The destitute rarely leave a written record behind. It is the province of the literate to record how others lived and died, Ely being a prime example. In his diary, we meet “a half-starved blind man whose stomach has rejected almost everything”; “a young widow whose hands and feet having been frozen, are now in a state of progressive putrefaction”; “a woman of colour, dreadfully mangled by her husband”; a boy of fifteen “who slit his throat after being impressed on board a British ship of war”; “an aged sailor…of whom little remains but skin and bones”; and a demented ninety-six-year-old woman “who differs from an infant only in her form and the love of taking snuff.” The list is long and depressing. “Their misery makes me sick at heart,” Ely wrote, adding that many are “too near the grave to care.”
Here, perhaps, lay the most obvious truth. Those who filled the almshouse infirmary were chronic patients—discarded and forgotten. Many had been there for months, some far longer. In a typical entry, Ely approached the bed of a young man in a coma. It had become a daily routine—a prayer uttered to no response. “He will open his eyes no more,” the minister wrote, “until the resurrection.”
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A larger almshouse was sorely needed, far removed from respectable glances. And no spot seemed better suited than the old Bel-Vue Estate, the city-owned stretch of land along the East River that contained the municipal pesthouse where young Alexander Anderson had been the resident physician. In 1811, the Common Council negotiated a deal with the heirs of the Kip’s Bay Estate to purchase “six [additional] acres, 1 road, 28 perches and eighty Seven Square feet of land adjacent to…Bellevue for the consideration of twenty two thousand four hundred and ninety four and 50/100 dollars.” The goal was to fuse these two properties into one, providing a single complex for the diseased, desperate, criminal, and insane.
What followed was the largest and most expensive construction project in New York’s history. To help raise money the city ran another lottery, the grand prize won, to the consternation of many ticket holders, by a free Negro. Meanwhile, the Common Council appropriated $45,792 to hire the “Stone Cutters, Carpenters, Blacksmiths, Masons and laborers” needed to lay the foundation and build a new dock. Throughout the spring of 1811, advertisements like this one appeared in the local press:
TO MASONS
Proposals Will Be Received at the Almshouse Until the First of May Next for Doing the Mason’s Work of a Brick Workshop With Stone Cellar to be Two Hundred Feet in Length and Twenty-Five Feet in Width. Also, Proposals for the Workmanship of Two Brick, Hospitals With Stone Cellars, to be Each Seventy-Five Feet In Length and Twenty Five-Feet in Width. The Above Buildings are to be Built on the ground At Bellevue, a Plan, and a Particular Description of Them to be seen at the Almshouse.
Governor DeWitt Clinton laid the cornerstone in a boisterous celebration of civic pride. But then the War of 1812 intervened, and British warships blocked New York harbor. Stalled by various shortages, the complex took five years to complete. Opened in 1816, it housed the great bulk of New York City’s welfare institutions: an orphanage, a morgue, a pesthouse, a prison, a lunatic asylum, and a huge four-story almshouse with an infirmary attached. Costing an incredible $421,109, it sat behind an imposing stone wall and bore the name: Bellevue Establishment.
The structures were massive—the largest New York had ever seen. A sure sign of their importance was the decorative artifacts brought from Federal Hall, where George Washington had taken his first presidential oath of office in 1789: the embroidered wrought iron railings, the gold-plated weathervane, the very stone on which Washington had stood. “There is no eleemosynary establishment in the American Union equally splendid,” marveled Yale’s famously dour president Timothy Dwight.
At the dedication, a local minister urged the inmates to embrace their new surroundings. “Some of you, I am persuaded, indulge extreme anxiety on your removal so far from the city,” he said of the isolated location. But fear not. Bellevue was a special place, designed “to wipe away your tears and supply all your necessities.”
David Hosack had his doubts. He worried that New York City remained woefully unprepared for the medical crises that lay ahead. His words were cited in the newspapers, which added dire predictions of their own. Under intense pressure, city officials promised to build a much larger pesthouse on the Establishment grounds. Opened in 1826, the imposing brick structure stood on a bluff directly above the East River. There was talk of naming it “New York City Hospital,” but complaints arose from the trustees of New York Hospital, who did not want their private facility confused with a lowly welfare institution. The Common Council agreed: “The Building lately erected…shall hereafter be…known by the name of Bellevue Hospital.”
