The rebels sensed victory. “Five of the [board members] are homeopaths,” boasted a Hahnemann supporter, “and one more vote is alone required to give [us] half the wards in the largest hospital in the country.” It wasn’t to be. The rebels’ error, it appeared, lay in interpreting the rejection of bleeding and purging by many physicians as an endorsement of Hahnemann’s approach, which wasn’t remotely the case. What most of them wanted, said a local doctor, was a path “between the two extremes, neither verging towards meddlesome interference on the one hand, nor imbecile neglect on the other.” In short, a middle ground.
And that seemed the majority view at Bellevue as well. Most physicians there now rejected the “heroic medicine” of the past while still considering Hahnemann a quack. Typhus, tetanus, peritonitis—it hardly mattered. The lancet, leeches, and gut-wrenching mercury purges were on their way out; opium, quinine, and whiskey were already in. “Blood-letting, as clinical observation has shown, is not a curative measure,” a Bellevue study announced. “King alcohol appears to reign supreme.”
On the advice of Valentine Mott and other Bellevue dons, the Medical Board formed a “select committee” of three members, two of them firmly in the “allopath” camp. Their “majority report” mocked Hahnemann as a dangerous fraud, akin to the English monarchs who once claimed healing powers through “the royal touch.” Bellevue had come too far for such nonsense, they wrote. Surrendering half the wards to charlatans would reverse the momentum that had turned it from a wretched almshouse into “a well-appointed hospital crowded with grateful patients.”
There was more. Bellevue’s stature depended in large part on the clinical opportunities it provided. “No one who visits can fail to be struck with the throng of students and medical men who crowd its ample theatre, and the eagerness with which they listen to the instruction,” the report went on. “[This] high standing has given it a national reputation in the medical profession, and rendered it an object of inquiry and compliment abroad.”
The message was clear: those who controlled the hospital might soon be running a medical school as well. And with that came the duty to train would-be physicians in a responsible manner, ignoring the “foolery” of Samuel Hahnemann and his misguided legions.
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The pieces were in place. The Bone Bill had dramatically aided medical education in New York state, and the homeopaths had been routed. With close to one thousand beds spread across thirty-four different wards, Bellevue offered clinical riches on a massive scale. From Boston, meanwhile, came word of a breakthrough—a miracle, really—that would revolutionize medicine and hospital care as few things had before.
In Harvard’s Countway Medical Library hangs a massive canvas of a surgeon standing over a young man who appears to be asleep. The surgeon, holding a scalpel to the patient’s neck, is surrounded by a group of curious colleagues; behind them are rows of spectators in neatly angled seats. Painted over a full decade by Robert Cutler Hinckley, The First Operation Under Ether ranks among the most famous scenes in medical history.
The procedure took place in an operating theater in Massachusetts General Hospital on October 16, 1846. The origins of surgical anesthesia—who perfected it; who cheated whom out of fortune and glory—are still in dispute. One historian recently described the tangle as “fishy enough to populate an aquarium.” But most agree that this brief demonstration in Boston marked anesthesia’s successful debut. It was here that a local dentist named William T. G. Morton put a tube to the lips of Gilbert Abbott, “a consumptive young man with a vascular tumour [on] his jaw,” and told him to breathe in the vapors. It took about four minutes for the sulfuric ether to do its job. With Abbott seemingly unconscious, Morton turned to Dr. John Collins Warren, the surgeon standing beside him, and said, “Sir, your patient is ready.”
The operation took twenty-five minutes. Anticipating the screams that normally followed the first incision, Dr. Warren was astonished to hear none. When Abbott awoke, his tumor cut away, he claimed to have felt nothing beyond a bit of roughness on his neck. Warren then turned to the audience and uttered what some insist are the five most famous words in American surgery: “Gentlemen, this is no humbug.”
