On any given Sunday, it was said, Kleindeutchland’s beer halls and wine gardens did a brisker business than its churches. But German Catholics in New York City faced a special problem: their diocese was a solid Irish preserve. When they demanded their own priests, speaking their own language, Archbishop Hughes acquiesced. When they built their own churches, he didn’t blink. The strategy, said one diocese official, was simply to “ignore their existence.” As a result, a German Catholic could no more fathom the idea of going to St. Vincent’s than he could of going to Bellevue. One hardly seemed better than the other.
The German migration had included a large number of physicians—so large, in fact, that by 1850 fully one third of New York City’s medical community had been born and trained in Germany. Before long, a dispensary appeared, offering “medical advice to inhabitants of New York City who speak the German language, our indigent sick [being] ignorant of the English tongue.” No references were required, no religion was preferred, and care was provided free of charge. “The institution is open every day with the exception of Sundays and holidays,” read its first brochure. “The hour of 12–1 is set aside for children and women, and the hour 1–2 is for all other patients.”
Medical journals lauded the doctors who worked there, calling them some “of the best in the city,” while noting their “modes of treatment not in use in American institutions”—a reference to the homeopathic methods popular among German physicians. Growing steadily, the dispensary took on the name “German Hospital” and moved from Kleindeutschland to Manhattan’s Upper East Side in 1868, along with much of the upwardly mobile German American community. Over time, homeopathy would give way to more traditional practices, though the doctors and nurses still spoke German to the patients—and to each other—well into the twentieth century.
That largely ended, however, with the hyper-patriotism of World War I. A ferocious backlash led orchestras nationwide to stop playing the music of Bach, Beethoven, and Wagner. Several state governments banned the teaching of German in schools, and cities took to scrubbing German names from thoroughfares and public buildings. In Chicago, Hamburg Street became Shakespeare Street and the Bismarck Hotel became the Randolph Hotel. New York City proved no exception. In 1918, the trustees of German Hospital reluctantly agreed to rename their institution for the land on which it stood: Lenox Hill.
—
While Jews had been a small part of the great German migration, their numbers were large enough to swell New York’s Jewish population, once dominated by Spanish and Portuguese refugees, from two thousand in 1846 to more than forty thousand by 1860. Like other groups, Jews had typically boarded their indigent sick with families in the community. Sending a landsman, or fellow Jew, to a place like Bellevue or even New York Hospital was unthinkable. Stories had long circulated about Protestant clergy who specialized in deathbed conversions. (In the Jewish rendering, a young transient named Kahn becomes violently ill, is carted off to Bellevue, and must beg to be “buried among Yehudim.”) The new German Dispensary was an improvement, though hardly ideal. Jews spoke many languages. They celebrated a different Sabbath and worried that gentiles would mock their religious rites, “their tefillin and zizit.” The time had come to build a special house for their indigent sick, as instructed by the Talmud.
An attorney named Sampson Simson took the lead. A graduate of Columbia College and a protégé of Aaron Burr’s, Simson donated the land on West 28th Street, between Seventh and Eighth Avenues, and coaxed sizable gifts from others—the largest one, $20,000, coming from Judah Touro, a New Orleans businessman best known for preserving North America’s first Jewish cemetery in Newport, Rhode Island. Another $7,000 was raised through a novel device—the fund-raising dinner—held at Niblo’s, the city’s premier restaurant and saloon. “There were over 800 persons present and the entertainment was faultless,” the New York Times reported, complimenting “the Israelite women” for “cooperating in so noble a cause.”
Naming the institution was simple. Inscribed boldly above the entrance were the words JEWS’ HOSPITAL, with the Hebrew name BET HOLIM written alongside. But recognizing the donors proved more difficult. Their names were already well known to the community. Was it appropriate to list them on the hospital walls as well? Some community leaders thought not. Further attention bordered on the unseemly, they believed, undermining the true intent of charity and needlessly humbling the poor.