Still, Hosack wanted more. He dreamed not of a larger pesthouse, or a bigger almshouse infirmary, but of a true public hospital “fully commensurate with the increasing population of the city.” When Hosack died in 1835, there seemed little chance of this. But he did live long enough to see the first of several crises that would help bring his grand vision to life.
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In the first half of the nineteenth century, New York overtook Philadelphia as America’s largest city. Yet its astonishing population growth—from 96,000 in 1810 to 942,000 by 1860—produced more worry than pride. New Yorkers had known their share of boom and bust, division and disorder. They had survived British occupation, economic panics, devastating riots, epidemics, and fire. But nothing had prepared them for the crush of human cargo now arriving daily on their shores. New York had become the world’s leading port of entry for immigrants fleeing famine and persecution, or seeking a fresh start. Most stayed only briefly before heading west to farm, lay track, dig canals, mine coal, and pan for gold. Those who settled in New York were often too poor, or too exhausted, to go any farther. One port officer likened them to hogs “vile, offensive, and pestilential…literally wallowing in their own filth.” By the Civil War, close to half the city’s population would be foreign-born, with Ireland providing the lion’s share, and Germany a distant second.
Until the early 1800s, New York hadn’t extended much beyond the wharves and warehouses dotting lower Manhattan. “Shipping and trade were the chief occupations, and the artisans were largely independent workers,” wrote a student of city life in the days before massive immigration and steam-powered factories. “Housing conditions were favorable; gardens and orchards were common; there were no tenements. Judging from what reports are available New York appears to have been a reasonably clean and tidy town.”
This, perhaps, was an exaggeration. New York never resembled a scrubbed and orderly city; busy seaports rarely do. But as commerce and immigration expanded in the nineteenth century, New York became a different place. The completion of the Erie Canal, linking the city to the agricultural heartland, dramatically fed the growth. So, too, did the introduction of rail lines bringing grain and cotton for shipment abroad. California gold helped fuel the banks and stock market that turned Wall Street into America’s financial center. Travelers to the city described a pulsing new energy—“a sea of masts” in the harbor, “streets jammed with carts, dray, and wheel barrows,” buildings “rising everywhere.”
New York had its share of shabby boardinghouses and fine brick mansions. But its mainstay had long been the “artisan dwelling,” with a store or workshop on the ground floor and the family quarters above. Over time, a fair number of these merchants and tradesmen had moved away, selling their homes and shops to agents who converted them into multiple dwellings for the immigrant poor. By the early 1800s, the city’s northward expansion had reached, and overwhelmed, a five-acre spring-fed body of water near Canal Street called the Collect, or Fresh Water Pond, known for its “great depth and unusual purity.” Once a center for ice-skating and shoreline picnics, the Collect would become one of Manhattan’s first ecologic casualties—a dumping ground for dead animals, rubbish, and factory waste. Too dangerous to drink, a place of “insufferable stench,” it was fi
lled with dirt and carved up for residential use. On this landfill rose the infamous slum known as Five Points.
Heavily Irish, Five Points contained a sprinkling of German immigrants and former African slaves. Most residents hailed from Counties Cork, Kerry, and Sligo—places of extreme poverty well before the devastating potato blight of the 1840s. A visitor to County Kerry described the tenant cottages there as the “most miserable I ever beheld.” Those who reached New York naturally sought out Irish Catholic enclaves with the cheapest housing and the best chance for an unskilled job nearby. In Five Points, they found both.
This neighborhood, long since gone, is now part of American folklore. Moviegoers know it as the backdrop for Martin Scorsese’s violent epic, Gangs of New York. In the nineteenth century, it appeared regularly in travel accounts of the United States. So celebrated was its reputation for squalor and mayhem that curious out-of-towners often toured its streets—an activity described as “slumming” in the press. Frontiersman Davy Crockett paid a visit to Five Points, as did presidential candidate Abraham Lincoln. “I saw more drunk folks, men and women, that day, than I ever saw before,” said Crockett, no innocent himself. Charles Dickens inspected the neighborhood (with a police escort) during a trip to America in 1842. It was, he lamented, a “world of vice and misery….All that is loathsome, drooping, and decayed is here.”
