epidemics - Building the Skyline

November 27, 2023 by Jason Barr Leave a Comment

How Deadly Were Gotham’s Tenements? Infectious Disease in the 19th Century (Part II)

Troy Tassier and Jason M. Barr November 27, 2023

Prominent in the list of dangerous and aggressive nuisances are the tenement houses of the city….We thus speak of the inhabitants of the tenant-houses as constituting a class, and as being allied with the cause of sickness, pauperism, and crime. New York Times, June 12, 1865.

Throughout the 19^th century, New York City tenements garnered a reputation for vice, immorality, and, above all else, disease. As the above quote makes clear, most residents of tenement neighborhoods were lumped together and considered of equal nuisance. However, our previous blog post examined the risk of infectious disease mortality across Gotham’s wards during the height of tenement expansion from 1868-1910. We found something peculiar: some tenement neighborhoods had much lower infectious disease mortality rates than the citywide averages.

Density across Manhattan in 1895. Source NYPL Digital Collection.

In particular, the Lower East Side tenement wards were some of the safest in the city. On the other hand, more central and west-side tenement areas in lower Manhattan were among the most dangerous in terms of infectious disease mortality (see Figure 3 in Blog Post I). These differences beg the question: Why were some tenement areas relatively safe and others less so?

To begin the investigation, we plotted the rates of infectious disease mortality in the safe (Lower East Side) and less safe (risky) wards (Greenwich Village, Five Points, and the First and Fourth Wards) over time. The significant difference in risk began in the late 1880s. The decade from 1868-1878 saw minimal differences between these two regions. What was the same, and what was different about these wards? The short answer: it’s complicated!

Death Rates from Infectious Disease in Safer Tenement Wards vs. Riskier Wards. Note: The red line is the long-term city average (0.95%) from 1868-1910. Safe wards: 7, 10, 11, 13, 17. Risky wards: 1, 4, 6, 14. Source: here. For ward map see here.

Which of these things is not like the other?

Let’s review the possible hypotheses and see what the data suggest.

Tenement Concentration

At the beginning of our period, the 1870 census reveals that each group had about the same share of tenement homes, around 65 percent. Thus, each contained about 20 percent more tenements than the city-wide average. By 1900, New York’s explosive population growth led to a skyrocketing share of tenement dependence, with approximately 75 percent of all Manhattan residential units in tenements. (Data sources and analyses are here).

The safer wards closely matched this average, while the risky wards had a slightly higher share than the citywide average. Given that tenements were used citywide to house most residents, the presence of tenements in and of itself did not make one area riskier than another.

Density

Differing population density provides another possibility for the differences in mortality. Concentrating people increases the chances that an outbreak will spread quickly. However, density doesn’t fully explain the observed mortality difference. The safer wards were far denser than the risky wards. We can see the hyper-density of the Lower East Side (LES) tenements in the above map from the 1895 Tenement-House Committee.

In particular, the Tenth Ward had over 650 people per acre in 1900. All the wards in the safe grouping had at least 430 people per acre. On the other hand, the densest risky ward, the Fourteenth, had only 315 people per acre. All the other risky wards had under 235 people per acre. In short, the difference in mortality was not due to density.

Average Wealth

Wealth provides another potential reason for the difference in risk. Historically, more impoverished areas tended to be harmed the most during epidemic outbreaks. Other than the First Ward (which was wealthier per capita), the riskier wards had personal property per capita near the city median of $82 and real property per capita lower than or near the city median of $947 per capita. These wards were far from wealthy. However, the safer wards were even less affluent, on average. The LES Tenth, Eleventh, and Thirteenth Wards were the most impoverished of the city in terms of median wealth per capita—yet they had much lower infectious disease mortality.

Dampness and Poor Ecology

Could ecology and topography provide an answer? Damp areas and former marshes pre-European settlement might provide more fertile ground for disease than higher ground with better drainage, particularly for cholera and other waterborne diseases. We considered various possibilities, such as former marshlands, the presence of streams and other water sources, and the presence of Oak Tulip trees that grew on hillsides, where drainage was good. Again, none of these lead to a clear difference. In some areas, land conducive to the spread of infectious disease is associated with minimal mortality. Other sites that had a favorable environment had high rates of mortality.

In summary, most of the things that we associate as potential and obvious risk factors for infectious disease do not, in fact, correlate well with the different levels of infectious disease mortality. However, other differences stand out and begin to reveal the story of what was determining tenement health.

So, What’s the Answer?

To begin, we must step back and examine the bigger picture of change in the city. Manhattan’s population grew rapidly during this time. Between 1870 and 1910, the population increased by nearly 250 percent, from 942,000 to 2,330,000. Part of this increase occurred in the northern wards that were previously underdeveloped. The population of the Twelfth Ward (the northernmost and largest ward in terms of land area) grew by an astounding factor of 28. This was partly due to its minuscule population as of 1870 and its sheer size.

The city’s median ward saw its population increase by 26%. However, growth was very uneven across the island. Several southern wards, including three tenement wards in the risky group, saw population declines.