The hospital board felt otherwise. Listing the contributors, it agreed, was both a reward for a good deed and an incentive for others. When Jews’ Hospital opened in 1855, four marble tablets bore the names of each donor, with a fifth one honoring the recently departed Judah Touro, “whose liberal bequeath to this institution,” it read, “is hereby acknowledged…in the erection of this memorial.” A tradition had begun.
The new hospital admitted only Jews, except “in cases of accident or emergency,” and required payment from those who could afford it. But records showed that fewer than 10 percent of the patients contributed to their own support. Much like St. Vincent’s, Jews’ Hospital attracted recent immigrants, unattached and desperately poor. The male patients were mostly itinerant peddlers, wrote an attending physician, “cast upon our shores without profession or trade.” And many female patients worked as domestics in the homes of other Jews, “coerced into service as a means of subsistence.”
Jews who died at Jews’ Hospital—or any New York hospital—were buried in a Jewish cemetery, rarely in Potter’s Field. Indeed, one of the enduring stories of the Bellevue morgue involves an attendant who tricked the Hebrew Free Burial Association into taking the unclaimed body of an Irishman by stuffing copies of a Jewish newspaper into the dead man’s coat. “Somewhere in a Jewish cemetery today,” it is said, “rests this son of Erin, and quite comfortably, no doubt, beneath the Star of David.”
The most controversial issue facing Jews’ Hospital in these early years concerned the performance of autopsies. Were they permissible under religious law? The issue grew so heated that the chief rabbi of the British Empire was asked to intervene. His opinion—that autopsies be permitted in cases where knowing the cause of death might aid the living—became the standard in most Jewish institutions.
When the Civil War began in 1861, Jews’ Hospital opened a special ward to treat wounded Union soldiers. Two years later, in the midst of the violent draft riots that tore through New York City, it admitted dozens of badly wounded victims, almost all of them gentiles. By war’s end, Jews’ Hospital had changed its strictly sectarian ways, allowing it to receive funding from the state. It would be renamed Mount Sinai Hospital in 1866.
The coming years would see a host of these facilities, each with a special clientele. Presbyterian Hospital would cater to Presbyterians, St. Luke’s Hospital to Episcopalians, St. Francis Hospital to German Catholics, and Columbus Hospital to “poor Italians unable to make themselves understood.” In a prescient speech on the state of medical care, circa 1857, Dr. B. W. McCready noted that New York had just begun a process started centuries ago in cities like London and Paris. “Here our rich men have not yet had time to die and endow hospitals,” he explained, singling out Jews’ and St. Vincent’s as models for what hopefully lay ahead.
Like David Hosack, however, the prestigious McCready wanted more. A great metropolis required a great public hospital, he said, and Bellevue’s time had come. “May the beauty and salubrity of its site…be equally preeminent in the successful cultivation of medical science and in the relief of human suffering.” New York City, he conceded, was in desperate need of both.
—
The 1850s had seen dramatic changes at Bellevue. The Great Epidemic, the waves of immigrants, the growth of Blackwell’s Island, the emergence of voluntary hospitals—all played a role in its reinvention. Standing on the nearly abandoned Establishment grounds, Bellevue Hospital now occupied the main building where the old almshouse had stood. Physical improvements followed. In 1853, the Common Council allotted Bellevue $60
,000 to build a new morgue. The remains of Protestant patients would still be sent to Potter’s Field in the Bronx, but the bodies of Catholics, in response to heavy pressure from Archbishop Hughes, would be ferried to the new 350-acre Calvary Cemetery in Queens—the “City of the Celtic Dead”—where a free burial awaited. Two years later, a four-hundred-seat, glass-domed operating theater was added to Bellevue at a cost of $100,000, sparking rumors of a medical school to come.
But perceptions changed slowly. Hospitals were still viewed as places to be avoided by the “better” classes, and Bellevue, now the largest in the United States, remained the ideal magnet for lurid stories and exposés, often with good cause. Rats were abundant in New York City at the time—as, alas, they are today—and Bellevue, abutting the East River with its maze of pilings and wharfs, was especially vulnerable. One visitor, an observant sort, counted forty of them in a single bathtub. “Myriads swarm at the water side after nightfall, crawl through the sewers and enter the hospital,” the New York Times reported, quoting parts of a sensational affidavit from a Bellevue physician, despite warning its readers that the details were “unfit for publication.”
