The Living City | New York City >> 1910s

A half-century after the Citizens Association report, the City's public health officials were continuing to adjust and incorporate new ideas into older patterns of practice. Further, it was incorporating the germ theory into older notions regarding the relationship of the changing urban environment on the health of its people. In large measure because of the efforts of the organizers of the 1865 report, the City now had in place a permanent Department of Health that had the responsibility of controlling some of the City's worst environmental problems. Garbage collection, meat and milk inspections, pure water and sewerage systems had been installed throughout the City. Dead animals were now regularly picked up off the streets and fire safety codes augmented stricter enforcement of housing laws. Yet, serious and pervasive problems persisted and the types of diseases the City faced appeared to be changing. Neither smallpox, the classic epidemic disease of the eighteenth and nineteenth century, nor polio, a twentieth century terror, would be completely controlled until after World War II. Similarly, the influenza pandemic following the First World War claimed the lives of 12,000 New Yorkers and millions worldwide.

Despite decades of agitation and a rapidly evolving view of disease causation, the Department of Health was still faced with daunting environmental hazards. In 1912, the Public Health Department issued an Annual Report that, in dispassionate a language as possible, detailed the continuing environmental problems that New Yorkers faced. The Department of Health picked up over 20,000 dead horses, mules, donkeys and cattle from the City's streets during the year and recorded 343,000 complaints from citizens, inspectors and officials about problems ranging from inadequate ventilation, leaking cesspools and water-closets to unlicensed manure dumps and animals kept without permits. It also removed nearly half a million smaller animals such as pigs, hogs, calves and sheep. Furthermore, its meat inspection unit removed 5,669,470 pounds of spoiled poultry, fish, offal, pork and beef and carted 1,946 cubic yards of night soil from the backyards and privies of the City's tenements.

The scope of activities had expanded enormously over the course of previous half-century and the Department's budget now amounted to nearly $4 million. Significantly, a "remarkable and continuous decrease in the death rate ... accompanied the development ... of public sanitation," the Annual Report began. "In 1866, the year in which the department was organized, the death rate of New York City was 36.31 per thousand." But, the rate continued to decline, decade after decade, and had recently fallen to below 16. The Department was justifiably proud for over the course of just 45 years, there was a decrease of over fifty percent.

Somewhat startling, however, was the emergence of changing patterns of death in the City. The Report's author wondered whether the nature of disease in the City was undergoing a perceptible shift. "An enormous reduction in mortality [had] taken place in all age groups below forty-five, while there has [been] an actual increase in the mortality at all ages over forty-five." The infectious diseases of the nineteenth century such as smallpox, typhoid fever, diphtheria and pulmonary tuberculosis appeared to be claiming fewer and fewer of the City's children and young adults. But, cancer, heart disease and pneumonia were claiming larger and larger numbers of elderly. "Without exception," the Report quizzically pointed out, "the diseases in which a reduction of mortality has been effected belong to the class of infectious diseases, while of those diseases in which there has been increase in the mortality only one, pneumonia, belongs to that group." To the public health officials writing the Annual Report, "these facts [were] doubly significant." On the one hand, they showed "in an unmistakable manner the success of public sanitary administration which has heretofore directed its efforts almost entirely against infectious diseases." On the other hand, the Report "point[ed] with equal clearness toward the field in which public hygiene must [focus] in the future, namely, the reduction of mortality from the diseases of middle and old age."

Occupational deaths and injuries were dramatically underscored in 1911 with the Triangle Shirtwaist Company fire. One hundred and forty-six women died when they were unable to escape locked floors of the garment factory. This event not only prompted city government to form the Bureau of Fire to enforce factory fire regulations, but this disaster stood as a potent example of the injustice levied against poor immigrant workers. The Triangle Shirtwaist fire mobilized support for labor organization.

Unlike the moral undertone of the Sanitary Report of 1866 which had lain the groundwork for the creation of the Department, forty-six years later the 1912 Annual Report used decidedly different language to describe the progress of the past five decades. The victory of sanitary science over the disease toll of poverty and commercial development pointed to some lessons that appeared self-evident in early twentieth century America: "Generally speaking, a study of the vital statistics of New York or any community can hardly fail to indicate the enormous advances achieved by sanitary science in the past fifty years. Since the full benefits of the methods and practice of sanitary science are available to any intelligent and well-organized community which will make the necessary expenditures, it may be truly said that within certain limits public health is purchasable."

The moral tone of the 1866 Citizens' Association Report was replaced with new, professional and technocratic approaches to controlling infectious diseases. Cleaning the streets and improving sewerage systems, providing pure water and quarantining the sick became administrative and organizational feats that were accomplished without the moral and political fervor that had marked earlier reform efforts. For many in the City, infectious diseases became less of a threat and New Yorkers undoubtedly benefited, as measured both by declining mortality and lowered costs, from the improved environment. Public health supplemented its original mission to prevent disease with a new mission to attack the specific sources of disease through the use of the laboratory, medical science, individual treatment and the identification and sometimes the isolation of individuals capable of spreading disease.

The culmination of fifty years of political struggles to establish the Department as an important arm of the City's administration had left it with a new mandate and a changing set of problems. No longer would public health be limited to environmental engineering and food inspection. In future years it would find itself coming into conflict with providers of medical care as prevention of disease through inoculation and vaccination, prenatal and well-baby care, factory inspection and occupational disease prevention as well as treatment of communicable diseases such as syphilis and gonorrhea would force the field to venture in areas previously the preserve of the physician. Further, the emergence of chronic diseases and the apparent decline of infectious illness challenged the Department to redefine its mission and elaborate a new purpose and role. By the 1970s, just before the reemergence of communicable diseases such as AIDS and tuberculosis as pressing health problem in the country, public health professionals would venture into a wide range of policy and administrative areas.