These three tenement wards stood in stark contrast to the safer tenement wards, each with a population that doubled (or more) between 1870 and 1910. This growth led to a sharp difference in density in this area compared to the other neighborhoods. This sharp rise in population and density would be expected to lead to more disease and not less. So, what happened? The explosive growth led to new construction in the area. These newly erected tenements met requirements that reformers put in place to keep the population safer from disease..

Enter Tenement Laws

As the population of Manhattan exploded, reformers worried about dangers of tenements. By all accounts, some dwellings were beyond horrible. The New York Times wrote of basements and backyards filled with sewage that drained into first-floor apartments. Interior rooms and entire apartments had no light or windows. Households with seven or more people lived in 6-foot by 7-foot rooms without space for everyone to sleep at once. Because of these poor living conditions, reformers called for action. As chronicled in the New York Times in 1865:

The fact is that the population of the city has become alarmingly great, and unless some attention is paid to its sanitary condition we shall be forced by the grim monster itself to bow down in dust and ashes of bereavement….

Is there a responsibility nowhere? Cannot something be done by the people, which will compel authorities to root out such abominations, remove such nuisances, and thus do much toward redeeming the children from lives of infamy, misery, and pollution?

In response, New York City passed a series of reforms to improve the safety of tenement buildings. The First Tenement Act of 1867 required a fire escape for each dwelling and a window for every room. The windows were intended to provide fresh air, ventilation, and light. However, many newly built apartments were compliant simply by installing a window to an interior hallway, which did little to improve ventilation.

Left: A Rooftop View of Two Dumbbell Tenement Shafts. Right: The Bottom of a Shaft. Sources: Left: Wikipedia. Right: Report of the Tenement House Department of the City of New York 1902/1903.

The Dumbbell

A series of additional acts improved conditions further and closed many loopholes. In 1879, windows were required to face a source of fresh air and light—not a hallway. Yet this, too, was met by developers with minimal compliance. Many newly built tenements simply added a narrow gap between buildings. This new building style became known as the dumbbell tenement after an 1879 competition meant to generate fresh ideas for tenement designs.

Developers typically erected this style of tenement stacked next to each other with only the narrow air shaft closed on each end, separating them as seen in the picture above. While this improved ventilation somewhat, later laws created more improvements. However, there was a problem with the dumbbell. Many buildings were not yet connected to sewers, and tenants could dump human waste and other garbage out of apartment windows into the narrow gap between buildings, creating new health problems. This was partly corrected in 1887 when each building was required to have an interior privy.

Two Tenement Plans. Left: A tenement that met the ventilation requirements of the pre-1901 laws. Right: A “new law” (1901) tenement plan that met the courtyard ventilation requirement. Source: Report of The Tenement House Department of the City of New York 1902/1903.

The New Law

Finally, in 1901, stricter and more comprehensive standards were established. New requirements ensured better lighting in hallways. Most importantly, indoor bathrooms were mandatory, and each tenement needed a large courtyard. The last requirement ensured ventilation because each room now had a window that opened onto the courtyard, a street, or the backyard. Most of these “new law” tenements were built in areas with the largest growth. These were the areas with the lowest infectious disease mortality in the city.

Safety with Growth

Data on new buildings and compliance with tenement laws is less available than data on infectious diseases. However, from the available data, the safer wards, which had higher rates of growth, were constructing more new tenements as the laws evolved to ensure more safety. This is also the time during which we observe the difference in infectious disease mortality in the two ward groupings.

For example, from an 1891 New York City Department of Health report, we found that the safe wards had 144 instances where building plans were filed for plumbing and drainage that year. The risky wards only had 16. A similar report in 1891 documents filings concerning light and ventilation. There were 152 filings for new building plans in the safe wards and 25 in the risky wards. From these data, it appears that by the 1890s, more new tenements were being constructed in the safer wards. This period falls shortly after the second generation of tenement laws were enacted.

We also can get a sense of the rate of new construction by looking at the total number of existing tenements in each ward in years where this data is available. In 1896, the safer wards contained 193 more tenements than in 1892. The number of tenements in the riskier wards increased by only 67 in these four years. Though we can’t directly ascertain building ages or compliance with the laws, certainly some buildings were torn down and replaced with improved and safer structures. The data gives us a sense that the safer group of wards had newer building stock that met the safer building codes of various tenement acts. Compliance with these more recent reforms likely made the Lower East Side Wards safer.

Additional evidence comes from reports of new tenement construction in tenement districts after 1901. The report’s maps show that far more new tenements were built in the safer wards.

New law Tenements Erected between January 1902 and July 1903. Dots represent 1902 construction and triangles represent 1903 construction. The majority of new tenements during this time period were built in the safer wards. Source: Report of The Tenement House Department of the City of New York 1902/1903.

Rear Tenements

The 1900 tenement house census gives us another glimpse of the age and quality of the building stock by counting the number of rear tenements in each ward. Rear tenements were additions located in the back alleys of tenement neighborhoods. Many were ramshackle dwellings that were even more spartan than the typical tenement buildings you see in movies or on a tour at the New York City Tenement Museum.

