In September 1668, Samuel Megapolensis, the pastor of the Dutch church in the newly created city of New York, wrote to a friend about how the Lord had “visited us with dysentery, which is even now increasing in virulence. Many have died of it, and many are lying sick.”

What Megapolensis was describing was probably the city’s first outbreak of yellow fever, which would ravage the city on and off for over a century. He continued:

It appears as if God were punishing this land for its sins. Some years (ago) there appeared a meteor in the air. Last year we saw a terrible comet in the west, a little above the horizon, with the tail upward, and hanging over this place. It showed itself for about eight days, and then disappeared. So we fear God’s judgements, but supplicate his favor.

More than 350 years later, New York is in the midst of another epidemic, with the number of confirmed COVID-19 cases rising every day. It’s instructive to recall that we have been here before: From yellow fever and cholera to polio and the Spanish flu, the very shape of the city has long been dictated by its response to epidemics. Revisiting these past outbreaks not only provides insight into the city’s resilience, but also points toward ways that the pandemic may reshape New York once again.

Yellow fever was so devastating to early New York because—like the new coronavirus—no one had natural immunity. This stood in stark contrast to smallpox, the virulent disease most prominent in the 16th and 17th centuries; while that disease devastated American Indian communities (the population of the Iroquois Confederacy and aligned groups was reduced by as much as 87 percent), many colonists had acquired immunity to the disease while still living in Europe, where smallpox outbreaks were almost routine.

Accurate statistics for early yellow fever outbreaks are hard to find, but in 1702, Lord Cornbury, New York’s colonial governor, wrote that “in ten weeks time, sickness has swept away upwards of five hundred people of all ages and sexes.” To put that in perspective, New York City’s population at the time hovered around 5,000; 10 percent of the city died in less than three months.

While the most common vector for yellow fever was mosquitos bites, in the 17th and 18th centuries the disease was blamed on everything from bad vapors (the so-called “miasma” theory of disease) to poor sanitation to increased immigration—so much so that it came to be known as “the strangers’ disease.” To battle the miasma, in the 1730s, New York began to regulate livestock inside city limits, and slaughterhouses and leather tan yards moved to the area near the Collect Pond, which covered the area where Foley Square’s courthouses now stand.

This did nothing to stem the tide of the disease. Spurred by an outbreak in 1793, New York City created its first Department of Health, which “enacted a series of increasingly stringent quarantine laws, created a three-man Health Office Commission to administer them, and authorized the Common Council to pass sanitary ordinances, abate nuisances, and appoint a sanitary inspector.”

While the health commission didn’t have much power beyond reacting to disease outbreaks, elsewhere in the city, doctors and reformers were considering how to tackle public health issues. One quarantine location, a farm outside the city limits called “Belle Vue,” was purchased in 1798 by the city’s downtown hospital and soon, as Bellevue Hospital, became a key spot for isolating victims. In 1799, responding to calls to clean up the city’s dirty wells, Aaron Burr received a charter for a water supply firm called the Manhattan Company. Best known for its financing arm (the Bank of the Manhattan Company, forerunner to today’s JP Morgan Chase), Burr’s business did lay some wooden pipe in lower Manhattan, and for the first time, a few New Yorkers had running water.

But Burr’s water source, located near the Collect Pond, was itself unsanitary. In 1803, the Common Council voted to drain and fill the pond, which had become polluted by the nearby slaughterhouses. The city dug a canal that ran to the Hudson River and paid out-of-work New Yorkers a pittance to help fill the drained basin. The canal was back-filled in the 1820s and is now Canal Street; the reclaimed land where the pond stood gave rise to the Five Points neighborhood, which soon became the location of some of the city’s most overcrowded immigrant housing.

As the Collect Pond was being drained and filled, a commission was mapping Manhattan’s rectilinear street grid from Houston to 155th streets, charting a course for wealthier New Yorkers to escape the confines of lower Manhattan. One criticism of the new plan was its lack of open space, but the commissioners noted that unlike Paris or London, where “a great number of ample places” such as parks “might be needful,” in New York the “large arms of sea” embraced Manhattan, making it “in regard to health and pleasure...particularly felicitous.”