It was true, of course, that Five Points contained a surplus of taverns and brothels, and that farm animals roamed its putrid alleys and yards. But many neighborhoods shared these problems, as New Yorkers well knew. By 1811, more than 1,300 groceries and 160 taverns were licensed to sell “strong drink” in the city, which had barely 100,000 people and not many Irish. Several years later, the diarist Edmund Blunt warned that “so long as immense numbers of swine are allowed to traverse the streets, so long as inhabitants think themselves justified in throwing out their garbage to them for food,” the city would remain “proverbial for its filth.” Others grimly agreed, noting thoroughfares covered in the waste of slaughterhouses, the droppings of horses, and the excrement from overflowing backyard privies.
What made Five Points unique, aside from its rural Irish flavor, was the incredible overcrowding. Families and boarders found themselves crammed into dwellings known as “rookeries” (the precursors of tenements), which rose to four and five stories. So many were built, one attached directly to the next, that Five Points soon rivaled the worst slums of London in terms of human density.
Its most infamous rookery, though not by much, was a converted brewery near the Collect landfill. An account of a visit there by a group of Protestant clergy is worth quoting—less for its accuracy, perhaps, than for the contempt it heaped upon the tenants. Entering a basement room, the group counted twenty-six people. “A man can hardly stand erect in it,” the leader wrote. “The smoke and stench of the room was so suffocating that it could not be long endured, and the announcement that [some children] had the measles to boot, started most of our party in a precipitous retreat from the premises.
“Miserable beings!” he concluded. “Life is at best an unpleasant necessity, but to them it must be an awful punishment.”
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In 1832, cholera came to Five Points. It arrived during a lull in the city’s ongoing struggle against epidemic disease. Smallpox had receded a bit, thanks to the growing popularity of vaccination. And yellow fever had mysteriously disappeared from New York and other Northern seaports, moving southward to terrorize cities like Memphis and New Orleans. As for cholera, little was known. It had only reached Europe in the 1820s, moving along Asian trade routes by caravan and boat. An intestinal disease, cholera spreads when food and water are contaminated with the excrement of infected victims. The bacterium responsible, Vibrio cholerae, causes the body to expel huge quantities of liquid through vomiting and explosive diarrhea. What makes cholera so terrifying is the damage it can do within hours of entering the system. There is no incubation period, no time to prepare. The victim can be fine in the morning and dead by nightfall.
Cholera in the United States is a distant memory, though it remains a serious threat in the developing world. Effective sewage systems, chlorinated water, powerful drugs, better hygiene—all played a role in its demise. Should a case of cholera appear, the patient would be pumped full of fluids and given an antibiotic to kill the microscopic invaders. Of course, none of this was known in 1832. Some saw dirt and dampness as the culprit, others swore off shellfish, unripe fruit, green vegetables, even milk. But most medical thinking still blamed miasmas—noxious atmospheric clouds—for spreading deadly epidemic disease.
Like yellow fever, cholera seemed to favor recent immigrants, with the Irish at greatest risk. A Bellevue Hospital physician explained why. “As a class of people,” he wrote, they were “exceedingly dirty,” “exhausted by drunkenness and debauchery,” and “crowded together in the worst portions of the city.” In truth, Five Points did suffer higher rates of cholera for reasons all too clear. First, there was no means of escape. The people were too poor to pack up and leave when an epidemic occurred, unlike wealthier New Yorkers who fled the city in droves. (One observer compared the exodus of “well-filled stage coaches” in 1832 to the stampede from Pompeii “when the red lava flowed.”) Second, these immigrants had no choice but to use whatever water was at hand. In Five Points, that meant a series of shallow wells polluted by the fecal waste from backyard privies. Rich folk could drink from purer sources. Some even paid to have fresh water carted in from lakes and springs north of the city—not because they feared contamination, but because it tasted better. That simple preference likely saved their lives.
