Bellevue

by David Oshinsky

  —

  By the time Alexander Anderson returned to Bel-Vue in the summer of 1798, New York was in the midst of an unprecedented calamity. The body count from yellow fever already reached into the thousands. Witnesses described a city abandoned to coffin makers, gravediggers, and those too poor or too sick to flee. A number of dutiful physicians and medical students had stayed behind to help, including Anderson’s Columbia classmate Walter Jonas Judah, the first native-born Jew to attend an American medical school. Judah had vowed to protect the members of Shearith Israel, New York’s only Jewish congregation, though his duties quickly grew. He worked “tirelessly with the afflicted,” it was said, prescribing treatments and paying for the medicines from “his own pocket.” Judah died that September, at the age of twenty. He was buried in Chatham Square, New York’s oldest Jewish cemetery. His tombstone, still visible today, reads:

  In memory of

  Walter J. Judah

  student of physic who, worn down

  by his exertions to alleviate the

  sufferings of his fellow citizens

  in that dreadful contagion

  that visited the City of New York

  in 1798, fell victim to the cause

  of humanity…

  Bel-Vue, meanwhile, was overwhelmed. A crude addition was erected to handle the fevered bodies deposited daily by horse cart and river barge. As the resident physician, Anderson employed the standard practices of the time. His guide was Dr. Benjamin Rush, the revered statesman-physician who had signed the Declaration of Independence and served as Washington’s surgeon general in the Revolutionary War. For treating yellow fever, Rush employed copious bleeding and huge doses of calomel, which he termed “the Samson of drugs.”

  Anderson embraced Rush’s “heroic” approach. His diary is filled with entries like: “Two young seamen arriv’d in a cart. The violence of their fever demanded blood-letting, which I performed immediately.” But Anderson’s tenure at Bellevue proved briefer than before. Vowing to “hold out while the Epidemic continues,” he nonetheless resigned a few weeks later, victimized by yellow fever in an unimaginable way.

  In July, his three-month-old son had contracted the disease. “I was up all night trying every method for [his] relief, but he died at 2 this morning,” the diary read. “At day-break I took a walk [to find] a cabinet-maker. I knock’d him up, and bespoke a coffin.” In early September, yellow fever claimed Anderson’s brother, and then his father, leading him to depart Bel-Vue to watch over his surviving family members.

  It did them no good. A few days later, Anderson’s wife took sick and died. “The sight of [her], ghastly and emaciated, coughing up blood, struck me with horror,” he wrote. “Those who knew her worth may imagine my feelings.” In October Anderson’s mother fell to yellow fever, completing the virtual destruction of his family. “I feel surpris’d at my own composure,” he noted, “and am more disposed to impute it to despair than resignation.”

  On New Year’s Eve 1798, Anderson reviewed the horror and tragedy of the previous months. “I have made more use of liquor than in all my life together,” he admitted. But his religious faith had seen him through. “A tremendous scene have I witnessed,” read his final entry. “Yet I have reason to thank the Great Author of my existence, and am still convinced that whatever is, is right.” For twenty-two-year-old Alexander Anderson, being right meant taking responsibility for society’s most fragile members. Forgotten today, he stands as Bellevue’s first physician, serving a riverfront pesthouse in a murderous time.

  Anderson soon abandoned the medical career his parents had forced upon him. He married again, fathered six more children, and returned to engraving, the work he loved, earning the distinguished title of “America’s First Illustrator.” But his brief autobiography, composed in 1848, is marked less by contentment than by gloom. “Constant employment has caused time to slip away,” he wrote, “till I find myself in my seventy-third year. I have raised and supported a large family under rather discouraging circumstances, and what comes next is in the book of fate.” Anderson died in his bed in 1870, at the age of ninety-five.

  As yellow fever marked the life of this extraordinary physician-engraver, so, too, would it mark the place where he began and ended his medical career. In 1798, the Common Council bought the Bel-Vue Estate from Brockholst Livingston for £1,800, to be “opened only upon extraordinary occasions [for] those suffering the violent assaults of fever.” It was used sparingly until 1811, when the cornerstone was laid for a new almshouse complex on the grounds. While few could deny the land’s natural beauty, it had earned a frightful reputation as well. “Bel-Vue, a few miles from New York, on the East River [is now] considered by the people at large as A House of Death,” wrote a popular pamphleteer. “So odious is the idea of being put there [as] to lessen one’s chance of recovery.”