“At six Monday morning,” the affidavit began, “I was called…to see Mary Connor, an unmarried woman, aged 31 years. I immediately examined, and found [a] child beneath the hips of the mother, in a lifeless condition, and mutilated, apparently by rats. The nose…upper lip and a portion of the cheeks seemed to be eaten off. The toes of the left foot and a portion of the foot were eaten off, or apparently so. The lacerated portions were covered with sand and dirt.”
The Times did note the doctor’s opinion that the infant had died of natural causes before “the gnawing was done.” (An investigation by the coroner would support this contention.) But the newspaper offered a warning as well: “The vermin have full possession of the building,” it said, and any plan to remove them short of gutting the structure “will be more than amazing.”
Such was the confused and turbulent state of Bellevue Hospital—at once promising and repulsive. It had come a long way since its days as an almshouse appendage and a pesthouse for victims of epidemic disease. Progress had been erratic over the years, yet a new Bellevue had emerged. David Hosack’s grand vision was finally at hand. New York City could now boast of a true public hospital, standing alone.
4
TEACHING MEDICINE
In 1847, with the Great Epidemic at its peak, a city alderman accused Dr. Meredith Reese, Bellevue’s lead physician, of “pocketing an unlawful fee for the sale of dead bodies from [his] institution.” Though a special committee would exonerate Reese, calling the charge against him “entirely unfounded,” the incident stoked memories of the infamous Doctors’ Riot of 1788. Almost sixty years had passed since that bloody confrontation, but little had changed. New York’s medical schools still relied on grave robbers to meet their “anatomical needs.” The bodies still came from the city’s poorest burial grounds, which remained the easiest to rob. And the demand for corpses still outpaced the supply, leading to fears that medical training in New York might grind to a halt. “It is well known,” said a local physician, that “more than 600 young men…have had their studies arrested by a [dearth of cadavers.]”
The shortage fell hardest on the city’s two established medical schools—the College of Physicians and Surgeons at Columbia and the Medical College of New York University—while jeopardizing hopes for a third one at Bellevue Hospital. Fresh cadavers were an essential teaching tool; without them, students had to rely on illustrations and wax figures. Even the most devoted anatomists knew that grave robbing had to stop: it produced too few corpses and put the robbers at great risk. What was needed, they believed, was a way to increase the cadaver supply by portraying dissection as a public good. Didn’t better medical training benefit everyone in society, rich and poor alike? “For the sake of living humanity,” a local physician pleaded, “permit your colleges to dissect the dead!”
Exactly which dead spurred a bitter debate. It was one thing to claim that dissection served a larger purpose, quite another to determine whose remains would wind up on a slab in an anatomy class. Taking the lead was New York University’s John Draper, a British-born physician with well-known anti-Irish views. For years, Draper had lobbied the state legislature to increase the supply of fresh corpses to medical schools. Taking the moral high ground, he titled his 1854 proposal “An Act to Promote Medical Science and Protect Burial Grounds.” Others called it “the Bone Bill.”
At the time, New York state law allowed but one category for legal dissection: executed criminals. Draper’s proposal added corpses from prisons and almshouses not picked up within twenty-four hours—a sizable pool. The wording was blunt: “All vagrants dying, unclaimed, and without friends, are to be given to the institutions in which medicine and surgery are taught for dissection: the debris to be buried in the public cemetery.” The beauty of the bill, Draper argued, was that it satisfied the needs of medical education without resorting to grave robbing. Cemeteries would once again be safe havens. The respectable dead could finally rest in peace.
There was moral posturing as well. Those supporting the Bone Bill believed that prisoners and paupers owed a final debt to society. “By offering up their bodies to the advancement of a humane science,” a state legislator declared, “they will make some returns to those whom they have burdened by their wants, or injured by their crimes.” The twenty-four-hour grace period allowed grieving friends and relatives to claim those deserving a proper burial, leaving only the unworthy behind. The clear intention was to send only the lowest of the low to medical schools for dissection—those “whose vices have worn out the patience of their friends.”
