The History of public health in New York City has played a major role in social and political history since 1625. The main themes include history of. unsanitary condition; sanitation laws; organization of government public health agencies; provision of clean water supplies; disasters and epidemics of contagious diseases; the role of physicians and nurses; hospitals, medical schools, and philanthropies; minimizing infant and maternal mortality; changing life expectancies.
Before 1865
Before 1775, New York city was a relatively clean and healthy town. In the Dutch era before 1680s, cleanliness was a very high priority. By 1700 the need to help business had become an equal priority. By the 1790s it was a fast growing city facing the serious health consequences of increased population density and inadequate sanitation infrastructure. The main actions in public health in New York City before 1800 were reactions to sudden deadly epidemics.John Duffy, A History of Public Health in New York City, 1866–1966 (1974). pp 611–617 has a useful summary; Duffy, A History of Public Health in New York City, 1625–1866 (1968) is comprehensive. During the occupation of the city in the American Revolution, 1776–1783, the British housed thousands of prisoners of war in very unhealthy hulks in the harbor. Half of them died from disease.Philip Ranlet, “In the Hands of the British: The Treatment of American POWs during the War of Independence.” The Historian 62#4 (2000), pp.731–57. online
The city's first health measures were primarily focused on responding to outbreaks of diseases such as smallpox, yellow fever, and diphtheria. Doctors and ministers interpreted epidemics as God's punishment for misbehavior. Prevention did not appear as a viable option. However city leaders did use the quarantine to isolate New York from epidemics in nearby cities. In 1793, with a major yellow fever epidemic in Philadelphia, leading doctors organized a committee to prevent ships and sailors from entering New York's ports.Thomas R. Frieden, Protecting Public Health in New York City: 200 Years of Leadership (2006) pp. 4–8.
Business needs as well as human welfare helped shape laws regulating public markets, The goals were to maintain fair prices and food quality. Early attempts to manage garbage and human waste focused on minimizing offensive smells and sights. As poor immigrants arrived after 1783, there was a steady deterioration of the sanitary conditions and a corresponding increase in the crude death rate.Duffy, (1974) pp. 611-617.
Epidemics were short alarming episodes. By contrast in quiet times the government was passive. The Board of Health, established in 1805, usually did little until an epidemic brought business to a standstill. As early as 1790 a few doctors were studying which neighborhoods, ethnic groups or local conditions were connected to the most serious yellow fever outbreaks. This started a tradition of research that culminated in the 1860s, by which time experts doing in-depth statistical studies were setting public health policy.Richard Plunz and Andrés Álvarez-Dávila, "Density, equity, and the history of epidemics in New York City" (Earth Institute at Columbia University, 2020) online
1866-1897 Metropolitan Board of Health The Metropolitan Board of Health was established in 1866 by the Radical Republican who controlled the state legislature. It became a model for many American cities due to its innovative approach and effectiveness in addressing public health issues.John Duffy, A History of Public Health in New York City, 1866-1966 (1968) online pp.1–31."1866 – The Metropolitan Health Act was passed in New York" online
The Board was given extensive powers to create, execute, and judge ordinances related to public health. This comprehensive authority allowed for swift and effective action in addressing health crises. The Board leadership consisted of four police commissioners, the health officer of the Port of New York, and four commissioners appointed by the governor, three of whom were required to be physicians. This diverse makeup ensured a balance of expertise and perspectives.
Within weeks of its formation, the Board secured agreements with city butchers to clean up and relocate slaughterhouses, imposed health standards on the milk industry, improved water supply, and began cleaning city streets. When the cholera epidemic broke out in the spring of 1866, the Board successfully fought it with a stringent health code, house-to-house inspections, disinfectants, and quarantines. This resulted in a significantly lower death toll in New York City compared to other major cities.
The Board's formation was preceded by a comprehensive sanitary inspection of New York City, which revealed widespread poor living conditions in the slum districts. This data-driven approach to identifying and addressing public health issues became a standard practice adopted by other cities. Furthermore, the Board recognized the connection between housing, politics, morals, and health, setting a precedent for addressing the social determinants of health. The success of the Metropolitan Board of Health in improving public health conditions and managing disease outbreaks demonstrated the effectiveness of a centralized, empowered health authority. This model was subsequently adopted by other cities and states, shaping the future of public health administration in America.
Great Blizzard of 1888
The Great Blizzard of 1888 was the most severe recorded blizzards in American history. The storm paralyzed the East Coast from the Chesapeake Bay to Maine, as well as the Atlantic provinces of Canada. Upwards of of heavy snow fell in New York City and nearby areas. Sustained winds of more than produced snowdrifts in excess of . Railroads were shut down and people were confined to their homes for up to a week. Railway and telegraph lines were disabled, and this provided the impetus to move these pieces of infrastructure underground. Emergency services were also affected during this blizzard.