  Almshouse, pesthouse, death house—these are the indelible roots of Bellevue Hospital, thrust deep in the bedrock of America’s fastest-growing city.

  2

  HOSACK’S VISION

  New York City is no stranger to the mob. Its past is littered with explosions of public rage, from the Stamp Act Riots of 1765 to the Draft Riots of 1863 to the Hard Hat Riots of 1970, with endless turmoil in between. One of the most violent episodes occurred in 1788, when a crowd stormed the city jail bent on lynching several men held there in protective custody. These weren’t traitors or murderers or disobedient slaves. They were, oddly enough, physicians and medical students accused of digging up corpses in the dark. The so-called Doctors’ Riot ended with a full-scale military assault, leaving dozens wounded and several dead. Largely forgotten today, it would taint public perceptions of “medical men” and their practices for decades to come.

  In 1750, two of these men, John Bard and Peter Middleton, performed the first dissection of a human cadaver in North America. The body, carefully chosen to avoid a public backlash, was that of a criminal hanged for a gruesome murder. But having established dissection as a teaching tool, Bard and Middleton had created a dilemma: Where would anatomists obtain a fresh supply of corpses? In New York City, as elsewhere, the local cemetery provided the answer.

  Body snatching soon became a rite of passage for young doctors and medical students. Working on moonless nights, dressed entirely in black, they pilfered fresh remains from the city’s most vulnerable graveyards—the one attached to the almshouse, for example, and those in which slaves and free Negroes were interred. Their raids aroused little interest until word got out that the corpse of a young white woman had been removed from the graveyard of Trinity Church, a hallowed resting ground. Other such “discoveries” followed, “raising a considerable clamor among the people,” reported the New York Packet. “The interments not only of strangers and the blacks [have] been disturbed, but the corpses of some respectable persons [as well].” When letters of protest appeared, one of the grave robbers posted a mocking reply. “Through your excess of sympathy for the impassive bones of the dead, you have forgot the poor sufferings to which the living world is daily liable,” he wrote, adding: “I take thee to be the most stupid of asses.” It was signed, “A Student of Physic, Broadway, N.Y.”

  The address was revealing. In 1771, the city had received a royal charter to build a private hospital for “the reception of such patients as require medical treatment, surgical management, and maniacs.” Located on Broadway, it had housed wounded British troops during the Revolutionary War and then been consumed by fire. It wouldn’t reopen until 1791, under the name of New York Hospital, but a few rooms had been leased in the damaged structure for an anatomy class run by surgeons calling themselves the “Tribe of Dissectors.”

  The Doctors’ Riot began on an April Sunday, when a group of children playing outside the Broadway building spotted a corpse dangling in a second-floor window. One of the boys ran to tell his father, a mason by trade, who was working nearby. Within minutes, a swarm of laborers had stormed the building, tools in hand. “In the anatomy r
oom were found three fresh [corpses], one boiling in a kettle, two others cut up with certain parts of the two sexes hanging up in a most brutal position.” The workers grabbed various body fragments—arms, legs, and heads—to show to the angry crowd gathered below. Then they dragged the terrified dissectors into the street.

  A lynching seemed likely. “It is a wonder,” a source remarked, that the young men “did not become anatomical specimens themselves.” They were saved by the intervention of Mayor James Duane and the local sheriff, who bravely hustled the dissectors off to jail. As word spread, mobs ransacked their homes. A few days later, a crowd estimated at five thousand—the largest ever seen in the city—marched on the jail chanting, “Bring out your doctors! Bring out your doctors!” Blocking the way were the dons of New York society—Mayor Duane, Governor George Clinton, John Jay, Alexander Hamilton, and Baron Friedrich von Steuben—backed by a phalanx of state militia, bayonets fixed and gleaming.

