In 1866 it was estimated that 20,000 People were then living in cellars in New York. Ten years before that period many of the city houses had been shaky from quick building; after the war, figuratively speaking, they had fallen into the cellars. At that time New York could hardly claim distinction as a great city. Travelers referred to it as an overgrown village, into which had been shoveled slovenly hordes of European immigrants. The annual death-rate was thirty-four per thousand, while that of London was about twenty-three per thousand. And it must be remembered that New York’s new population was composed of vigorous men and women, the cream of other localities, with what should have been healthy offspring, who had quickly centered here, ambitious and active; whereas London was an ancient city, bearing the ills of its own age. It must be remembered also that at that time the medical profession knew little of bacteriology; antitoxins were unknown; people lived like ostriches, with their heads in the sand concerning questions of sex hygiene and child hygiene; and the science of sociology had yet to be discovered. Cities had always existed, it is true, but they had to be constantly replenished by fresh blood from the country, and most of them had space to spread out into the country, and thus absorb naturally some of the health that comes from fresh air. But here was a city that had little chance to spread. It was confined to a narrow, rocky island, and was growing more rapidly than any other city in the history of the world. “Bounded on one side by a bluff and on the other side by a sound,” it was burrowing into the earth and climbing constantly into the air to make room for its fast-growing population. It was the center of the fiercest contest for money and power, yet it failed to hold long those who came there. The men that made money went to Europe to spend it, and those that fell in the fight went to the West to recuperate. Immigrants that arrived there with money went on to the West or the South; those without money stayed. The result was that New York did not primarily become a city of residence, but the resort of those who either through the necessity of poverty or the necessity of ambition sojourned there. Of all American cities it became the most artificial; there life came to be lived at its highest tension; there the struggle for existence became fiercest. It is apparent that in such a city Nature cannot be left to her own devices. When man deserts Nature, she promptly retaliates by deserting man. And, in substitution of so-called “natural” living, there has been developed the present-day mode, built up of scientific analysis, skilful treatment, and thorough organization. A NEW DEPARTURE