Summary: Many people today feel that life in New York has become uniquely difficult. Some imagine that the city was cleaner, safer, and more livable in the distant past. Historical reality tells a different story: Preindustrial New York was marked by extreme filth, unsafe water, rampant disease, pervasive poverty, and living conditions that made everyday life harsh and dangerous compared to contemporary times.

Discontent fueled the 2025 New York City mayoral election and Zohran Mamdani’s victory. A common theme echoed across the five boroughs: New York is a hard place to live. “We are overwhelmed by housing costs,” said Santiago, a 69-year-old retiree, outside a Mamdani rally. Those opposed to Mamdani had their own complaints. María Moreno, a first-time voter from the Bronx who supported Andrew Cuomo, lamented, “Now everything’s dirty, and our neighborhood does not feel safe.”

Today’s voters have legitimate grievances. The city’s housing costs, quality-of-life issues, and perceptions of disorder weigh heavily on residents’ minds. But it’s important to keep things in perspective. Different voters may romanticize different eras, but many seem to share a sense that if they could travel back far enough in time, they’d find a New York that was once clean, safe, and affordable. When Americans were polled in 2023, almost 20 percent said that it was easier to “have a thriving and fulfilling life” hundreds of years ago. Across the country, as one writer put it, people are engaged in an “endless debate around whether the preindustrial past was clearly better than what we have now.” In fact, Mamdani’s politics are grounded in an ideology that first arose from the frustrations of the early industrial era.

If Americans could go back in time to preindustrial New York City, however, they’d likely be horrified and possibly traumatized. Despite today’s real challenges, most New Yorkers would not trade places with their predecessors.

Long before the rise of factories and industry, New York City was a bustling port, founded by the Dutch as New Amsterdam in order to trade furs in the early seventeenth century. As early as 1650, local authorities enacted an ordinance against animals roaming the streets to protect local infrastructure—but to no avail. Then, in 1657, according to the Dutch scholar Jaap Harskamp:

New Amsterdam’s council attempted to ban the common practice of throwing rubbish, ashes, oyster-shells or dead animals in the street and leave the filth there to be consumed by droves of pigs on the loose. When the English took over the colony from the Dutch, pigs and goats stayed put. . . . Pollution persisted. The streets of Manhattan were a stinking mass. Inhabitants hurled carcasses and the contents of loaded chamber pots into the street and rivers. Runoff from tanneries where skins were turned into leather flowed into the waters that supplied the shallow wells. The (salty) natural springs and ponds in the region became contaminated with animal and human waste. For some considerable time, access to clean water remained an urgent problem for the city. . . . The penetrating smell of decomposing flesh was everywhere.

Into the early twentieth century, urban living in the United States felt surprisingly rural and agrarian, with an omnipresent reek to match. As late as the mid-nineteenth century, pigs roamed freely through New York City streets, acting as scavengers, and nearly every household maintained a vegetable garden, often fertilized with animal manure.

Indoor air quality was no better. A drawing from Mary L. Booth’s History of the City of New York depicts a seventeenth century New Amsterdam home with smoke from the fireplace swirling through the room. Indoor air pollution remains a serious problem today in the poorest parts of the world, as smoke from hearths can cause cancer and acute respiratory infections that often prove deadly in children. One preindustrial writer railed against the “pernicious smoke [from fireplaces] superinducing a sooty Crust or furr upon all that it lights, spoyling the moveables, tarnishing the Plate, Gildings and Furniture, and Corroding the very Iron-bars and hardest stone with those piercing and acrimonious Spirits which accompany its Sulphur.”

That said, before industrialization, though inescapable filth coated the interiors of homes, the average person owned few possessions for the corrosive hearth smoke and soot to ruin. By modern standards, New Yorkers—like most preindustrial people—were impoverished and lacked even the most basic amenities. According to historian Judith Flanders, in the mid-eighteenth century, “fewer than two households in ten in some counties of New York possessed a fork.” Many were desperately poor even by the standards of the day and could not afford housing. One 1788 account lamented how in New York City, “vagrants multiply on our Hands to an amazing Degree.” Charity records suggest that the “outdoor poor” far outnumbered those in almshouses.

Water quality was infamously awful. In seventeenth-century New Amsterdam, as Benjamin Bullivant observed, “[There are] many publique wells enclosed & Covered in ye Streetes . . . [which are] Nasty & unregarded.” A century later, New York’s water remained as foul as Bullivant had described. Visiting in 1748, the Swedish botanist Peter Kalm noted that the city’s well water was so filthy that horses from out of town refused to drink it. In 1798, the Commercial Advertiser condemned Manhattan’s main well as “a shocking hole, where all impure things center together and engender the worst of unwholesome productions; foul with excrement, frogspawn, and reptiles, that delicate pump system is supplied. The water has grown worse manifestly within a few years. It is time to look out [for] some other supply, and discontinue the use of a water growing less and less wholesome every day. . . . It is so bad . . . as to be very sickly and nauseating; and the larger the city grows the worse this evil will be.”