  Words proved useless. The crowd surged forward, hurling rocks and brickbats. John Jay and Baron von Steuben were badly bloodied before Governor Clinton gave the order to fire. Hit by several volleys at close range, the crowd fell back without reaching the jail. Estimates of those killed that afternoon ranged from three to well more than a dozen, because so many of the wounded were carried home to die.

  The riot had erupted at a tense time in the city—the interval between the writing of the Federal Constitution and its successful ratification by the states. Some saw the lawlessness in New York as an example of what a strong government was meant to control; others thought the authorities had gone too far. What most everyone could agree on, however, was the arrogance of the grave robbers in pursuing their controversial goals. Such moral blindness, said a shaken physician, had “seriously interrupted the cordial feeling which has always existed between the medical community and the laity.”

  A few months later, the New York state legislature passed a law “to Prevent the Odious Practice of Digging Up and Removing for the Purposes of Dissection, Dead Bodies Interred in Cemeteries or Burial Places.” The sentences ranged from a fine and imprisonment to “standing in the pillory [and] other corporal punishment (not extending to life or limb).” The law also provided that the bodies of executed criminals “shall be delivered to a surgeon for dissection, as such court shall direct.” Though no doubt meant as an anti-crime measure—a warning to potential murderers and arsonists of punishment beyond death—it also affirmed the need for cadavers in medical research.

  But this was hardly a solution. There simply weren’t enough executed criminals to meet the demand for corpses, and the public was in no mood to supply any other kind. The dissection of unclaimed bodies wouldn’t be legalized in New York state for another half century, a delay that only encouraged these dangerous nocturnal raids. The crime became so common that almost every prominent physician confessed to having taken part—none more boldly, or frequently, than David Hosack, the founder of “modern” Bellevue and the architect of public hospital care in New York City.

  —

  To elite members of New York society, brilliant, imperious David Hosack was the doctor of choice. His patients included Alexander Hamilton, DeWitt Clinton, steamboat inventor Robert Fulton, and Vice President Aaron Burr. In 1801, Hosack tended to Hamilton’s oldest son, Philip, after a duel that took the young man’s life, and then, three years later, to the elder Hamilton following his deadly duel with Burr on the very same New Jersey ground. His “sufferings during the whole of the day [were] almost intolerable. I had not the shadow of a hope for his recovery,” wrote Hosack, who nevertheless charged Hamilton’s estate $50 for services rendered during his good friend’s “fatal illness.” Hosack’s annual income sometimes exceeded $10,000, an immense sum that included earnings from his medical practice and the tutoring fees he charged eager students who lined up at his door.

  Hosack lived like royalty. He owned an elegant townhouse in lower Manhattan, which became a salon for literary greats like Washington Irving and William Cullen Bryant, and a country estate in the Hudson Valley, where he cultivated exotic plants and herbs. A founder of the New-York Historical Society, Hosack also created the nation’s first botanical garden on the land where Rockefeller Center now stands. A granite slab there bears the inscription:

  IN MEMORY OF DAVID HOSACK

  1769–1835

  BOTANIST, PHYSICIAN, MAN OF SCIENCE

  AND CITIZEN OF THE WORLD…

  Born and raised in New York City, Hosack entered Columbia College in 1786 to pursue a medical career. Determined to be a surgeon, he attached himself to the man whose anatomy class would ignite the infamous Doctors’ Riot—Dr. Richard E. Bayley. Hosack wasn’t present when the mob stormed the dissecting rooms that fateful Sunday, but learning of the trouble had rushed there to help. Caught in the crowd and “knocked down with a stone striking him in the head,” he might have been killed had not a bystander carried him away. Hosack fled New York for the calm of Princeton, New Jersey, where he completed college before entering the University of Pennsylvania Medical School. Studying with the great Benjamin Rush, he wrote his dissertation on the mysterious plague known as “cholera,” theorizing—incorrectly, it turned out—that “an acid” was “the most proximate cause of the disease.”