In most cases, rear tenements were the lowest form of shelter in the city. Sometimes, they were built purposely as residences. Other times, they were converted sheds or sometimes even old outhouses. Generally speaking, they were not the four- or five-story stone and brick structures that most envision when considering New York City tenement houses. The number of rear tenements in the risky Fourth and Sixth Wards was far higher than in any other ward of the city—nearly one in four. Again, this leads one to believe that the building stock in the risky wards was older than in the safer wards.

From whence They Came

The final significant distinction between these two groups of tenement wards concerns the place of origin of the respective tenement populations. As of 1900, each risky ward contained between 61% (1^st Ward) and 78% (4^th Ward) Irish or Italian immigrants. The Irish fleeing famine in the mid-19th century likely had little of monetary value upon arrival. While many immigrants from other locations certainly lacked wealth, they presumably were not as destitute on arrival as the Irish famine refugees.

On the other hand, the safer ward groupings contained populations overwhelmingly from Eastern Europe. Each of these wards had at least 75% of its population originating from Russia, Poland, Germany, or the Austro-Hungarian Empire. Many immigrants were Jews escaping discrimination and persecution. While they may not have been wealthy upon arrival, many were likely not as poor as those who settled in places like Five Points.

Two Photos of Rear Tenements in late 19^th Century Manhattan. Note the traditional tenement buildings sit in the background of each photo. Source: Jacob Riis’s 1890 book, *How the Other Half Lives: Studies among the Tenements of New York.* Images from here.

Reform for the Win

Putting all of these factors together, a picture begins to emerge. The riskier wards likely had older, less sanitary, and less safe dwellings concerning infectious disease risk. Because of their earlier reputation as bastions of infectious disease, they were likely avoided by all with the financial means to do so.

At the same time, other Irish and Italian neighborhoods emerged farther north in the city. The Fifteenth Ward, discussed in the previous post, contained just over 50 percent of residents with Irish or Italian heritage. So did the 21^st Ward just to the south of present-day Grand Central Terminal. Other areas throughout the city had significant Irish and Italian immigrant populations where people with relatively higher incomes could settle. The fact that some people remained in the most disease-ridden area of the city in older, decrepit housing likely indicates that these people didn’t have the financial means to escape to anywhere better.

On the other hand, the safer Lower East Side tenements likely contained newer buildings that were more sanitary and included more ventilation and light. It wasn’t that these areas were wealthy–far from it–but the living conditions and newer building stock likely allowed the people who settled there to avoid at least some risk from infectious disease mortality.^[1]

Reevaluating Death and Disease in the Tenements

While New York City’s 19^th-century tenement neighborhoods received a bad reputation for high infectious disease rates, there is far more nuance than the folklore suggests. Disease was part and parcel citywide in the 19^th and early 20^th centuries. No area, rich or poor, tenement or not, was spared from infectious disease risk. Yes, some tenement areas were particularly dangerous, but not all. Likely, the evolving tenement reforms of the late 19^th and early 20^th centuries created safer conditions in the tenement districts that saw the most population growth and new construction of safer buildings.

You can read Part I of the blog post series here.

Troy Tassier is a professor of economics at Fordham University. He is the author of the forthcoming book, The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us During Outbreaks. He also writes the At the Margin Substack newsletter.

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^[1] One can also understand how these wards might have earned an undeserved reputation simply because of their density. With so many people living in these areas, even an average level of infectious disease would stand out in absolute numbers. If two wards each had one percent of their population die during an infectious disease outbreak but one of the wards contained five times the density compared to the other, the denser ward would have five times the number of deaths. Thus, if newspapers and other sources of information simply report stories about the number of casualties, the denser areas will garner a more dangerous reputation that they don’t deserve simply because of the sheer number of deaths.

November 6, 2023 by Jason Barr Leave a Comment

How Deadly Were Gotham’s Tenements? Infectious Disease in the 19th Century (Part I)

Troy Tassier and Jason M. Barr November 6, 2023

Those sickened must be cured or die off, & being cheifly [sic] of the very scum of the city, the quicker [their] despatch [sic] the sooner the malady will cease.

John Pintard, a founder of the New York Historical Society and a former secretary of the New York Chamber of Commerce wrote these words to his daughter on July 13, 1832. New York City’s first great cholera epidemic had begun just two weeks earlier. The outbreak continued through September and 3,500 cholera deaths were officially recorded within the city. In just three months, 1.5 percent of New York City’s population died from the disease.

Pintard’s crass words matched the feelings of many 19th-century upper-class New Yorkers. For Pintard and others like him, illness from infection, particularly cholera, was a sign of moral turpitude. Those with an upright character were protected from ghastly contagions. In another letter to his daughter, Pintard stated these feelings explicitly: “At present [cholera] is almost exclusively confined to the lower classes of intemperate dissolute & filthy people huddled together like swine in their polluted habitations.”

Location of Officially Recorded Cholera Deaths in 1832. Source: Pulitzer Center.

