MUNICIPAL SANITATION: DEFECTS IN AMERICAN 
CITIES. 
' At the last meeting of the Public Health Association of Germany, 
in Wurzburg, each member received a handsome volume entitled 
“Wurzburg, insbesondere seine Einrichtung fur Gesundheitspflege 
und Unterricht ” ; that is, Wurzburg, especially its institutions for the 
care of public health and for education: a “ Festschrift ” or memorial 
volume, dedicated to the German Public Health Association, prepared 
at the request of the city, and published at its expense, by the Sani- 
tary Association of the city. 
Wurzburg is a University town of a little over 60,000 inhabitants, 
about the size of Wilmington, Del., or Dayton, Ohio; smaller than 
New Haven, Conn., or Cambridge, Mass. The “Festschrift” con- 
tains chapters on the geology, climatology, ground-water, river, his- 
tory, population, and death-rates of the city, and on its water-supply, 
sewerage, public baths, abattoirs, gas-works, schools, hospitals, public 
disinfecting establishment, modes of caring for the dead, prison, parks, 
laboratory for examining suspected articles of food and drink, and on 
the University and its laboratories and appendages. Some of these 
chapters are prepared by officers of the city, others by Professors of 
the University, and those requiring it are well illustrated by plans 
and views of the principal buildings. 
It is, in short, a complete manual of Wurzburg in its sanitary and 
educational relations—such a book as every educated citizen of the 
place would be glad to possess, and as every parent who was thinking 
of sending his son to the University would" wish to examine. We 
have nothing like it for any city in the United States, and it must be 
confessed that if any of our municipalities were to set about the prep- 
aration and publication of such a work, the results would probably 
not be very satisfactory when compared with the Wurzburg Fest- 
schrift. 
The great majority of the dwellers in our cities have not, hereto- 
fore, taken any active personal interest in the sanitary condition of 
their respective towns. They may grumble occasionally when some MUNICIPAL SANITATION: DEFECTS IN AMERICAN CITIES. 
305 
nuisance is forced on their notice, but, as a rule, they look on the city 
as a sort of hotel, with the details of the management of which they 
have no desire to become acquainted. They employ certain paid ser- 
vants to look after municipal affairs: there is a Board of Health, or a 
Health Officer, whose business it is to prevent or mitigate nuisances, to 
stop epidemics, and to keep the death-rate low; there are engineers 
to manage the water-works, sewage disposal, etc., and there are news- 
papers to criticise and instruct the authorities upon any and every 
possible subject connected with the cleanliness and healthfulness of 
the place. The individual citizen, if he thinks about the matter at 
all, usually concludes that this is all that need be done, and that if the 
results are not wholly satisfactory they must be accepted as the nec- 
essary outcome of politics or the weather, and do not involve him in 
any responsibility. Quite recently, however, there seems to be a 
growing interest in sanitary matters in our cities, and people are ask- 
ing whether the death-rates are higher than they ought to be; whether 
the city is in good condition to resist the introduction or spread of 
cholera, and to what extent it is worth while to expend money to 
secure pure water, clean streets, odorless sewers, etc. It seems desira- 
ble that this curiosity should be gratified as far as possible wherever 
it exists, and to this end it is proposed to present to the readers of 
The Forum some information as to the healthfulness, sanitary condi- 
tion, and sanitary needs of a few of our large cities. 
The best measure of the healthfulness of a given locality, whether 
it be a house, a block, a ward, or a city, would be the amount of sick- 
ness in proportion to the population, during a given time; but this 
measure we can use only in rare instances, because wTe cannot ascertain 
the amount of sickness. The next best measure is the number of 
deaths which occur in each thousand years of life, that is, in a thou- 
sand people living one year, or one hundred people living ten years, in 
the locality, being what is commonly called the annual mortality, or 
death-rate. To ascertain this we must have the number of deaths re- 
corded during the year, or, better, during a series of years—and the 
mean population for the period in question ; and to draw reliable and 
useful conclusions we must be able to calculate the death-rates sepa- 
rately for infants, adults, and old people, and for different parts of the 
city. Mere gross death-rates for the total population of a whole city 
give us very little useful information. Take, for example, the follow- 
ing table of death-rates of certain American cities for the year end- 
ing June 1, 1890, in which still-births are reckoned as deaths: 306 
MUNICIPAL SANITATION: DEFECTS IN AMERICAN CITIES. 
Cities. 
Death-rate per 
1,000. 
Death-rate per 1,000 
of Children under 
five years of age. 
Death-rate per 1,000 
of Impnts under 
one year of age. 
