the City of New York. . . (New York, 1858), pp. 294-297.

In 1862 the New York state legislature passed an act making it a misdemeanor to "keep cows for the production of milk for market, or for sale or exchange, in a crowded unhealthy condition, or feed the same on food that produces impure, diseased, or unwholesome milk." See David T. Valentine, comp., A Compilation of the Laws of the State of New York Relating Particularly to the City of New York (New York, 1862), p. 965.

It seems scarcely necessary to reiterate the opinion which has been so often expressed by myself and others as to the value of good milk as an article of diet, and the disastrous effects of the impure substances which are called milk, and which are in great quantities supplied to our citizens, possessing scarcely any of the attributes of that important article of consumption. Medical books contain abundant evidence of the deleterious effects of an imperfect diet in children, and that swill milk is an article of that description is indisputable. . . That swill milk will not coagulate as readily or as perfectly as pure milk, shows that it is not milk in the proper sense of that word, though it may have been drawn from the source whence milk is taken. The microscope reveals the fact that the butter globules of this villainous stuff are essentially different from those of pure milk; and it is a well established law that any change in the mechanical organization of a compound body is an indication of a change in its physiological and chemical constitution. Pure milk, whose butter globules are always the same under the microscope, is the most wholesome food that can be given to a child; but swill milk is exactly the reverse. The property of coagulation of the milk is essential to its digestion. In the case of pure milk the gastric juice effects that process in a few minutes in the stomach, and the process of digestion and nutrition goes rapidly on. But with swill milk, coagulation requires sometimes as many hours as the other requires minutes. Without this coagulation in the stomach there can be no digestion, and no nutrition, and the mass of impure substance either remains in the stomach undigested, producing distressing symptoms of various kinds, or passes into the bowels, resulting in diarrhea, dysentery, cholera morbus, and many other direct diseases, besides numerous secondary ills not so apparent to the common observer, but which may be traced by the eye of the physician to the influence of impure or insufficient food.

If, in addition to the statements and illustrations already made upon this subject, any argument is needed by our fellow-citizens to prove the influence, direct and indirect, of impure diet, and examination of our necrological records will furnish it. For example, the total number of deaths of persons under five years of age in 1856 was 13,373. Of this number the deaths from diseases attributable, more or less directly, to defective diet and bad air, amounted to nearly one-half, viz, 6,558 . . .

In considering this dark catalogue of infants slaughtered, we are not to overlook the important fact that it is often owing to the debilitated condition of the body, arising from insufficient nutrition, that great havoc is made by several other diseases. It is not difficult to understand how a child, whose veins were filled with good blood, the result of nutritious diet and pure air, may withstand the shock of scarlet fever, or measles, or inflammation of the brain or lungs, or any other of the numerous ills which infant flesh is heir to, to which the victim of swill milk must almost certainly succumb. In this view we must add another thousand to this holocaust of children in that single year.