In part, people of Pintard’s ilk were correct in their belief of the concentration of cholera. The Sixth Ward, the location of the infamous Five Points neighborhood, contained the most severe concentration of cases and deaths as the following map of 1832 cholera deaths reveals. The large red blotch in the middle is in Five Points. Although not known at the time, cholera was a waterborne disease and spread more easily in Five Points because the neighborhood was constructed over the filled-in Collect Pond, creating poor drainage before New York fully built out its water and sewer system. That the poor immigrants were “forced” to live over former swamps and lakes was, certainly, due little to their supposed immorality or “dissolution.” It was simple finance–those in Five Points couldn’t afford to live elsewhere.

The Safety Dance

As a prophylactic, many wealthy, on the other hand, simply fled to safer and more spacious environments. As historian Charles Rosenberg writes,

A hyperbolic and sarcastic observer remarked . . . ‘fifty thousand stout-hearted. . . New Yorkers scampered away in steamboats, stages, carts, and wheel barrows.’ Farmhouses and country homes within a thirty-mile radius of the city were filled. Yet the exodus continued . . ..

However, only the wealthy could afford to escape. Rosenberg further laments, “The poor having no choice, remained.”

The 1832 cholera epidemic wasn’t the first or the last outbreak to roil New York society. Smallpox and yellow fever were persistent concerns throughout the early decades of New York’s growth. Cholera, measles, tuberculosis, typhus, typhoid fever, and other infectious diseases would continue to devastate families throughout the 19^th century.

Poverty as Vice

In the popular consciousness, Manhattan’s Lower East Side tenements became synonymous with filth, poverty, density, and disease. In 1842, Charles Dickens described one dilapidated tenement in his American Notes for General Circulation:

What place is this, to which the squalid street conducts us? A kind of square of leprous houses, some of which are attainable only by crazy wooden stairs without. What lies beyond this tottering flight of steps . . . A miserable room lighted by one dim candle and destitute of all comfort, save that which may be hidden in a wretched bed. Beside it sits a man: his elbows on his knees: his forehead hidden in his hands. ‘What ails that man?’ . . . ‘Fever’ he sullenly replies without looking up.

Jacob Riis provided the most famous descriptions of life in the tenements in his 1890 classic, How the Other Half Lives: Studies among the Tenements of New York. Like Dickens, poverty, density, disrepair, and disease are inexorably intertwined in many of his descriptions. He describes one tenement apartment,

The family’s condition was most deplorable. The man, his wife, and three small children shivering in one room through the roof of which the pitiless winds of winter whistled. The room was almost barren of furniture; the parents slept on the floor, the children in boxes, and the baby was swung in an old shawl attached to the rafters by cords . . . The father, a seaman, had been obliged to give up that calling because he was in consumption, and was unable to provide either bread or fire for his little ones.

“Consumption,” at the time, was the term for tuberculosis.

Blaming the poor, for citywide epidemics, Riis wrote, “In the tenements all the influences make for evil; because they are the hot-beds of the epidemics that carry death to the rich and poor alike.”

Density and Disease: A Deeper Analysis

These quotes and others like them, give a sense that some lower class neighborhoods were continually beset with disease, while the ones housing the prudent and “upright” upper class were disease-free. Yet, the 1832 cholera map displayed above shows that there was clearly disease and suffering throughout the city. So, we thus need to return to the question, were the tenements really that much worse than other districts in terms of infectious disease mortality? Are the conclusions of the rich and the reformers as grim and conclusive as they suggested?

To investigate this question, we compiled data from the National Bureau of Economic Research (NBER), Historical Urban Ecological data set. The data set contains information on a variety of 19^th– and early 20th-century demographic and health-related data, including deaths from various infectious diseases from 1868 through 1927. The data set does not include all years—in particular data from the 1918-1919 influenza pandemic is missing, as well as infectious disease data for the years 1880-1888—but it does allow for us to study broader trends across time and space.

We focus our analysis during the height of tenement growth from 1868-1910. The data is organized at the level of New York City wards, which were neighborhood demarcations used for elections of various municipal offices, such as aldermen (analogous to today’s city council members). Across Manhattan, there were 22 wards. While they are numbered in a somewhat haphazard fashion (shown on a map below), in general, the lower-numbered wards were closer to the southern tip of the island.

Death Rates

During this period, the data reveal that, on average, about 0.95% of New Yorkers died per year from infectious diseases. Although rates of death certainly varied by age (with the youngest children particularly susceptible), we can think of this as a baseline risk that each person living in the city faced. In other words, unadjusted for age, location, or time period, an individual had just under a 1 in 100 chance of dying from an infectious disease each year. However, from the historical descriptions, we would expect that certain areas had higher risk than others.

To identify these differences, we run statistical tests (regressions) aimed at identifying the New York City wards with the most risk while controlling for yearly trends (mortality was falling over the second half of the 19^th century). (Data sources and results are given here.) The map below shows each ward’s death rate relative to—that is, above or below—the citywide average. The results suggest that the reformers and the wealthy scoffers did not quite have their stories right.

Blue indicates the ward had, on average, a lower death rate than the city average. Red indicates above the city average. White is about the same as the city average. Death Rate = total deaths from infectious disease / population. Source: here.