Newark 
29.04 
119.60 
389.35 
New York 
28.63 
116.75 
367.82 
„T , i White 
25.41 
' 87.33 
339.93 
New Orleans ] Colored 
36.61 
118.17 
482.17 
„TT. , . i White 
19.79 
79.25 
273.92 
Washington j Colored 
38.22 
205.20 
696.12 
Brooklyn 
25.54 
100.22 
324.43 
Boston 
24.79 
102.27 
330.00 
22.61 
94.76 
329.22 
Baltimore | Colored 
36.41 
208.23 
714.08 
San Francisco 
23.61 
89.14 
325.88 
Philadelphia 
22.67 
89.88 
292.78 
Cincinnati 
22.36 
89.35 
259.72 
Cleveland 
21.95 
93.94 
210.07 
Chicago 
21.06 
85.58 
285.90 
Detroit 
20.42 
84.09 
278.34 
Buffalo 
19.90 
75.06 
274.05 
St. Louis 
19.14 
72.64 
264.79 
Indianapolis 
18.85 
78.82 
274:15 
St. Pauf 
16.82 
71.54 
228.82 
It is evident that the proportion of colored people in a city makes a 
considerable difference in its death-rate, and that the proportion of in- 
fants present is a still more important factor. In every large city the 
death-rate in certain districts is from two to three times as great as it 
is in other districts; hence to obtain really useful measures of the 
healthfulness of a place—which will show where the dangerous spots 
are, and where remedies should be applied, we need to know the aver- 
age population and the number of deaths for different districts with 
distinction of ages and, in some cities, of color, in order that we may 
calculate these local death-rates. In the absence of this information 
we have no definite, reliable and accurate, or, in other words, scientific, 
means of discovering the location and character of the trouble in a sick 
city, or of telling whether the remedies are useful or not. We may 
guess, and estimate, and prescribe, as the doctors used to do before 
they learned how to count the pulse, and measure the temperature, and 
listen to the sounds of the lungs and heart, but it is all a matter of 
opinion and rule of thumb, with great variations in size and shape of the 
said thumbs. A proper system of municipal bookkeeping, which will 
show for different parts of the city the quantity of, and loss and gain in 
life, is, therefore, a very important sanitary need of a large city. The 
sub-divisions required for this purpose will not usually be wards, because 
ward boundaries are not formed with reference to altitude, or drainage, 307 
MUNICIPAL SANITATION: DEFECTS IN AMERICAN CITIES. 
or character of habitations, or other things which influence the health- 
fulness of a district. They should usually be smaller than wards, each 
including, as far as possible, a fairly homogeneous group of people, as 
for example a tenement-house group, a waterside group, a best house 
group, etc. 
Now it should be distinctly understood that it is not an easy matter 
to obtain the information and keep the records required for such a set 
of books as has been indicated. There is not much difficulty in ob- 
taining the records of deaths required, although even for this purpose 
constant vigilance is required to secure accurate returns as to age and 
cause of death, and, for persons dying in hospitals or public institutions, 
the proper locality to which the death should be charged; but the 
great trouble is to obtain the data as to the mean, or average, popula- 
tion of each group of ages in each district. No city in the United 
States has, or has ever had, such data for different parts of the city 
with the exception of the gross population by wards. In the eleventh 
census an attempt was made to provide such data for New York, 
Brooklyn, Philadelphia, Boston, Baltimore, and Washington, and the 
result may be the commencement of this kind of local records; but 
each large city should from time to time, at least once in five years, 
obtain this information for itself, ascertaining for each house the name, 
sex, age, race, and occupation of each inhabitant, and then compiling 
these by blocks or squares so as to be available for statistical material. 
Attempts to cheapen and simplify such a count by omitting details of 
age, race, and occupation are very poor economy ; these details are re- 
quired for many purposes in studies of means to improve the social 
condition, as well as of preventing unnecessary deaths, of the people. 
The most important factor in municipal sanitation is the general 
water-supply. For all our large cities this is abundant in quantity, 
since over half of it goes to waste, through leak) fittings, in trickling 
drops and tiny streams which do not even serve to cleanse the waste- 
pipes. The quality is also generally good. Nevertheless, almost every 
city has present or prospective difficulties in preventing dangerous or 
offensive pollutions of its supply, and the recent possibilities of an in- 
vasion of cholera have drawn attention to the matter almost everywhere. 
With a general water-supply comes the necessity for means of 
prompt removal of the water which has been fouled by use, that is, of 
sewerage. All of our large cities, with the exception of Baltimore, are 
provided with sewers, but these are in some cases unsatisfactory, hav- 
ing been badly planned, worse constructed, and too much uncared for, 308 
MUNICIPAL SANITATION: DEFECTS IN AMERICAN CITIES. 
and everywhere there is much work to be done in this respect to meet 
the needs arising from growth and extension of the municipalities. 
If we turn to the list of subjects treated of in the Wurzburg Fest- 
schrift, we shall find several things considered as matters of municipal 
sanitation which do not seem to have received much consideration from 
municipal authorities in this country, such, for example, as public 
baths and washhouses, abattoirs, public disinfection stations, etc. 
Public wash and bathhouses are to be found in many European 
cities, and are of great value in promoting cleanliness of clothing and 
of the person among the poor. To them poor women can take their 
bundles of soiled clothing and bedding, and by the payment of a small 
fee can have the use of tubs, tables, hot and cold water, and drying 
facilities, and can also have a bath. In the evening, males can also 
obtain baths there. Some of our cities have waterside swimming-baths 
for summer use, but public washhouses under municipal management 
and control are practically unknown in this country. Abattoirs, or 
public slaughter-houses, where all animals are examined by skilled 
inspectors before being killed, where the meats can be inspected, and 
where all the nuisances and dangers connected with private slaughter- 
houses can be either done away with or reduced to the lowest limits, 
are to be found in only three or four of our cities. 