Essentially, having laid out what they thought would be “space for a greater population than is collected at any spot on this side of China,” the commissioners saw most of Manhattan—grid or no grid—as free and open space.

Within a couple of generations, that space would be gone.

In the 1830s, a decade that saw the city’s population grow from 200,000 to over 310,000, New York was hit by new disasters. In June 1832, a cholera outbreak killed 5,000 people in two months, particularly in the ever-growing Five Points. Because no one yet knew that the disease primarily spread through contaminated water, the city continued to ignore its water scarcity problems.

That changed when, in December 1835, a fire broke out in Hanover Square, destroying almost all of what was left of the Dutch and British colonial city. Though New York already had relatively strict fire codes, the blaze—which, unlike the cholera outbreak, hit the wealthiest precincts—highlighted the city’s continued reliance on well water. While Burr’s Manhattan Company was still (barely) in existence, it had never laid enough pipe to be viable. The houses being built in up-and-coming areas like Greenwich Village still had outhouses and water cisterns, sometimes next to each other, which did little to curb disease.

In response to the fire, the city created the Croton Aqueduct, which opened in October 1842. The system was built “following ancient Roman principles, with water descending by gravity from the Croton River dam, 40 miles north of the city in Westchester County.”

Not only did New York now have the ability to effectively fight fires, but new construction could also include indoor plumbing. Just as Greenwich Village had provided an escape for middle-class New Yorkers looking to get out of lower Manhattan, the promise of running water pushed homeowners northward to newly minted neighborhoods like Gramercy Park and Chelsea, which provided wealthier residents with the opportunity to live in cleaner, healthier homes.

But for the city’s growing working class, mostly immigrants from Germany and Ireland, conditions were growing worse. The erection of the city’s first tenement (likely at 65 Mott Street) in the mid-1820s sparked a new wave of density in the Five Points. By the time the Civil War Draft Riots broke out in July 1863, the city was home to over 800,000 people, almost a quarter of whom were Irish, with most of them living in the Five Points.

After the Civil War ended, reformers spearheaded movements to improve the health and welfare of the city’s immigrants. The first was the introduction of the “Act for the Regulation of Tenement and Lodging Houses in the Cities of New York and Brooklyn,” which mandated fire escapes, transoms for rooms without windows, and the installation of water closets (though these could be outside, and didn’t need to flush). In 1879, the law was strengthened to bring toilets inside and to provide a window in every habitat. This created what came to be known as a “dumbbell” tenement, with air shafts added between buildings for ventilation. But the shafts themselves were often too narrow to provide air flow and instead became filled with noxious odors and were receptacles for garbage.

In the end, the addition of outhouses connected to the city’s sewer system was a huge step forward in the battle against disease. As germ theory, which “states that many diseases are caused by the presence and actions of specific microorganisms within the body,” overtook ideas of miasma, this would prove crucial in supporting the health of New Yorkers.

But laying sewer pipes and adding tenement windows was only one part of the larger public health crusade. From the 1850s onward, the movement to create Central Park and other city parks was not just about correcting the errors of the 1811 grid, but in improving the health—both physical and moral—of New Yorkers. Indeed, to many in the 19th century, ill health was often tied to lax morals, and it’s little wonder that Central Park’s co-architect, Frederick Law Olmsted, saw the park as having a “harmonizing and refining influence upon the most unfortunate and lawless classes of the city.”

While most people no longer tie poor health to moral turpitude—which, in the 19th century, also had a distinct anti-immigrant slant—there’s no doubt that the park’s backers were right: spending time in green spaces is good for your health.

The early 20th century saw two more epidemics that tested New York City’s preparedness.

On June 8, 1916, four cases of poliomyelitis—better known as polio or infantile paralysis—were reported in the Italian community in Gowanus, Brooklyn. Polio, a viral disease, had begun to appear more regularly in the United States in the late 19th century, but was rarely widespread. The first major outbreak in New York had been in the summer of 1907, when about 2,500 cases were reported.