Across Wards

To focus on the heart of the matter, we have created a “matrix” of topologies by dividing the wards into those that contained relatively high or low density, respectively, and those that were “safe”/low-risk or “unsafe”/high-risk based on their death rates compared to the city average.

Low Density-High Risk: The First Ward

The First Ward sits at the southern tip of Manhattan. While it didn’t have the notoriety of the tenement wards for infectious disease it had the highest rate of infectious disease deaths anywhere in the city over our time of study. In the late 19^th century, before the opening of Ellis Island in 1892, this ward was the literal gateway for the majority of immigrants entering the United States through New York City. It is estimated that eight to twelve million immigrants passed through the Emigrant Landing Depot, known as Castle Garden, during its time of operation from 1855 to 1892.^[1]

Many of the immigrants arrived nearly penniless, and given their lack of funds they could not venture far from the landing when they first entered America. Often, they settled briefly in almshouses and boarding houses nearby as they searched for employment and more permanent housing. Unfortunately for these immigrants, our analysis suggests that the First Ward was the easiest place for contagions to multiply. Here deaths from infectious disease were 52% greater than the citywide average.

Although the First Ward receives far less attention than the Lower East Side tenements, elevated disease risk should not be surprising. During this time, the experience of most immigrants was tortuous. They were stuffed in the cavernous underbelly of a ship without ventilation and, in some instances, even light. It was not uncommon for some of these steerage passengers to die from disease or starvation en route to America. Although many were inspected for disease upon arrival, some infected passengers certainly passed through the port and into the First Ward undetected. Various diseases were thus let loose to fester in the First Ward where many immigrants made their first night’s sleep.

A photograph of New York Harbor, Governor’s Island, Staten Island, and Castle Garden Aquarium, 1894. J.S. Johnston photograph collection, 1890-1899. Source: nyhistory.org.

Low Density–Low Risk

In contrast to the First Ward, the adjacent Second Ward was one of the safest in the city. It sits between the southern port and the notorious tenement districts. John Pintard, whose quote began this post, was elected an Assistant Alderman of the East Ward (which became the Second Ward at a later date). This area was the original seat of affluence in Manhattan and home to many who made their fortunes as Manhattan’s first merchants and bankers.

However, after the Civil War, this district was given over nearly entirely to industry and commerce and had few residents of any stripe. Similarly, the Fifteenth and Sixteenth Wards also contained far lower infectious disease mortality. Each of the Second, Fifteenth, and Sixteenth Wards had infectious disease mortality 16% lower than the citywide average.

Late in the 19^th century, the northern wards of the city were at the heart of a great migration. As the lower wards became overcrowded, transportation options (such as the horse-drawn streetcars and later the elevated railways and the subway) allowed for faster and easier commutes from homes to places of work. Much of New York’s middle-class population moved north. As they did so they skipped over the dense tenement and manufacturing districts that populated Lower Manhattan above the Second and Third Wards.

Many of the affluent landed in places like the 15^th and 16^th Wards, along Broadway, Fifth Avenue, and around such parks as Washington Square and Madison Square. Throughout this period the northern wards had relatively low density and infectious disease mortality was near average or slightly below. Even the 22^nd Ward, home to Hell’s Kitchen, with shanty towns along the Hudson River docks, had infectious disease risk lower than the city average.

The High-Density Neighborhoods

Focusing now on the high-density neighborhoods, we see something that is not, in fact, obvious. Some of the densest wards had infectious disease death rates that were far lower than the city average. In fact, some of the most-dense tenement districts had the lowest infectious disease mortality in the entire city. This certainly suggests that density, in and of itself, was not the great evil that reformers portrayed it to be, at least in terms of infectious disease risk.

In particular, the tenement neighborhoods of the Lower East Side had two clusters—a higher-risk zone and a lower-risk one. The higher-risk zone was located in the central wards of Lower Manhattan that included Five Points, Little Italy, and Greenwich Village. The lower-risk zone, on the other hand, was located on the east side, and included dense Jewish and German neighborhoods. In fact, in 1900, the Tenth Ward, home to many Jewish immigrants, was arguably the densest neighborhood on the planet, with some blocks having densities as high as 1,000 people per acre. Yet, the Tenth Ward had infectious disease mortality 19% lower than the city average.

The Infection Puzzle

This variance in rates of infectious disease mortality across the tenement districts offers up a puzzle. Density and poverty were not uniform predictors of disease mortality. What was going on? Why did the reformers seem to overgeneralize and misunderstand what was happening in the 19^th century? We will provide the answers in Part II of this blog post, coming soon.

Continue reading Part II of the post here.

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^[1]Unfortunately, a fire at Ellis Island destroyed most of the Castle Garden immigration records in 1897 so precise counts and much history of entry through Castle Garden are lost.

June 16, 2020 by Jason Barr 1 Comment

Disease and Unease in New York City (Part I): Mortality Rates since 1800

Jason M. Barr June 16, 2020

Pandemic 2020

On March 11, 2020, the World Health Organization officially declared the COVID-19 outbreak a pandemic. The first case appeared in Wuhan, China, on December 31, 2019. It arrived in the United States toward the end of January. On March 1, the New York metropolitan region saw its initial infection, and soon after, it became one of the world’s epicenters.