  The next stop was Europe. Hosack attended medical lectures and clinics in Edinburgh and London—a must for striving physicians—but came away unimpressed. Edinburgh had “passed its meridian,” he thought, providing “polish” to a résumé but little more. Hosack had no interest in mimicking the cloistered world of the British physician. He hoped not only to examine patients, but to treat them as well. Returning to New York City in 1796, he became a professor of “materia medica” (in modern terms, pharmacology) at Columbia, while beginning a partnership with a prominent surgeon, Samuel Bard. In 1806, Hosack put his talents to work at a place quite familiar to the top medical men of his day. He became a visiting physician at the almshouse infirmary, the forerunner to Bellevue Hospital.

  The job paid nothing. Men of Hosack’s stature were expected to volunteer their services free of charge. Dr. Benjamin Rush had directed the almshouse infirmary in Philadelphia, while Dr. Joseph Warren, another Revolutionary War hero, had done so in Boston. Known for his well-heeled patients—“he is liberal, hospitable, and expensive,” a friend wrote—Hosack had long tended to the poor. His good works included a birthing clinic for destitute women and a citywide campaign to vaccinate against smallpox. The almshouse infirmary seemed the logical next step.

  There was more to this than simple charity, however. A visiting physician not only got to treat the sort of cases he would rarely see in private practice, he could also bring his student apprentices along with him, thereby increasing his fees. With its endless supply of compliant bodies, the almshouse remained the best place for experimenting with drugs and therapies and matters of the knife. Private patients were not inclined to be teaching exhibits for young men hoping to become doctors; almshouse patients were unlikely to resist.

  Hosack urged his students to base their diagnoses on “long and habitual observation at the bedside of the sick,” as opposed to blind loyalty to established norms. A botanist at heart, he favored mild remedies like chicken broth, lemonade, and medicinal baths over harsher methods like bleeding and purging. Once, following a rash of tetanus cases at the almshouse, he prescribed only “wine, spirits, and brandy”—affording the victims, if nothing else, a more peaceful demise.

  Hosack rode to the almshouse twice each week in a polished mahogany carriage, complete with coachman and driver. And this led, quite innocently, to one of the more bizarre incidents of his career. In 1808, an almshouse resident named Lucy Williams accused Alexander Whistelo of fathering her child. “He carried me to a bad [place] and locked the door,” Williams alleged. “I scuffled with him a long time, but…he [wore] me out.” The story had an odd twist: Whistelo was Hosack’s carriage driver.

  Charges flew back and forth, with the almshouse comm
issioner demanding support for “this bastard child.” Hosack responded by calling Lucy Williams a liar. The “proof,” he claimed, was in the skin color. It would be impossible for Williams, a mulatto, and Whistelo, a full-blooded Negro, to produce an infant even “whiter” than the mother.

  A public hearing was held, chaired by the mayor. With one exception, the parade of doctors called to testify supported Hosack’s view of the case: the child’s fair skin, the “want of crisp hair,” and the absence of “primitive” features all defied “the general laws of nature.” Whistelo could not have fathered the child.

  The mayor, a good friend of Hosack’s, posed a rhetorical question before reading the verdict. “Why would a woman choose to name a black father when she could name a white man?” He answered simply: “We do not know—some love the darkness rather than the light.” Alexander Whistelo was exonerated. Lucy Williams and her child were returned to the almshouse, still wards of the city. David Hosack remained the visiting physician. The white father was never found.

  —

  New York was rapidly urbanizing in these years. The almshouse complex, a stone’s throw from City Hall, held close to eight hundred dependents by 1800, more than twice the intended number. Visitors were shocked by the “haggard paupers and undisciplined children peering from [its] windows, hanging on the fences, and wandering in the park.” The view from within was even worse. Among the witnesses was Ezra Stiles Ely, a young minister who kept a diary of his daily visits to comfort the sick and pray over the dead. Most entries included a description of the almshouse infirmary, where “the groans of agony” met “the stink of disease.” Ely wrote of patients in rags, uncollected corpses, “bodies stowed as thick as they could lie.” He claimed that “nine cases out of ten” were moral degenerates, and his diary is seeded with examples, from the foul breath of prostitutes to the blasphemy of drunks. “Not half an hour before he expired,” Ely wrote of one, “he used his brief and dying [respite] to hurl wicked curses.”