If you were to time travel to Manhattan in the mid-19th century, you would encounter filthy streets, rampant disease, and political corruption. In short, the same problems that most cities in the world experienced at the time. Only worse.
When the Civil War ended, New York City boasted a mortality rate of 1 death for every 36 citizens. Living there was more fatal than Boston (1 in 41), Philadelphia (1 in 43), or anywhere in Western Europe. And unlike Philadelphia, which had benefited so much from Benjamin Franklin’s organized city planning, New York was constructed around a different model—the tenement system.
As immigrants poured in, rapacious landowners capitalized on the real estate opportunity by building huge housing developments. Dark, damp, dirty, and unventilated, the crowded structures were nests of wretchedness. Cellar-dwellings were below sea level, so residents slept on elevated planks to avoid floating when the tide came in.
Polluted drinking water and nonexistent sewers meant that the streets were no better. The result was that the city “gradually became the natural home of every variety of contagious disease, and the favorite resort of foreign pestilences.”
The Father of Public Sanitation
As a youngish physician during the Civil War, Smith wrote the Union Army’s surgical handbook and pioneered a knee operation that became standard until the 20th century. As an older physician, he started the American Public Health Association, the country’s first nursing school, and state hospitals where the mentally ill could receive more humane treatment. Later, after raising health concerns related to urban deforestation, he planted trees that line New York City streets to this day.
Smith’s most important contribution, however, was his campaign on behalf of the poor and dispossessed. He was part of a growing movement of reform-minded physicians known as the “sanitarians.” They saw environmental conditions as the primary spreaders of disease and blamed the inefficient public health department for New York’s astronomical mortality rate. Though this seems like a no-brainer, the city’s public health officials disagreed.
When he became the editor of the American Medical Times in 1860, Smith began publishing editorials about the need for better “civic hygiene” in New York. His cries were gradually heard, and three years later a “Citizens’ Association” made up of influential businessmen and lawyers appointed Smith to lead his band of sanitarians in gathering information about the problem.
Smith directed the largest sanitation survey ever made. Dividing the city into districts, he sent out physicians house-to-house, recording data on diseases and inspecting the cleanliness of tenements and public buildings. What they found was abhorrent: trash leaking from rotting wooden garbage boxes, blood from slaughterhouses flowing into streets. Children earned loose change by sweeping sewage on Broadway, clearing pathways for well-to-do citizens.
As he was finalizing the report, Smith went before the New York state legislature in February 1865 to present his findings, calling for the city to pass a bill establishing a health board that included qualified medical professionals. In April, he published the results of the sanitation survey.
The report shocked the nation. Despite this, three days after Gens. Grant and Lee met at Appomattox, the bill was defeated. Three days after that, President Lincoln was assassinated.
Longevity
Given his importance, it is surprising that a full-length biography of Smith took so long to appear; it was published this year. Physician-scholar John M. Harris Jr. painstakingly researched Smith’s life, drawing on previous notes from a busy mentor who had shelved the project. He even tracked down Smith’s personal letters kept by his descendants. The resulting book, “Pestilence, Insanity, and Trees: How Stephen Smith Changed New York,” offers the most complete picture of the doctor’s life.
Mr. Harris compares Smith to an earlier great physician, the Founding Father Benjamin Rush. Like Smith, Rush was an educator and public reformer who shaped the course of the nation. In “The City That Was,” written towards the end of his life, Smith wrote that “our century opens with a far brighter outlook.” He thought that improved public sanitation would eliminate infectious diseases entirely, even predicting that, “it now seems possible to restore the patriarchal age” when living past a hundred would be the norm. After Smith’s passing, some newspapers mocked his longevity expertise by observing that he died at 99.
Smith’s optimism may not be as naïve as it once seemed—according to the Pew Research Center, the world’s centenarian population is expected to grow eightfold over the next generation. So, one century’s laughable conjecture becomes the divination of the next. Just another way that Stephen Smith was ahead of his time.
