From sea hospitals to sanatoriums: How NYC has contained contagious diseases over the last century

Posted On Fri, July 5, 2019 By

Posted On Fri, July 5, 2019 By In Features, History, Policy

Sea Breeze Hospital in Coney Island via Library of Congress

As of this month, there have been 619 confirmed cases of measles in New York City since September, according to health officials. The current measles outbreak is mostly contained in the ultra-Orthodox Brooklyn communities of Williamsburg and Borough Park. While the city believes the outbreak is slowing, it has revealed just how challenging it can be to keep highly contagious diseases under control in high-density cities like New York. But fortunately, New York has a gold standard for managing outbreaks of contagious diseases. From managing the flu pandemic of 1918 to the tuberculosis surge at the turn of the 19th century, the city’s public health officials have been containing outbreaks for well over a century.

A typist wearing a gauze mask in 1918; via the National Archives and Records Administration


Last year marked the centennial of the 1918 flu pandemic. In the end, the pandemic took anywhere from 500,000 to 1 million people’s lives worldwide. Somewhat remarkably, despite being a major port, only about 20,000 New Yorkers’ lives were lost. While 20,000 lives lost is still a high death toll, compared to many other U.S. cities, New York suffered fewer losses.

Historians suggest that New York’s proportionately lower death toll during the 1918 flu pandemic had much to do with the health department’s rapid response, which included imposing a strict quarantine on anyone who was found to have the flu. When cases developed in boarding houses or tenements, the city went a step further and removed the patients to a city hospital where they were held under observation and treated.

A dormitory at the Municipal Lodging House via Library of Congress

As confirmed flu cases soared and exceeded the capacity of local hospitals, the Municipal Lodging House, the city’s first homeless shelter, was converted into a care facility. But the flu pandemic of 1918 wasn’t the first or only contagion that has challenged city health officials over the past century.

The Adirondack Cottage Sanatarium in Saranac Lake, NY; via Library of Congress

Upstate sanatoriums and sea hospitals in Coney Island

Throughout the nineteenth and early twentieth centuries, New York City health officials frequently found themselves battling outbreaks of contagious diseases. Among the most common was tuberculosis. Between 1810 and 1815, tuberculosis accounted for 25 percent of deaths in New York City and by 1900, it was still the third most common cause of death in the United States. By the early twentieth century, however, researchers had discovered the tubercle bacillus. As knowledge of germs and how they spread increased, medical practitioners came to appreciate that isolation was a key part of prevention, but when it came to tuberculosis, some forms of isolation proved more effective than others.

Children with nurses at “Sea Breeze Junior”; via Library of Congress

Patients who lived in locations with lots of fresh air, sunlight, rest, and nourishing food were found to fare much better than patients left in dark rooms with little fresh air. This realization led to the construction of sanatoriums. One of the first sanatoriums in the United States was the Adirondack Cottage Sanatorium. Since not everyone could afford to leave the city, however, by the early twentieth century, solutions were being constructed closer to home—this included a “sea hospital” at Coney Island known as the Sea Breeze Hospital.

A child with tuberculosis sitting outside of Sea Breeze Hosptial; via Library of Congress

The Sea Breeze Hospital, which operated for roughly three decades, was built for poor children and in some cases, also for their mothers. Since most children who ended up at the Sea Breeze Hospital had to stay for months and often years, the hospital operated as a separate community and even had its own school.

Response to the current measles outbreak

To be clear, there are no plans to set up upstate sanatoriums or sea hospitals to contain the current measles outbreak. As outlined on the city’s website, in response to the ongoing measles outbreak in Williamsburg and Borough Park, “students attending a child care program serving the Orthodox community, or pre-K program or grades K-12 in a yeshiva who do not have the required number of doses of measles-mumps-rubella (MMR) vaccine must be excluded from school effective immediately including those who are not in compliance with daycare and school MMR vaccine requirements and those with a medical or religious exemption.”

To date, the exclusion only applies to child care serving the Orthodox Jewish community and yeshivas in the 11204, 11205, 11206, 11211, 11218, 11219, and 11249 zip codes. As per the current restriction, the city has stated that students “cannot return to school until they are appropriately vaccinated, or until the outbreak is declared over, even if they have an approved religious or medical exemption to measles immunization.” But this is also why the city’s current response continues to be controversial.

While the restrictions may sound reasonable to some people, some people in New York’s Orthodox Jewish community have viewed the city’s response to the measles outbreak as a targeted attack on the community. While city health officials maintain they are simply responding to the outbreak as needed, the current measles outbreak and controversy reveals just how challenging urban disease control can be. Historically and to this day, containing contagious diseases in high-density areas is a fine balancing act—one that calls on city officials to act quickly and develop both the policies and infrastructure needed to cull the spread of disease.


Neighborhoods : Coney Island



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