In 1831, a letter in the New York Evening Journal described the state of the water supply:

I have no doubt that one cause of the numerous stomach affections so common in this city is the impure, I may say poisonous nature of the pernicious Manhattan water which thousands of us daily and constantly use. It is true the unpalatableness of this abominable fluid prevents almost every person from using it as a beverage at the table, but you will know that all the cooking of a very large portion of the community is done through the agency of this common nuisance. Our tea and coffee are made of it, our bread is mixed with it, and our meat and vegetables are boiled in it. Our linen happily escapes the contamination of its touch, “for no two things hold more antipathy” than soap and this vile water.

In 1832, New York experienced a devastating outbreak of cholera, a bacterial disease that typically spread through contaminated water and killed with remarkable speed. A person could wake up feeling well and be dead by nightfall, struck down with agonizing cramps, vomiting, and diarrhea. The epidemic killed about 3,500 New Yorkers.

The initial actions taken to protect city water supplies were often private in nature. In fact, throughout the eighteenth and early nineteenth centuries, private businesses generally supplied urban water infrastructure. Despite such efforts, drinking water remained generally unsafe, even after industrialization, until the chlorination of urban water supplies became widespread.

The pervasive grime took a visible toll on New Yorkers. Between drinking tainted water, eating contaminated food, inhaling smoke-filled air, and living with poor hygiene, the average resident sported visibly rotten teeth. One letter from 1781 described an acquaintance: “Her teeth are beginning to decay, which is the case with most New York girls, after eighteen.”

The dental practices of the time were often as horrifying as the effects of neglect. The medieval method of using arsenic to kill gum tissue, providing pain relief by destroying nerve endings, remained common until the introduction of Novocain in the twentieth century. As late as 1879, the New York Times ran a story with the headline “Fatal Poison in a Tooth; What Caused the Horrible Death of Mr. Gardiner. A Man’s Head Nearly Severed from His Body by Decay Caused by Arsenic Which Had Been Placed in One of His Teeth to Deaden an Aching Nerve—an Extraordinary Case.” The story detailed the gruesome demise of a man in Brooklyn, George Arthur Gardiner, who died “in great agony, after two weeks of indescribable suffering.”

Preindustrial New York City wasn’t uniquely miserable for its time. Life was harsh everywhere, and cities around the world contended with the same foul smells, filth, poor sanitation, and grinding poverty. Rural villages were no better. Peasant families often brought their livestock indoors at night and slept huddled together for warmth. In many cases, rural peasants were even poorer than their urban counterparts and owned fewer possessions. Farm laborers frequently suffered injuries and aged prematurely from backbreaking work, while fertilizing cesspits spread disease and filled the air with an inescapable stench.

Though they may have been slightly better off than their rural counterparts, the struggles of early New Yorkers are worth remembering. However daunting the problems of today may seem, a proper historical perspective can remind us of how far we’ve come.

This article was originally published in City Journal on 1/13/2026.

“The growth of health care spending in the United States seems to have permanently slowed thanks in part to technological advances making medical treatments cheaper and more effective, according to a paper discussed at the Brookings Papers on Economic Activity (BPEA) conference on March 27.

The United States spent more than $5 trillion on medical care in 2024, or 18% of its gross domestic product (GDP). That’s up a bit from 17.2% of GDP in 2010, but far below the 21.2% share of GDP—nearly $1 trillion less—forecast by government actuaries in 2010.”

From Brookings.

“Now researchers at Stanford Medicine and the University of Colorado, Boulder, have found that a metabolite that spikes a thousandfold in pythons after a large meal causes obese laboratory mice to shun their food pellets and lose weight — mimicking the effect of semaglutide drugs such as Ozempic and Wegovy.

Although it’s too soon to tell whether this metabolite, called pTOS, will translate to a new weight loss drug in humans, the study solidifies the power of studying extremes in the animal kingdom. Reptiles have repeatedly gifted humans with clinically significant drugs. Snake venom is chockful of biologically active compounds that have been developed into blood pressure medications and anticoagulants. And semaglutide arose from the discovery of a hormone in the Gila monster that regulates blood sugar levels.”

From Stanford Medicine.

“Vanderbilt Health has pioneered a safe and effective technique for recovering hearts for heart transplantation, according to a new study recently published in the Journal of the American Medical Association.

The technique, termed REUP (rapid recovery with extended ultraoxygenated preservation), avoids traditional methods that reanimate the heart within or outside the donor’s body. It consists of using oxygenated blood and del Nido cardioplegia solution as a flush for more than 10 to 12 minutes with a newly recovered donor heart. This is a follow-up study after Vanderbilt Health researchers published their initial series in The New England Journal of Medicine.

Vanderbilt Health researchers looked at 24 adult patients who received lifesaving transplants of DCD (donation after cardiac death) hearts recovered with REUP. Of those, only one developed severe primary graft dysfunction requiring temporary extracorporeal life support and significant acute cellular rejection after transplant.

The study showed REUP resulted in good outcomes preserving hearts for up to eight hours, including in older donors and without concern for geographical limitations to get these hearts, broadening the pool of available organs to people waiting for a lifesaving heart transplant.

Using the REUP technique did not prevent recovering other organs, the study also found.”

From Vanderbilt Health.