Pain was one of the two biggest obstacles to major surgery—the other being postoperative infection. By the 1840s, a well-informed surgeon knew enough about human anatomy to prevent serious blood loss through the binding, or ligation, of surrounding arteries and vessels. But the operation itself caused such intense suffering that it had to be done lightning-quick, with several men to hold the patient down.
In the days before anesthesia, Dr. Warren recalled, the surgeon would actually quiz the patient on the operating table before proceeding. “ ‘Will you have your leg off, or will you not have it off?’ If the patient lost courage and said, ‘No,’ he had decided not to have the leg amputated, he was at once carried back to his bed in the ward. If, however, he said, ‘Yes,’ he was immediately taken firmly in hand by a number of strong assistants and the operation went on regardless of whatever he might say thereafter. If his courage failed him after this crucial moment, it was too late and no attention was paid to his cries of protest.”
The best that could be done, aside from merciful speed, was to dose the patient with laudanum or whiskey and then stuff his ears with cotton to muffle the sound of the instruments slicing through flesh and bone. Surgeons confessed to vomiting before each procedure; one compared his work to “a hanging.” “There is not an individual who does not shudder at the idea of an operation, however skillful the surgeon or urgent the case,” wrote another, “knowing the great pain that the patient must endure.”
Anesthesia would have its critics. Some saw physical suffering as a punishment from God, not to be tampered with; others worried about the dangers of inhaling a foreign gas. Samuel Hahnemann viewed pain as both a vital diagnostic tool and a natural part of healing. “Better let the patient suffer a while,” he wrote, “than complicate the troubles and retard the final recovery, or risk the patient’s life.”
But these were minority opinions, to be sure. The news from Boston that day was electric. No longer would pain “make all men cowards,” wrote an ecstatic Valentine Mott. Patients would lose their fear of the knife, allowing surgeons to perform operations “which the most bold and adventurous of [us] would not have had the temerity to touch.” For those like Hahnemann who opposed anesthesia, Mott had a message: “Away with the stupid fanaticism that would inculcate the patient endurance of suffering when it could be relieved.”
The impact was dramatic. Before anesthesia, demonstrations in the operating theater had been so ghastly that guidelines were needed to keep order. At Bellevue, surgeons were told: “it is better to lecture before or after cutting human flesh, and not while the agonized patient is writhing under prolonged torture, or held still while gaping wounds are coldly commented on.” It did little good. A Bellevue intern wrote that “the first operation I witnessed without anesthesia was so disquieting…that I was nearly driven from the profession”—and he wasn’t alone. Numerous young men, including Charles Darwin, quit their medical studies for fear of inflicting such pain on others. “To behold the keen shining knife…to hear the saw working its way through the bone produced an impression I can never forget,” one of them recalled. “I could not look upon the operation, but covered my eyes to keep myself from fainting.”
As Mott predicted, the “calculus of suffering” was forever changed. At Bellevue, the number of major operations slowly increased, as did the quality of those who performed them. Joining Mott was a group destined to lead the field: Lewis A. Sayre in orthopedic surgery; Frank H. Hamilton in fractures and battlefield wounds; and Stephen Smith in general surgery and public health. All—save Mott, now well into his seventies—would be founding members of the Bellevue Hospital Medical College.
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Their announcement came early in 1861, promoting a new school on the Bellevue grounds. Quite naturally, it stressed the connectio
n between a medical college and a hospital with “immense” clinical resources. Students at Bellevue would travel seamlessly between their classes and the wards. Births and operations would be studied in real time. Anatomy would be taught in “commodious” dissecting rooms with “abundant material”—thanks to the Bone Bill of 1854. “The day is not far distant,” the circular boasted, “when Bellevue will rank, not only as the first hospital in our country, but as one of the most important schools of medical education in the world.”
There were no firm standards for admission beyond a three-year apprenticeship with “a responsible practitioner of medicine,” which was rarely enforced. The curriculum included four terms of lectures, clinics in obstetrics and surgery, and dissection classes in the morgue. Graduation required an exam “in each of the departments of instruction” and “an acceptable thesis in the handwriting of the candidate.” Forty percent of the entering class lived outside New York state, many coming from New England and a handful from foreign countries—a testament, it appeared, to the promise of a hospital-linked medical college.
