REPORT. TO THE GOVERNOR OF THE STATE OF NEW YORK: THE Board of Health of the Metropolitan Sanitary District of the State of New York, composed of the counties of New York, Kings, Westchester, and Richmond, and of the towns of Newtown, Flushing, and Jamaica, in the county of Queens, in accordance with the 19th section of chapter 74 of the Laws of 1866, respectfully transmits its Annual Report for the year 1866. This is its first report, and includes a general review of its proceedings from March 5th, 1866, the day of its organization, to the 1st of November, a period of nearly eight months. Sanitary science has attracted considerable attention during the past eighty years, but it is only recently that an earnest interest in the subject has been manifested. This is a remarkable fact, considering the antiquity of the Mosaic Code, the greatest collection of health laws ever published, and the numerous examples of sanitary intelligence furnished by ancient Greece, Rome and Carthage. The Hebrew laws directed what animals should be used for food, how they should be slaughtered, and that, if diseased, they should be rejected; and included rules for the conduct of the sexes and for the observance of cleanliness in their persons, homes and camps. Formerly these laws were imperfectly understood, but they are now acknowledged to be of supreme wisdom. Divine in their origin, they were impressed upon the minds of the people in the awful words, "thus saith the Lord." They were enjoined by threats of punishment and premature death to the disobedient, and by promises of happiness and long life to the faithful. Greece and Rome built aqueducts, gymnasia, baths and sewers-some of which still remain-and enacted laws relating to food, which were calculated to produce a hardy race of soldiers. The world fell back into barbarism, and all sanitary measures were neglected. The plague prevailed annually in Europe, and, as is supposed, carried off fully one-third of the inhabitants. The great fire of London, in the year 1665, followed the great plague. “It destroyed thirteen thousand houses and eighty churches, in four hundred streets. After this the city was rebuilt, with more roomy houses and broader streets, and the plague never returned again. The imperfect drainage still exposed the city to fevers and dysenteries, and from the former cause alone the annual mortality was between one and two thousand." The great fire was an impressive lesson as to the value of sanitary measures, and London, by gradual improvements, has become one of the largest and healthiest of cities, and has reduced its mortality from one in twenty to one in forty-five of its inhabitants. It is interesting to trace the reduction of the mortality, as civilization has advanced. In Geneva, the average length of life is now forty-five years. In 1833 and the ten years previous, it was forty years and five months. Two hundred years ago, the average period of life in that city and Canton was only twenty-one years. Marc d'Espine, a celebrated authority, shows that in Geneva from A. D. 1500 to A. D. 1600, the probable length of life was five years, and in the succeeding century eleven years, and at the close of the next century from 1790 to 1800. it was thirty-two years. In England, in 1801, the mortality was 1 in 44. In 1818. the mortality of London was 25.83 to 1,000 | Epidemic Cholera The death rate in the most populous city of the world, has decreased as sanitary measures have been adopted, the prevalence of epidemic diseases occasionally occurring to prevent the diminution from year to year. The same diminution of the mortality, is noticed in American cities, with the exception. of New York. In Boston, 1855, the mortality was 1 in 39. 1 H In Providence 1854, the mortality was 1 in 36. In Providence since then, the mortality was 1 in 43 to 57. The present mortality of London is 1 in 45. Liverpool, 1 in 44. Philadelphia, 1 in 44 to 57. The following Table of the Death-rate for the City and County of New York, from 1810 to 1865, is furnished by Dr. Harris. DEATH-RATE. (CITY AND COUNTY OF NEW YORK, 1810 TO 1865.) 1810 1815 1820 1825 1830 1835 1840 1845 1850 1854 1855 1857 1 in 1 in 1 in 1 in 1 in 1 in 1 in 1 in 1 in 1 in 1 in 1 in 1 in 1 in 1 in 46.50 41.50 37.20 34.40 39.00 40.40 39.70 37.50 33.50 23.00 27.50 27.20 36.00 32.00 33.33 1860 1863 1865 21.50 23.90 26.80 29.07 25.64 22.22 25.19, 26.66 29.85 43.48 36.36 36.76 27.77 31.25 30.30 So that New York, with its bountiful supply of water and more eligible situation, when compared with London, has increased its mortality from 1 in 46 to 1 in 331. How much can be accomplished by proper precautions in securing the health and lives of the people, is demonstrated by the following statement of Dr. Harris : "In one of the most densely populated wards (the Fifteenth Ward of New York), the death rate has been for several years less than 17 to the 1,000, and even during the terrible heat of last July, the uniform low mortality of that section was scarcely affected. The death rate in this ward with its 27,000 inhabitants, was, during the six months ending October 1st of the present year (1866), at the rate of 16.31 to the 1,000. In the same period, from April 1st to October 1st, 1866, there were in the Sixth Ward, bounded by Chatham, Canal and Broadway, 571 deaths, equivalent to an annual mortality of 54.63 to the 1,000. The Fifteenth Ward was insalubrious until it was sewered, paved and improved in the character of its population. Its boundaries are Fourteenth street on the North, Bowery on the East, Houston street on the South, and Sixth avenue on the West. The same success of sanitary precautions is manifested in the notoriously unhealthy parish of St. Giles, in London; every street and court has been brought under control, and the death rate has decreased from 50 in the 1,000 to less than 15 in the 1,000 annually. The same facts are established in Liverpool, Glasgow, Manchester and Salisbury, 'the sick city healed,' in which the mean rate of mortality was, by sanitary improvements alone, in ten years, reduced from 28 deaths in 1,000 to 15 in 1,000. Could the same improvement have been made in New York, during the ten years preceding 1865, with a similar reduction of the death rate, more than 12,000 lives would have been saved during that one unhealthy year. The rate of mortality that year was, on an estimated population of 825,100, precisely 30 to the 1,000; the total deaths reported by the City Inspector that year, being 24,843." LANE MEDICAL LIBRARY STANFORD UNIVERSITY MEDICAL CENTER STANFORD, CALIF. 