Without modern sanitation, life would be nightmarish—human and animal waste would fester on the streets along with garbage and food scraps, producing a stench so foul that you'd want to keep your windows closed even in the sweltering heat of summer (for the moment, envision lacking the luxury of air conditioning). The offensive odors and accumulating muck would be the least of your worries, however—preventable diseases such as cholera and yellow fever would be rampant, your life expectancy would be extremely short, and infant mortality rates would be staggeringly high.

This is what life was like for many of the previous inhabitants of what is now New York City, from the arrival of the Dutch in the 1600s until the establishment of an official Department of Street Cleaning in the late 19th century. Robin Nagle, professor of anthropology at New York University, chronicled this fascinating history of sanitation and public health in an illustrated lecture July 26 at N.Y.U.'s School of Medicine. Nagle's talk, "How Street Cleaners Saved the City: Garbage, Government, and Public Health in New York," was dotted with vivid descriptions of how the burgeoning sanitation system was influenced by underhanded dealings, two wars, repeated outbreaks of communicable disease, devastating fires and water crises.

Early New York was a breeding ground for disease—pigs and other animals roamed freely, and people unreservedly discarded their garbage and industrial wastes in public areas. The natural springs and ponds in the region became so contaminated with animal and human wastes that by the end of the 18th century New York was in dire need of fresh water. Compounding this problem, there was a major outbreak of yellow fever in 1798, an illness residents attributed to contaminated water. This prompted the enterprising Aaron Burr to establish The Manhattan Company with the ostensible aim of piping fresh water into the city from Westchester County. In reality, Burr's operation did little to improve the water situation for residents, and he used his profits to start a bank to compete with that of his famous rival, Alexander Hamilton (Burr's enterprise was later incorporated into what is now known as JPMorgan Chase).

By 1832, there were accumulating reports that the city stunk so bad that travelers six miles away could rely on their noses to tell them when they were approaching the city. Cholera descended upon New York later that year, and as many as 100 cases a day were reported. Inadequate water to fight the Great Fire of 1835 finally prompted the city to seriously address the water problem, and the Croton Aqueduct was established in 1842. This system, complete with a fountain at City Hall Park spewing fresh water 50 feet into the air, was considered a major engineering feat of the 19th century. The system supplied water to residents until 1940.

Despite having solved some of its major water issues, New York had become one of the dirtiest cities in the world by the late 19th century with death rates that were comparable to those of medieval London. Fortunately, the miasma theory of disease (which held that bad smells cause sickness) was slowly being replaced with the germ theory of disease, and in 1881 the city established an official department of street cleaning in an attempt to improve conditions for inhabitants. The system was so rife with corruption, however, that desperate cries for improved sanitation from residents and the medical community fell on deaf ears.

It was not until 1896 that the city was "reborn" through the revolutionary actions of George Waring, a Civil War colonel. He established a system for hauling away refuse, and outfitted sanitation workers with crisp white uniforms to promote their visibility, suggest authority, and imply cleanliness. Finally, the streets and sidewalks were swept, garbage was collected, and the first recycling program was established. In 1903 street cleaners paraded the streets of New York City and sanitation workers were cheered. Waring's actions elevated the status of sanitation, highlighted its crucial role in improving public health, and paved the way for today's sanitation systems.

After a brief stint a few years ago as a sanitation worker with New York's modern-day Department of Sanitation, Nagle became the organization's anthropologist-in-residence where she helps inform sanitation workers about the legacy they are a part of and the importance of their work. Her new book about sanitation in New York, Picking Up, will be published later this year.

Image of sanitation worker from 1918 courtesy of The City of New York Department of Sanitation