That appeal, however, was not immediately realized. Students griped that there were too many boring lectures and too few bedside visits. And bitter feelings surfaced about “the habitual neglect of punctuality” among faculty members more interested in their “ordinary professional business” than in their teaching duties. Given the “liberal compensation” involved, the students clearly expected more. The end result was a vague faculty resolution regarding “dereliction of duty.” But no penalties were enforced.
Bellevue’s entering class was entirely white and male, reflecting the race and gender boundaries of the time. At Harvard Medical College a few years before, a tepid attempt by several faculty members to enroll a woman and three blacks had led to a full-scale campus revolt. Calling the move “socially repulsive,” the students successfully threatened to resign en masse and “complete our medical studies elsewhere.”
Until the Civil War, only one woman had ever earned a degree alongside men at an American medical school. In 1848, the dean of Geneva Medical College in upstate New York was asked by a physician friend to admit a brilliant candidate named Elizabeth Blackwell. A devoted feminist, born in England, Blackwell had been rejected everywhere else she had applied—one administrator telling her, “You cannot expect us to furnish you with a stick to break our heads with.” Fearing a backlash, the Geneva dean agreed to let the students decide the issue by unanimous vote. The students, thinking it a joke, gave their boisterous consent.
When Blackwell arrived on campus two weeks later, “a hush fell upon the class,” a witness recalled, “as if each member had been stricken with paralysis.” Though Blackwell would graduate with honors, the reaction to her medical degree was severe. “It is much to be regretted,” read a typical complaint, “that she has been led to aspire to…duties which by the order of nature and the common consent of the world devolve upon men.” Geneva barred female students thereafter.
Women seeking to become physicians often attended female homeopathic colleges. Manhattan housed two of them by the 1860s, but with few available resources they encouraged their students to audit medical lectures at Bellevue, which were open to anyone who bought a ticket. In 1864, the New York Times published a story that surprised no one familiar with medical school culture: female visitors, it said, had been repeatedly insulted at Bellevue and dreaded going there.
The story sparked a flurry of letters. Some blamed an “ill-bred” clique of male students for making “gross remarks too shocking to the moral senses to even be repeated.” Others, however, thought the boorish antics of the men less provocative than the misguided ambitions of the women. “The profession of medicine,” said one, “is too high for them to aspire to.”
A letter-writer calling herself “Mother of the Old School” worried that coeducation hurt both sexes by limiting what properly could be taught. Was it really possible to discuss intimate body parts and procedures in mixed company? “One of [our] ablest and most celebrated physicians has told me that in lecturing at Bellevue his cheek has blushed to find women as his auditors. With such feelings [he] cannot give true scope to his subject, his manliness is insulted [and he] must be obliged to study his language and clothe his sentences in a way least offensive to the [female] ear. Ought medical lecturers be thus annoyed and trammeled?”
The Times fully agreed. Certain occasions were ill-suited for mixed company, it thought, and this clearly was one. “For our part, we think it is incompatible with devotion to study…to have the sexes mingling in attendance at [one] of the great hospitals and medical schools of this city.”
The issue would not soon disappear. While some Bellevue faculty tolerated female auditors, others tried to drive them away. In 1872, a furor erupted when a professor of surgery, preparing “a cancerous penis” for amputation, supposedly grabbed hold of the organ, stretched it playfully for maximum amusement, and remarked: “Gentlemen, this is an old penis. I would rather amputate a younger one as it would prevent more mischief.” Then, counting aloud to three, he lopped off the cancerous part and tossed it “some distance” to the floor. As word of the incident spread, there were calls to fire the professor and replace him with “gentlemen who have not forgotten that their mothers, wives, and sisters are women.”