94305 The mortality among children in American cities is frightful; one third die in the first year, and one half before they have attained their fifth year. Even here there are gratifying signs of improvement, for the mortality is much less than formerly. In Geneva, records have been kept since 1590, and it has been ascertained that a child has now five times greater chance of living to the age of twentyone years than it had three centuries ago. Notwithstanding occasional exceptions, the rule has been one of improvement; and it has been stated that during the last seventy-five years the average period of human life has been prolonged ten years. What a remarkable fact! Conceive of the misery avoided, the pauperism prevented, the diminished tax upon the world in the way of charities to support the destitute poor, the increased industry added to the nations from such a multitude of healthy and productive laborers, and the future value of a healthy progeny from so enlarged and vigorous a stock. A single glance at such results shows the value of sanitary knowledge, and elevates hygiene as a science, which is destined to do more good than all the medicines that were ever discovered or administered to suffering humanity. This subject must arrest the attention of statesmen and legislators; for upon the observance of these laws depend national wealth, power, and greatness, and upon their neglect, national decay and ruin. But to return to the children, "the hope of the nation." All must be humiliated at their great mortality, unless an explanation of the fact can be discovered. It would seem that we can succeed in raising domestic animals, but fail in rearing our own children. Are the means used or the circumstances which surround infancy to be blamed for this? We believe that it is filth and its concomitants which cause this great destruction of life. The heat of our summers is excessive, but that alone cannot account for it; for there are certain portions of the city, where cleanliness, water, and good food, abound, which show very moderate bills of mortality. Hot weather and filth, which, combined, originate the thousand of odors which vitiate the atmosphere, destroy these delicate beings. To this cause must be added the bad constitutions inherited from parents. Children, as a rule, do not during the first four years of their life, show the external signs of this diseased constitution; but it exists, and undoubtedly exerts a depressing influence, and renders the child less able to bear up against the destructive tendencies of disease. A physician can do very little with these inheritors of scrofula and syphilis, when attacked by other diseases; he is expected to treat them successfully, but cannot explain to the disconsolate parents the cause of his failure. His resources are powerless against the slckness which is made virulent by the sins of ancestors, and although he fails, he cannot but admire the Infinite wisdom which cuts off, thus early, these puny-bodied and feeble-minded creatures, before they are old enough to generate their kind. In the struggle for life the weakest die und the strongest live, and by the action of this law the race is improved. We see its agency in individuals of the same race and in the different races, when compared with each other. The weaker cannot improve, and must be overridden and finally supplanted by the stronger Admitting this to be the fact, it is nevertheless true that the circumstances, which curtail the lives of human beings, can be so arranged that even the diseased may outgrow their inherited vices of constitution, and their descendants, in the course of a few generations, may become strong and healthy. We believe that in the course of time the intermarriage of diseased persons will cease, and, under wise laws, men will live their allotted term. What has been said of the causes of disease among children may be applied to all the preventable diseases of the race. Most of the fevers, diarrhoeas, dysenteries, and consumptions, are caused by bad air, impure water, insufficient food and ill-ventilated dwellings; and small-pox, measles, and scarlatina, although they have a specific origin, are aggravated by the existence of these causes. From the neglect of sanitary precautions, two hundred years ago, the cities would have become depopulated, if it had not been that they were constantly renovated by new blood from the country; and it is a fact that even now, in our large cities, this source of their invigoration is their salvation. All suffer from the neglected causes of disease, but the poor pay the heaviest penalty. Their labor is their only capital, and the whole of it is often sunk in the contest with disease. Drunkenness, dissoluteness, and wretchedness, are found growing like luxuriant weeds in all places where bad air and poor food are found, and the offspring of these sufferers is brought up in neglect, without the physical ability to do the work of the world, decrepit, diseased, and dependent. It is estimated that to every death there are twenty-seven cases of sickness; so that in New York, on the supposition that there are eight thousand preventable deaths a year, we have a total of two hundred and sixteen thousand cases of illness which might have been prevented. The advancement of medicine as a science proves that remedies, given in the old empirical manner, are useless and injurious. The physician now studies the action of nature in the various functions of the human body, both in health and disease. In connection with the study of diseased action arises, necessarily, the perception of the essential nature of the disease itself, and consequently, of the multitude of causes which produced it, and which, when produced, imperilled life. To study and avoid these causes, is true sanitary science, and to medicine it offers a glorious future. The religious and moral obligations of man to his fellow-men have of late years assumed a nobler and more philosophical development. No individual can succeed in any great reform, or even be secure in his' own personal elevation, unless the race advances with him, and this cannot be expected so long as the majority are overworked and underfed, and compelled by the necessities of their condition to neglect their moral improvement and the cultivation of the intellect. Labor-saving machines, and a shorter time devoted to work, may have in reserve a great prospective good. In the earnest effort to save the souls of men, it has often been forgotten that the sure way to success is to begin with relieving their bodily necessities. As physical comfort leaves time for the cultivation of the moral nature, so the discipline of the intellect is not to be left out of the calculation in its influence over the physical well-being; for it increases human wants and furnishes |