The general response by governors across the country was to close businesses, schools, and other public institutions, and send everyone home to “shelter in place.” While the epidemic in New York is far from over, isolation policies have worked to the degree that the region can begin to reopen. Arguably, the reason that the coronavirus requires a swift and forceful policy of social distancing is that not only can the infection cause terrible illnesses, but is also frequently fatal, either from the virus itself or a secondary disease, such as pneumonia. A recent study estimated that as many as 13 people out 1,000 infected are killed by it (compared to 1 in 1,000 for influenza), though that estimate is likely on the high end.

But this raises the question of how bad has the COVID-19 epidemic been in terms of mortality rates for dense cities like New York? In many respects, the history of cities is the history of the ebb and flow of shocks to our health and well-being. Here, we review over two centuries of mortality rates in New York City to not only place COVID-19 in context but also to see how the nature of mortality has evolved. To do this, we separate mortality rates into two parts. First is to look at the baseline or trend rates, and second is to review the so-called excess death rates–those years in which deaths were unusually high relative to the norm. How does the increase in deaths from COVID-19 compare to other big epidemics of the past like the 1918 influenza outbreak or the frequent smallpox epidemics of the 19^th century?

Our Urban History

Taking this long-run view allows us to draw some conclusions. First, there is a complex relationship between density and mortality. Just because a place is dense does not mean it automatically has a higher death rate. Manhattan’s death rate peaked in 1849, yet its population continued to rise until 1910. New York City’s death rate has steadily fallen over the last 170 years (data sources are here).

Second, the city is far healthier today than it has ever been in its 400-year history. Before the coronavirus came along, one could argue that it was experiencing a kind of golden age of low mortality. And while COVID-19 is likely to increase the number of deaths in New York by over 40% as compared to last year, ironically, the death rate for the city will be as it was in 1995.

Third, despite dire predictions of the COVID-19 epidemic destroying the city, a long-run view suggests this conclusion is premature. New York, over the centuries, has weathered many, many epidemics. Though the suffering they cause is devastating, the city has not only survived but has also become stronger as a result. The seeds of tragedy plant the flowers for a better, healthier place. Horrible events are met by collective action that improves the human condition (though frequently more slowly than it should). While this may be small comfort to those harmed, it should help us, as a society, feel more confident about our cities.

Lastly, just as land values can be an indicator of the health of a city’s real estate and economy, mortality rates can be an indicator of the health and well-being of its residents. Constant advances in technology, scientific knowledge, and medical treatments generate improvements in the quality of life. On the other hand, because of random shocks (outbreaks of disease or terrorism) or ongoing urban problems (such as crime, poverty, or failures in governance), these forces drag down health and increase mortality. As a result, the history of mortality is like a horse race between the “good” and the “bad.” When mortality rates are rising, or even flat, it means urban problems are occurring at a rate that, on average, offsets the improvements. When mortality is falling, it means that the advances are winning. In the very long run, the improvements have (and will) carry the day.

Mortality Rates for New York City, 1804-2020. Mortality rates are total deaths per 1,000 residents. Note for 2020, I assumed total deaths from 2019 plus deaths from COVID-19, as of June 16, 2020 (this means the actual death rate for 2020 will likely be higher). Sources: See here.

Mortality since 1800: A Helicopter View

Before we proceed, however, one caveat is in order. The focus here is on gross mortality rates: the number of deaths per 1,000 residents. It is admittedly an overly broad indicator. Different groups, of course, have different mortality rates, such poor versus rich, and infants and the elderly compared to young adults, and so on.[1] A more comprehensive history would need to detail how the less-advantaged groups have fared over time. The quality of a society can be measured by the health of those with the fewest resources. Nonetheless, gross mortality rates can help tell the story of a city’s health and history.

Looking at the broad sweep of mortality in New York City shows, roughly speaking, five major periods. Period I is from about 1800 to 1860. This was a time of rapid urban growth alongside frequent and devastating epidemics (as will be discussed in more detail below), with death rates peaking before the Civil War. Period II is from about 1860 to 1890. This time can be called post-peak mortality, where death rates fell over the period returning to a level that was not seen until the early 1800s. Period III, from about 1890 to 1925, is the Mortality Transition, as mortality rates steadily declined, and converged to those of the United States as a whole.

Period IV, from 1925 to 1990, is what might be called net-zero mortality—two sets of forces were working at odds—improved health and medical care were fighting against ongoing urban problems, such as air pollution, crime, and unemployment. While death rates for the city stayed in a limited band, they began to diverge from the United States, which saw declining mortality. Period V started around 1990, after the crack cocaine epidemic passed, and crime rates began to decrease.[2] The death rate in New York City dropped to a new low level. This is where we were when COVID-19 came along. In fact, starting in 1996, New York’s mortality rate has been lower than that of the United States. Pretty good for a city that was (proverbially speaking) told by President Gerald Ford in 1976 to “drop dead.”