1898–1945
Cleanliness was a heavily promoted virtue, supported by the middle class and led by the public health community of physicians and experts.Duffy, A History of Public Health in New York City, 1866–1966 (1974). Street cleaning became a major item of the city budget and produced the sort of jobs that the machines wanted to distribute to their working class clientele.Daniel Eli Burnstein, Next to Godliness: Confronting Dirt and Despair in Progressive Era New York City (2006) Horses were used—in 1900 there were 200,000 of them in the city, producing nearly of manure daily. It accumulated in the streets and was swept to the sides like snow. The stench was so strong that urbanites welcomed the newfangled motor vehicles as a profound relief.
The city took the lead internationally to combat diphtheria, an often fatal disease that struck thousands of children annually. Researchers applied laboratory-based advances in bacteriology and immunology to the treatment and prevention of this disease, thereby eradicating it as a major threat.Evelynn Maxine Hammonds, Childhood's Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880–1930 (1999)
Private hospitals: From charity to upscale science and luxury According to historian Mike Wallace, in the early 20th century, a significant shift occurred in the city's private hospitals. In 1911 came the partnership of Presbyterian Hospital with Columbia University College of Physicians and Surgeons, In 1912 New York Hospital forged its own alliance with Cornell University Medical College.Antonio M. Gotto, and Jennifer Moon, Weill Cornell Medicine: A History of Cornell’s Medical School (Cornell UP, 2016) online. These collaborations marked a pivot towards medical education and scientific research, fundamentally altering how these institutions operated and who they served. Previously, 19th-century religious and charitable hospitals functioned much like public ones, primarily caring for the sick poor. Their focus was on care rather than cures, with little integration of medical practice. Wallace argues that the emergence of scientific medicine changed everything. Improved antiseptic practices made hospitals the ideal location for surgery, as medical advancements rendered home operations increasingly difficult. Hospitals offered doctors crucial technical resources and supported their professional independence. They also employed trained assistants, often women, who helped physicians efficiently treat more patients. This evolution solidified hospitals as central hubs for medical practice. Despite receiving funding from corporate philanthropists for new facilities, hospitals faced escalating operational costs. To remain viable, they began targeting wealthier patients, who had previously only sought hospital care in emergencies. To attract this new clientele, hospital boards redesigned their institutions to mimic luxury hotels. For example, Roosevelt Hospital marketed its private patients' pavilion as a refined choice for individuals with "the most cultivated tastes."Mike Wallace, Greater Gotham: A History of New York City from 1898 to 1919 (2017) pp. 554–556.
1916 polio epidemic.
The 1916 New York City polio epidemic was an infectious disease epidemic of polio ultimately infecting several thousand people, and killing over two thousand, primarily in the borough of Brooklyn. The epidemic was officially announced in June 1916, and a special field force was assembled under the authority of Dr. Simon R. Blatteis of the New York City Health Department's Bureau of Preventable Diseases, with broad authority to quarantine those infected with polio and institute hygiene measures thought to slow the transmission of the disease. Polio was a poorly understood disease in this era, and no polio vaccine existed at this time. Official efforts to stem its spread consisted primarily of quarantines, the closure of public places, and the use of chemical disinfectants to cleanse areas where the disease had been present. Special polio clinics were established at various locations in the city for the treatment and quarantine of patients. Many informal remedies or preventative measures were tried by the frightened population, while public activities largely fell silent. Ultimately, the epidemic subsided in the winter months, with the cause remaining a mystery to investigators and the public.“The Epidemic of Poliomyelitis in New York, 1916.” British Medical Journal vol. 2, no. 2950, 1917, p.51. online
Spanish flu pandemic of 1918-1919 New York City suffered about 30,000 deaths due to influenza or pneumonia out of a population of roughly 5.6 million in the worldwide "Spanish flu" epidemic of 1918–1919. The pandemic disproportionately affected young adults with a doubling of deaths among 15- to 24-year-olds. Health officials reacted vigorously. They set up more than 150 emergency health districts and centers for home care and case reporting. Hospitals, gymnasia, and armories were set up to care for the sick. They imposed a maritime quarantine for incoming ship traffic arriving from high impact cities. They mounted a large-scale health education campaign and regulated access to public spaces such as schools and theaters, which remained open under careful monitoring. The police enforced anti-spitting measures.
Stephen Smith