The authors situate evidence of disease among the burial population of the Spring Street Presbyterian Church within evolving attitudes towards public health and civic order in 19th-century Manhattan. Two personal vignettes illustrate how individuals interacted with the physical space of the church’s vicinity at different moments in the history of municipal reform. The first, a 16-year-old girl named Louisa, was virtually absent from the historical record until the recovery and analysis of her skeletal remains from the church burial vaults. Her skeletal biography conveys the cosmopolitan nature of Manhattan social relations in the early 19th century and the complex ways that they interacted with contemporary debates on disease and moral improvement. The second individual, the author of a Harper’s Magazine article set at a fire watchtower across the street from the church, experiences a transformed infrastructure of the city by the last quarter of the 19th century. This writer’s impressions reflect coalescing middle-class attitudes towards civic order and their manifestation in the physical framework of the city. This public discourse emerged from a half-century of catastrophes in public health and security often pinned on distinct socioeconomic segments of the urban populace. Contrasting these two individuals’ experiences of life at Spring and Varick streets thus helps outline the trajectory of civic governance over the course of the 19th century and fosters critical awareness of the power of social representation in the emergence of modern civic authority.