This outbreak was different: investigators soon discovered a number of unreported cases in both Brooklyn and Manhattan, and by June 17, the health department had declared an epidemic. Households where someone had contracted polio could either choose to self-quarantine, or the victims would be sent to a city hospital. Since many couldn’t meet the city’s stringent quarantine requirements—including a separate room for the exclusive use of the patient and an attendant who was not engaged in any food preparation in the home—scores of children were taken away from their parents and many died at quarantine hospitals. Ultimately, over 23,000 people in the northeast would contract the disease, approximately 5,000 of whom would perish.

But this was just a trial run for what would arrive from Europe two years later, in 1918: influenza, which ended up killing somewhere between 50 and 100 million people worldwide in three waves and which, along with the 18 million people killed in World War I, nearly destroyed an entire generation.

As with polio, New York could tap into its preexisting health infrastructure. The Department of Health requisitioned armories and other public buildings to create field clinics, and launched a campaign that urged people not to spit in public or to cough on others. In the end, New York had one of the best outcomes in the United States: Around 30,000 New Yorkers were killed by the flu in 1918-19, a death rate of about 3.9 people per 1,000. (In Philadelphia, where the flu likely first entered the country, nearly 8 in 1,000 cases ended up being fatal.) Some attributed the city’s success to the novel practice of staggering retail, business, and entertainment opening hours so as to relieve subway congestion and keep New Yorkers farther apart (akin to today’s social distancing).

In the 1920s, the memories of these epidemics helped shape city housing policy. The Lower East Side was home to over a third of Manhattan’s population, with many people living in crowded, substandard tenements. Many reformers reasoned that improving housing conditions would be a necessary first step in preventing another disease outbreak. New subsidized apartments sprang up, like the Rockefeller-funded Dunbar Apartments in Harlem and the Amalgamated Dwellings in the Bronx. The Dunbar, modeled on the garden apartments popular in places like Jackson Heights, featured private courtyard entrances (as opposed to tenements, which were entered from the street), and “well-laid-out apartments with up-to-date kitchens and bathrooms” along with a “nursery, recreation room, playground, and private security.” (In contrast, many older tenements still had illegal outhouses.)

These privately funded buildings were followed by the first NYCHA buildings, the aptly named First Houses on East 3rd Street, which promised “sunshine, space, and air,” noting these were the “minimum housing requirements to which every American is entitled.” The tower-in-a-park design that blossomed over the next three decades is often credited to Le Corbusier’s Ville Radieuse and the architect’s belief that “widely spaced arrays of tall buildings would fix society’s woes.” Le Corbusier, like many of his modernist contemporaries, was influenced by the 1918 influenza outbreak, so his ideas that “town planning and house building” should “promote good health and sound morality” would have resonated in New York.

But the city knew sunshine and air alone were not enough. In NYCHA buildings, rent was due weekly, and borrowing from the public health response during epidemics, Housing Assistants were hired to both collect rent and to do a weekly welfare check. This way, the city felt it could stay one step ahead of any problems, including grave illness, and essentially put tenants in touch with a social worker on a regular basis.

It can be hard now—with so much of New York’s public housing riddled with vermin, mold, lead paint, and broken elevators—to see these buildings as a public health success story. But for those moving out of the crowded tenement conditions, the projects were a welcome change.

However, by the late 1940s, stiff tenant resistance had eliminated the weekly welfare checks and as vaccines for polio, yellow fever, and other scourges were developed in the 1950s, the imminent threat of a public health emergency faded. As New York entered the fiscal crisis of the 1970s, a lot of residential real estate suffered, but none more than the aging public housing stock, where deferred maintenance allowed problems to grow—sometimes exponentially.

Today, 1 in 15 New Yorkers relies on public housing. As New York faces the Covid-19 pandemic, how are the city’s most vulnerable tenants served by these buildings? In an era of social-distancing, the prescience of Le Corbusier’s emphasis on open space is apparent. But if New Yorkers are going to be asked to shelter in place to ride out the worst of the outbreak, is NYCHA up to the task? For nearly four hundred years, New York has been able to respond to disease outbreaks by building new hospitals, creating quarantine stations, and establishing safe zones. But assistance to its poorest residents is usually reactive and happens after the fact. From tenement air shafts to public housing green spaces, New York’s architecture looks over its shoulder at the last problem and rarely ahead to the next one.