Mortality Rates and Population for New York City (Manhattan) from 1804-1890. Notes: Mortality rates are deaths per 1,000 residents. The trend line shows that mortality rates over the period did not change, on average. Also note that population estimates before 1865 are in 5-year intervals. Sources: See here.

The Epidemic Century

From at least 1791 to 1900, New York City experienced frequent and devastating epidemics.[3] One can even say that epidemics were a regular part of life. The “normal” baseline death rate in New York City, in a good year, in the first half of the 19^th century was between 25 and 30 deaths per 1,000 residents. But constant epidemics continually moved the city above that rate. Epidemics often doubled the death rates above the baselines. Between 1804 and 1887, there were at least 25 epidemics, for an average of one every three years. In fact, in the years 1834, 1849, 1851, 1854, 1864-1865, and 1872, two epidemics were occurring at the same time.

The Diseases

By far, up until 1875, the most frequently recurring epidemic was from smallpox. This is ironic since a vaccine was known since the early 1700s. Yet it did not entirely disappear from the city until after 1902 (though a brief resurgence came in 1947). Two diseases tied for second, in terms of frequency: typhoid/typhus fever, and cholera. Typhoid/typhus fever was transmitted through contaminated food and water, and from direct contact with the infected. Cholera was also spread by contaminated food and water. Additionally, Yellow fever was a regularly appearing epidemic, which first arrived in New York in 1791 and disappeared after 1822. It was transmitted by mosquitoes, which likely spawned in the marshes and still waters of the island.

Arguably, the worst year for the city was 1849 (just at the height of immigration from the Irish Potato Famine) when over 5,000 people died of cholera, and the death rate spiked to 60 deaths per 1,000 residents. The additional deaths from cholera, if scaled up to today’s population count, would amount to the equivalent of about 95,000 additional deaths in 2019! And, in the three years from 1847 to 1849, there were some 8,000 reported deaths from typhoid, cholera, and smallpox combined.

Panic in the City

The random emergence of the epidemics caused the same kind of panics then as we see with coronavirus today. As one scholar writes about the 1832 cholera outbreak,

On Sunday, July 2, despite a calculated official silence, the existence of the first cases of cholera in the city was an open secret. Mass exodus from the city had already begun. To those able, flight was the immediate and traditional reaction. A hyperbolic and sarcastic observer remarked later that on Sunday “fifty thousand stout-hearted … New Yorkers scampered away in steamboats, stages, carts, and wheel barrows.” Farm houses and country homes within a thirty mile radius of the city were filled.

The feeling of dread was a common element of city life, as historical demographer, Gretchen Condran, writes,

Cholera and yellow fever defined the practical and emotional meaning of epidemics during the late eighteen and early nineteenth centuries. Virtually no deaths from these two diseases were recorded in the nonepidemic years. They arrived suddenly, ran their course in a matter of months, and then returned some years later with little or no warning….That a person could be well in the morning and dead before nightfall, a stark contrast to the lingering illness associated with many epidemic diseases like tuberculosis, added to the fear and panic that accompanied these epidemic diseases.

Was Density to Blame?

While I will have more to say about the role of urban density and epidemics in a future post, suffice it to say, the relationship between population density and the severity of epidemics is not so simple. Dense tenement districts were often hot spots for the epidemics, and the poor disproportionately suffered more than the rich, many of whom fled the city during the crises.

But over time, diseases like yellow fever and cholera would largely be eliminated, even as the tenement districts became more crowded. While poor hygiene and lack of sanitation were part of the problem, so was the city-wide environment. New York City, then as today, was a great hub of economic activity, and it was mainly through the port that diseases would enter and spread.

At the time, when germ theory was still not largely understood, health officials assigned blame for these diseases on many factors that seem strange to us today. There were also moral dimensions to their assessment—the poor immigrants huddled together in their dank, dirty tenements were responsible for these diseases because of their poor characters. Or as stated in an 1865 report by the Association for Improving the Condition of the Poor in New York (likely referring to the Irish),

[L]arge masses of the population are debased by the wretched condition in which they are compelled to live. These conditions should be improved; still, it would be true of many thousands, that if left to the uncontrolled indulgence of their reckless, filthy habits, they would convert a palace into a pigsty, and create “fever-nests” and hotbeds of vice and corruption, under circumstances most favorable to health, comfort, and social elevation.

The Mortality Transition

Starting around 1890 or so, the regularly occurring epidemics became less devastating. This is not to say the city was free of epidemics, but those that did occur killed proportionally fewer people. And overall, by the late 1880s, the death rate in New York City began to fall quickly. In 1890, there were 25 deaths per 1,000 residents. By 1925, it was more than half of that at 11.4.

The reasons for the mortality transitions were many. First, scientific knowledge of germ theory helped people better understand and prevent the spread of diseases. In the second half of the 19^th century, New York City expanded its water and sewerage system, which, over time, became universal. Housing reforms cracked down on excessive crowding and unhealthy living conditions. Mass transportation investments and rising incomes allowed people to live further away from the city center and have more housing.

