Sewers in the city: a case study of individual-level mortality and public health initiatives in Northampton, Massachusetts at the turn of the century

Emerging industrial communities of nineteenth-century New England experienced both rapid population growth and lagging development of public health infrastructures. In turn, high mortality in these newly urban cities contributed to a delay in the regional mortality transition of the late nineteenth century. Analyzing death records and a file of linked cause-specific death and manuscript census records for the industrializing community of Northampton, Massachusetts, we show that early in the city's development, mortality clustered near industrial activities and open sewers. When industrial areas were sewered, clustering of mortality abated, and differences between industrial and commercial areas of the town were no longer significant. These findings illustrate Szreter's emphasis on considering both the benefits and costs of development.' Initial development contributed to high mortality in newly emergent urban-industrial centers like Northampton and was abated only when lagging public health infrastructures caught up with rapid growth and development near the turn of the century.