Nothing came of it. Bellevue would remain the reluctant host for a generation of female auditors with nowhere else to turn. In 1916, looking back fifty years to her time as a medical student in New York City, Dr. Anna Manning Comfort recalled the dread she felt upon entering Bellevue’s massive walls. “There were 500 men students. We were jeered and catcalled,” she wrote, “and the ‘old war horses,’ the doctors joined the younger men. All the work at the hospital was made as repulsively unpleasant for us as possible.”
Each visit brought a fresh insult. “If I wore square-toed shoes and swung my arms they said I was too mannish, and if I carried a parasol and wore a ribbon in my hair they said I was too feminine.” Manning Comfort stuck it out as many of her classmates dropped away. Five decades had done little to dim the memories. Life for women students at Bellevue, she noted, was “beyond belief.”
5
A HOSPITAL IN WAR
Bellevue Hospital Medical College opened its doors on April 11, 1861. The following day, Confederate gunners rained down cannon fire on Fort Sumter, in Charleston harbor, and the Civil War began.
No Northern metropolis was more divided by this conflict than New York. The city’s financial elite—its bankers, speculators, and merchants—had extremely close ties to the Southern economy. Much of the credit needed by planters to buy slaves and harvest cotton came from Wall Street, and much of that cotton (or “white gold”) was shipped to British factories through the port of New York. By the 1850s, wealthy Southerners were a fixture in the city, shopping with abandon and filling the best restaurants and hotels. Even the downtown theaters catered to their tastes, with romps about “happy-go-lucky” plantation life. “[Our] city,” wrote the New York Times with modest exaggeration, “belongs almost as much to the South as to the North.”
New York City was a Democratic Party stronghold with a powerful immigrant working-class base. In the 1860 presidential election, Republican candidate Abraham Lincoln had carried New York State while losing badly in the city. The key issue was race. Recent immigrants in particular feared the consequences of emancipation, which they believed would lead thousands of newly freed slaves to flood Northern cities in search of jobs and housing. Sooner or later, warned the New York Daily News, “we shall find negroes among us thicker than blackberries swarming everywhere.” On the eve of the war, Democratic mayor Fernando Wood, a Southern sympathizer, actually floated the idea of turning New York into an independent entity—“a free city”—if the South seceded. Crazy or not, it raised the troubling question of whether Northern resolve was strong enough to preserve the Union. “The crucial test of this is New York City,” wrote one local newspaper, “the spot most tainted
by Southern poison.”
The answer came quickly. Fort Sumter ended loose talk of pacifying the South. The idea of “a free city” died a merciful death as New Yorkers closed ranks behind the Union. “Flags from almost every building,” Wall Street lawyer George Templeton Strong noted in his diary. “The city seems to have gone suddenly wild and crazy.” When President Lincoln called for 75,000 volunteers to put down the “rebellion,” New York’s recruiting centers overflowed. Regiments formed overnight, led by immigrant units like the First German Rifles, the Garibaldi Guard, and the Irish Brigade. Black volunteers, however, were turned away.
With doctors in high demand, men of all ranks and ages at Bellevue rushed to enlist—on both sides. Three dozen interns would leave during the war to serve the Union cause, while fifteen would join the Confederacy—men like Moses John De Rosset, an “assistant surgeon of artillery” in Stonewall Jackson’s command, and Isham Randolph Page, a “surgeon of artillery” in Robert E. Lee’s Army of Northern Virginia. Students and interns supporting the Union received a “certificate of completion” from Bellevue for their military service. Those supporting the Rebels did not.
Each Union regiment, about one thousand strong, was assigned a surgeon and an assistant. Early on, these positions were filled mostly by hometown doctors who had never seen, much less performed, a serious operation. The Bellevue volunteers were a clear cut above, having dealt with knifings, shootings, and bone-crushing accidents. They’d also trained alongside top-flight surgeons like Frank H. Hamilton, who had just offered his own services to New York’s 31st Regiment, which was expected to lead the fight.
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