In the constant struggle of health officials to prevent the spread of 
such contagious diseases as diphtheria and scarlet fever there are few 
things for which they find a more urgent need than hospitals specially 
calculated and set apart for the reception of this class of cases; yet very 
few cities are provided with them. There may be a shabby, desolate, 
dog-kennel sort of a building known as the pest-house, hastily erected 
during some former small-pox epidemic; but where is the place to which 
a lady living in a boarding-house, or temporarily stopping in a hotel, 
could take her child affected with scarlet fever ? ' Philadelphia, Balti- 
more, and Washington are now considering their needs in this respect, 
and a year or two hence it is to be hoped that they can give a satisfac- 
tory answTer to this question. What is wanted is a neat, attractive- 
looking building with a number of private rooms, and at least three 
totally distinct and isolated small wards for as many different kinds of 
contagious disease, where they will always be ready with clean and 
thoroughly disinfected rooms, bedding, and appliances to take the best 
possible care of a dangerous or suspicious case. 
Most of our cities are also in need of one or more public disinfection 
stations under skilled management, provided with the best modern MUNICIPAL SANITATION: DEFECTS IN AMERICAN CITIES. 
309 
means of disinfecting bedding, clothing, etc., and also with portable 
apparatus which can be sent to and used in an infected house. An- 
other important means of aiding to check the spread of contagious dis- 
ease, as well as of helping the very poor in their struggle to maintain a 
decent existence in the midst of sore trouble, is a public mortuary, a 
simple building in or near the poor quarter, where the bodies of the 
dead can be taken immediately after death and properly cared for, and 
where funeral ceremonies can be performed. The desire to preserve 
the dead mother or the dead child for two or three days in order to 
allow time to apprise friends and arrange for the funeral, is no less 
strong in the poor family than it is in the rich one; but when there are 
only one or two rooms, and the living must cook, eat, and sleep in the 
presence of the dead, this natural wish produces unnatural and some- 
times dangerous results. All large European cities, and many of the 
smaller ones, have public mortuaries, and their privileges are highly 
valued. They are not connected with pauper administration, a small 
fee is charged for their use, and they are used by transient visitors of 
the well-to-do classes when occasion comes. They are not morgues, 
although sometimes one room, with a separate entrance, may be set, 
apart for this purpose. They have a separate room for the care of the 
bodies of those dying of contagious disease, and special means of pre-. 
venting infection therefrom. I do not know of any public mortuary- 
belonging to any city in this country, although it is possible that there 
may be such. 
These illustrations of municipal sanitary needs are perhaps suffi- 
cient to explain the remark made near the beginning of this paper that 
if any of our cities were to publish a full and accurate account of its 
sanitary condition and needs, the result would probably not be alto- 
gether satisfactory. 
The problems of municipal sanitation will increase in importance 
in the near future. They must be handled by men who have devoted 
special study to them, but such men must be developed and sustained 
by an intelligent public opinion, demand, and sympathy. The steady 
increase of our cities, and of the poorer classes in those cities, is bring- 
ing about results which are attracting the attention of thinking men; 
and rapid transit, the housing of the poor, the education of the masses, 
the methods of dealing with the idle, criminal, and defective classes, 
are all inextricably complicated with sanitary problems and with each 
other. Voluntary associations of public-spirited citizens have been 
formed from time to time during the last thirty years in some of our 310 
MUNICIPAL SANITATION: DEFECTS IN AMERICAN CITIES. 
towns and cities, but they have usually been of only a few years’ dura- 
tion. Perhaps the Auxiliary Sanitary Association of New Orleans 
continued the longest. Quite recently a somewhat peculiar association 
of this kind has been formed in the city of Washington. This is called 
the “Sanitary League of the District of Columbia,” which declares its 
object to be the collection and diffusion of information with regard to 
existing or threatened dangers to the public health, and the aiding of 
the municipal authorities in their efforts to improve the sanitary con- 
dition of the District and to prevent the introduction or spread of dis- 
ease. The business of the League is managed by a council composed 
of the officers and of twenty-one additional members, elected annually 
by the members, and the work is divided amongst various committees, 
the most important of which are the local committees for the sub-dis- 
tricts into which the District has been divided. The chairmen of 
these local committees are members of the council, and each has au- 
thority to appoint as many members upon his committee as he deems 
desirable, the intention being that there shall be at least one for every 
square or block to collect information and furnish practical instruction 
when necessary. As no citizen of the District of Columbia has a vote, 
municipal politics there are very simple, and the conditions are un- 
usually favorable for the trial of such an experiment as that of the 
League, which it will be seen is somewhat like the Elberfeld system de- 
scribed by Professor Peabody in the December number of The Forum 
for 1892. 
In future articles the sanitary conditions and organizations of sev- 
eral of our large cities will be described and illustrated, so far as the 
obtainable data will permit. 
John S. Billings.