The Bone Bill had its opponents. Some raised ethical objections. “We cannot help but think that the necessities of medical science have been greatly overrated,” wrote the editors of Harper’s New Monthly. “Better that the causes of some bodily diseases remain concealed than that the knowledge of them be obtained at the sacrifice of some of the best feelings of the soul.” But the loudest protests came from the neighborhoods most affected by the bill. How, in God’s name, could anyone see “the bodies of men as of no greater import than the bodies of dogs?” thundered Five Points assemblyman Peter Maguire. On St. Patrick’s Day, thousands marched in Manhattan behind a green silk banner reading, “WE PROTECT THE SICK AND BURY THE DEAD.”
Passed by just one vote in 1854, the Bone Bill proved quite effective in securing its goals. Grave robbing would drop sharply in the coming years, and medical schools got their precious cadavers. As the 1855 catalogue of the College of Physicians and Surgeons put it: “Thanks to the enlightened liberality of the legislature, the supply of anatomical subjects has not only been ample but without the difficulties and dangers of [the past].”
A banner class was expected.
—
In the first decade of the nineteenth century, fewer than four hundred students received a medical degree in the United States. Between 1850 and 1859, that number reached 17,213, matching the nation’s enormous growth. Most American cities now claimed a medical school, and some rural towns did as well. But not everyone called this progress. The nation’s first medical schools, attached to well-established colleges like Harvard, Columbia, Dartmouth, and the University of Pennsylvania, had expected their applicants to have a modest classical education—a familiarity, at least, with Greek and Latin and natural philosophy (physics). Those days were long gone. The new “proprietary” medical schools required little more of a student than the ability to pay the tuition and fees. Typically some local doctors would rent a building, offer a series of lectures, collect their money, and hand out degrees. There was no professional oversight because most legislatures had already done away with the licensing of physicians on the grounds that it denied ordinary citizens the right to choose their favored vocation. As the state of Maine reported: “the field is now open to all.”
Profit was the driving force. The goal
was to pack in as many bodies as the buildings could hold. Few college graduates applied, preferring the loftier careers in the law and clergy. Once “accepted,” the medical student took two terms worth of lectures—the subjects varying with the size of the faculty. In a medical school with five “professors,” the student sat through five eye-glazing presentations each weekday; the term, lasting about four months, was repeated verbatim the following year for “mental retention.” There was no laboratory work (beyond basic anatomy) and no chance to examine a patient. To graduate, one passed a simple examination, paid a commencement fee, and sometimes wrote a thesis (which a modern observer compared to “the term paper of a college sophomore”).
Why would a young man pay money for this when he could simply hang out a shingle after apprenticing with a local physician? One reason was that a medical education probably did help those who had faithfully attended the lectures and participated in the dissections. A medical degree also attracted well-to-do patients in cities like Boston, Philadelphia, and New York, where credentials mattered more.
The College of Physicians and Surgeons (P&S) traced its roots back to the eighteenth century, with close ties to Columbia College, New York Hospital, and the city’s medical elite. Nothing better reflected its lofty status than its move, in 1856, to a brick and brownstone building on the corner of 23rd Street and Fourth Avenue, with ample classroom space, a surgical amphitheater, and a dissecting space with twenty-five tables. Its brochure boasted of rooms warmed by a hot air furnace, lighted by gas, and blessed with pure Croton water. Built for the princely sum of $90,000, it was financed entirely by the professors who taught there.
That they could afford to do this was telling. P&S had long recruited faculty members with the biggest medical reputations. Those fortunate enough to teach there generally stayed until retirement or death. The position guaranteed both a steady income from student tuition and a private practice attracting New York’s upper crust. Not surprisingly, the number of faculty positions remained rock solid—frozen at around seven or eight—despite a steady climb in enrollments. Exclusivity had its rewards.
Bellevue Page 8