Mortality Rates for New York City and the United States, 1920-1990. Note that mortality rates are deaths per 1,000 residents. From 1920 to about 1940, mortality rates in NY were lower than the U.S. Then they began to diverge, with rates in New York city rising from 1955 to 1970, a difficult period for New York. Sources: See here.

Flatlining

But starting in the 1920s and up until around 1990, mortality rates in New York remained steady, between 10 and 12 deaths per 1,000 residents. What is particularly noteworthy is that mortality rates declined faster in the U.S. than in New York City. However, New York was suffering from a series of problems that were counteracting improvements overall. The effect was a kind of net-zero for gross mortality rates—improvements and problems were offsetting each other. From 1955 to 1970, mortality rates in the city were, in fact, increasing, even while they were falling throughout the rest of the country.

New York, during its industrial heyday, was a very polluted and congested place. Starting in the late 1960s, the city’s industrial base began to disappear, putting many low- and middle-class people out of work. Racial problems intensified as cities throughout the U.S. saw the rise of so-called black ghettos, marked by hyper-segregation and concentrations of poverty, crime, and drugs. In 1975, the government was on the verge of bankruptcy and was forced to reduce services that protected the public. City problems were killing people faster than medical improvements could keep them alive.

Homicides in New York City, 1804-2019. The orange line is homicides per million residents. The blue line is percent of deaths from homicide. Sources: See here.

The Role of Homicides

New York City has always had to deal with violent crime and homicide. Here we take a brief detour to look at the long-run role of homicide in influencing mortality rates. The conclusion from this analysis is that homicides have always represented a small fraction of the total number of deaths, even in the most violent years. In the 1970s and 1980s, homicides accounted for between 2-3% of total deaths (which, of course, is still too many). In 2019, murder rates were as low as they have been since the 19^th-century. Before the modern period, the Civil War era was particularly violent, especially during the Draft Riots of 1863. Though the official figure was that 119 people killed, estimates of the actual number is as high as 1,200.

Mortality Rates in New York City, 1980-2020. The orange line up to 2019 are actual mortality rates. For 2020, mortality is estimated based on last year’s death rate and number of current recorded deaths from COVID-19. The red circle for 2001 is deaths from the 9/11 terrorist attacks. The black line is the mortality rates excluding HIV/AIDs, 9/11, and COVID-19. Sources: See here.

A New Hope: Since 1990

And then, perhaps unexpectedly, death rates in New York City began to decline. In 1990, mortality rates were about 10.1 people per 1,000 residents. By 2019, they were down to around 6.3, a reduction of over 37%. Many of the urban problems that plagued the city started to dissipate. Crime rates began to plunge, and the internet and telecommunication revolution created new employment sectors. New York City experienced a renaissance, and its residents were healthier as a result. Aside from the HIV/AIDS crisis (and some severe influenza outbreaks in 1957 and 1968), there has not been an epidemic in the city since 1918. However, between 1983 and 2017, some 83,000 New Yorkers died from HIV. In the worst years of 1994 and 1995, HIV-related deaths increased the mortality rate by 11% above baseline.

As of this writing, New York City has seen 17,351 confirmed COVD-19 deaths and another 4,692 probable deaths. The city will likely end the year with a mortality rate of around 9.0, which was last seen 25 years ago. As a comparison, the Spanish Flu Epidemic of 1918 increased the number deaths in the city by 25% as compared to the year before. To date, the coronavirus has increased the number of deaths by 42% versus 2019. So the COVID-19 epidemic will likely be worse than the 1918 flu epidemic, but not as bad as those that occurred before the Civil War.

The Future

Nonetheless, if there is one conclusion that emerges from the long run analysis is that all epidemics that hit the city were eventually banished. Sometimes, however, they took a while to be eliminated, but they were eliminated. Today, it is hard to feel and understand what diseases like yellow fever, cholera, and typhoid fever did to the people of the city, since their impacts happened so long ago. However, likely each one generated fear and panic and instilled a sense of impending doom. But the idea of New York City, as a home for strivers, as a vibrant center of culture and life will persist. It is this idea that moves us to solve our problems and will oneday return New York City back to us.

Thanks to Troy Tassier for helpful comments.

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[1] There is also another important issue to consider, namely that of measurement. The mortality rate is defined as the number of deaths per 1,000 residents. This is possibly problematic on two fronts. First, we don’t know the actual number of deaths in a given year, since reported deaths almost surely undercount the true numbers. Second, population counts also need to be approximately accurate. There’s not much that can be done on this front, but likely, today, measurements for both figures are more accurate and so, if anything, the under counts of deaths was much higher in the 19^th century, which would suggest even larger improvements in health and well-being than indicated by the official data. However, the problem with measuring COVID-19 deaths brings to light the problem of measuring death counts during epidemics.

[2] The HIV/AIDs crises began in 1983. Deaths peaked in 1995 and steeply dropped until 2000. Since then, deaths from HIV have steadily declined.

[3] Until 1874, New York City was Manhattan. After that, the city annexed the western parts of the Bronx. In 1898, the city then annexed the rest of the Bronx, Queens, Brooklyn, and Staten Island. Here death rates until 1900 are given for Manhattan; from 1901 to the present, death rates are for the entire city.