New York hadn’t seen an epidemic of this size since yellow fever several decades before. In June 1832, the Bellevue Establishment held 145 “general patients” and 97 “maniacs.” By summer’s end, it would admit more than 2,000 cholera cases and record 600 deaths. The victims, described by one doctor as “low Irish,” were young and single, for the most part, and recently arrived. “O’Neill was seized with the malignant cholera and died the next day,” read a typical case history. “He was very intemperate, had been drunk all week, and had fallen, while intoxicated, into the North [Hudson] River.”
Indeed, what is striking about these cases is the head-scratching that occurred in the rare instances in which a victim didn’t fit the Irish stereotype. “Mr. Fitzgerald was by trade a tailor and a temperate man,” wrote a perplexed Bellevue physician. “His wife was also a neat housekeeper, so that in this case neither of the most common causes of cholera, viz, dirt and intemperance, were present.” That the couple lived in Five Points—“the resort of all that is vicious and dissoluble”—seemed the best explanation.
The resident physician at Bellevue Hospital in 1832 was Isaac Wood, a member of New York City’s medical elite. A graduate of Queens College (Rutgers) Medical School, and a fearless body snatcher in his younger days, Wood now confronted a problem that few Westerners had ever seen, much less treated. Clueless as to the cause of cholera, or its remedy, Wood relied on the standard remedies for treating epidemic victims: bleeding and purging. For a disease like smallpox or yellow fever, such methods were bad enough; for cholera, which involved an extreme loss of bodily fluids, they bordered on torture.
Wood did see a silver lining, though. An epidemic of this size would allow him to increase his medical staff and perhaps find a cure for the disease. There were no rules regarding the “informed consent” of the patient in nineteenth-century America, and no constraints beyond a physician’s conscience and imagination. Free to follow their hunches, Wood and his assistants tried a variety of treatments. To increase “physical stimulation,” patients received “hot bricks to the feet and body,” “severe shocks of electricity,” and the “intense friction applied by the rubbing of two stout men.” One patient, eight months pregnant, was given heavy doses of calomel, killing her baby. She then became part of an experiment in which a vial of tobacco juice was injected into her arm at a temperature o
f 112 degrees. “Vomiting followed, with deep convulsive inspirations,” her doctor noted. “She felt sleepy but did not sleep; about 5 o’clock death closed the scene.”
Tobacco was believed to have purgative qualities, causing “excitement of the bowels.” Some at Bellevue thought it an ideal cleansing agent—instantly powerful, while doing no real harm. “The patient has only then to recover from the tobacco,” it was argued, “and he is comparatively well.” Early on, the substance was credited with saving numerous cholera victims, including “an idiot, aged 14,” whose “unceasing vomiting” had been eased with “a tobacco infusion by mouth.” “I am already satisfied that there is no remedy which we have yet tried that can compare with it,” a physician declared.
The problem, it turned out, was that no one beyond Bellevue could replicate these results. “Tobacco has been administered in nine cases—seven were positively injured,” reported the director of a nearby pesthouse. “The other two were for a short time revived, but soon collapsed again, and finally died.”
By autumn, cholera had killed 3,500 in a city of 200,000 people. Statistics showed foreign-born deaths at 2,486, or 71 percent of the total, at a time when immigrants, just starting to pour into New York, comprised barely 10 percent of its population. This meant that close to 15 percent of the city’s foreign-born perished in the 1832 cholera epidemic, as opposed to less than one percent of the native-born.
At Bellevue, Dr. Wood found himself “stepping over the dead and dying.” The bodies were piled into carts and hauled away for burial in mass graves sprinkled with lime. That summer, Wood himself became a casualty. Barely surviving his own bout with cholera, he left Bellevue to regain his health. There is no record of the treatment Wood received—it would take him five years to fully recover—though he appeared to swear off tobacco shortly thereafter. “I believe,” he said, “it is detrimental to many persons, and in various ways.”
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