By war’s end, the ambulance was widely recognized as a lifesaving tool. The next step seemed clear enough: if thousands of wounded men could be safely plucked from the chaotic hell of Antietam and Gettysburg, surely this concept could be applied to civilian life as well. But no one, least of all Stephen Smith, viewed an ambulance corps as a top priority given the massive health problems facing New York City in 1869. Smith had picked Dalton because of his obvious administrative talents—a view reinforced by none other than General Grant, who had warmly recommended his former subordinate as “the best man in the United States” for the job. Dalton, though, was adamant. While devising plans for citywide sanitary inspections, he proposed an idea, known as “Rapid Response,” that used police wagons to carry the sick and injured to Bellevue. The civilian ambulance seemed an obvious next step.
It wasn’t hard to see the need. In the past, a person lying in the gutter might be comforted by caring strangers, brought to the nearest druggist for “restoratives,” and then dumped into a passing conveyance for a bone-jarring ride to a hospital, or perhaps back home. These were the lucky ones: many more victims were left untreated until it was too late, much like the wounded Union soldiers at Bull Run. In pushing his case, Dalton compared the shameful neglect of these soldiers to the current situation in New York, his favorite example being an exhausted workingman who had fallen from a streetcar one night near the Battery, at the southern tip of Manhattan. “He was taken to the nearest house, and there he lay bleeding…while kindly passers-by tried to find a wagon to take him to Bellevue.” But one man’s horse had “worked all day,” another’s had “a stone in his shoe,” and a third was “too skittish” for the trip. “It was three o’clock in the morning before [a wagon was found] and it bumped and joggled over the street, subjecting the man to exquisite pain.” He died along the way.
Dalton’s plan called for a small fleet of ambulances housed at a single hospital. Needing a sleek vehicle that maneuvered easily through city traffic, he approached the Abbot-Downing Company of New Hampshire, a leading stagecoach maker. Together they crafted a model of finely polished black wood, light enough for a single horse to draw, yet sturdy enough for a driver, a surgeon, and two patients lying down (or eight sitting up). The cabin stood high above the wheels for extra suspension. Each side had the word “AMBULANCE” emblazoned in gold lettering, with a gas lantern and night reflectors. A foot pedal sounded a bell to warn pedestrians. Inside were a couple of stretchers, a cabinet stocked with whiskey and bandages, a stomach pump for the poisoned and suicidal, and a straitjacket for those of “a demonstrative disposition.” One writer called it “the Victorian equivalent of a portable emergency room.”
Bellevue seemed the perfect testing ground. Having interned there, Dalton knew that it admitted more patients, with more injuries, than any hospital in the city. His plan linked Bellevue to local police stations by telegraph. Each message sounded a gong in the hospital’s newly outfitted stables. Handed a destination slip, the ambulance team headed for the emergency, avoiding rutted alleys and cobblestone streets when they could. City traffic was the biggest obstacle. Huge steam locomotives moved freight at a snail’s pace on poorly tended rails. A dozen streetcar lines jockeyed with carts, carriages, and pedestrians on thoroughfares smeared with the manure of forty thousand horses. (“Modern martyrdom,” wrote the New York Tribune, “may be succinctly defined as riding on a New York omnibus.”) By law, the Bellevue ambulance was given the right-of-way over all vehicles except the fire wagon and the U.S. mail, and that seemed to help. A reporter along for a ride noted: “As we swept around the corners and dashed over the crossings, both doctor and driver kept up a nervous sharp cry of warning to the pedestrians who darted out of the way with haste, or nervously retreated to the curb….[Even] the surliest of car-drivers and the most aggressive of truckmen…pulled up or aside to afford passage.”
The job of ambulance surgeon proved hard to fill. The twelve-hour shifts and $600 yearly salary attracted so few applicants that Bellevue took to staffing the post with new interns too intimidated to refuse. But the hospital had better luck recruiting the drivers, mostly immigrants who saw the $500 annual salary, plus room and board, as a step up from common laborer, which, indeed, it was. The driver had to know the geography of Manhattan, “with special reference to the shortest distances from one given point to another.” But the key requirement was speed. The ambulance was expected to cover a mile in from five to eight minutes “in the business district,” and from four to six minutes “in the less crowded part of the city.” Teams competed for the fastest response times—the record held by Thomas Coughlin and his horse, Baby, on a run between Bellevue and the original Madison Square Garden, where a circus performer had been injured. The ambulance traversed the half-mile route in under two minutes, crossing four streets and several trolley tracks, passing under two elevated railways, and taking the turns at close to full gallop.
The early Bellevue ambulance cases were not unlike those rushed to an emergency room today. A sampling from a three-month stretch in 1872 included a worker badly injured in a boiler explosion; an “intoxicated woman” who fell from a third-floor window; a “steady and hard drinker knocked down and run over by a milk wagon”; a “poorly nourished” Irish boy “caught in the wheels of a streetcar”; and “a healthy-looking German [who] attempted suicide with a butcher’s knife.” “Unfortunately for himself and perhaps the rest of mankind,” the admitting physician scribbled, “he did not succeed.”
A fair number of cases were alcoholics who had passed out on the street—policemen finding it easier to summon an ambulance than to escort the offender to the “drunk tank.” Those who died along the way were sent to the morgue and placed on slabs next to a large glass window for public viewing and identification. Unclaimed bodies were stuffed into pine boxes and placed aboard the perversely named tugboat Hope, “a grim, black, demonic-looking craft,” for the short, final voyage to Hart Island in the Bronx.
What gave the Bellevue ambulance its reputation were a series of bloody clashes in the summers of 1870 and 1871 between local Irish Protestants and Catholics. For years, New York’s smaller Protestant faction had taunted its rival with a parade commemorating the Battle of the Boyne, where, in 1690, the forces of Protestant King William of Orange had crushed the army of the recently deposed Catholic King James II. As the event grew larger over the years, so, too, did the angry protests. On July 12, 1870, some two thousand well-lubricated “Orangemen” marched up Manhattan’s West Side singing “Protestant Boys” and chanting “Croppies Lie Down” as they passed through heavily Irish Catholic neighborhoods. An angry, swelling crowd followed the marchers to Elm Park. “BLOODY RIOT,” blared the next day’s New York Times. “Three Killed, Six Mortally Wounded, and a Hundred Others Injured.” Praising “the promptness and bravery of the police,” the newspaper spotted something new—a small fleet of polished black ambulances picking up the crumpled bodies and rushing them to Bellevue. Each vehicle had a policeman sitting inside to keep the bloodied “Papists” and “Orangemen” from resuming the brawl.
A few months later, the city added five ambulances and horses to the Bellevue force. This proved fortuitous since the Elm Park riot was but a run-up to the main event. In 1871, Tammany leaders, under extreme pressure from their Catholic base, refused the Orange Order’s request for a parade permit on the grounds that the city could no longer provide adequate protection for the marchers. The decision enraged New York’s non-Catholics, who demanded a tough stance against “Irish hoodlums” preaching “free murder, free drunkenness, and free rioting.” It bordered on extortion, they charged, to allow a raucous St. Patrick’s Day Parade down the city’s main thoroughfare each year while denying others the same privilege. Powerful interests, including newspaper publishers, businessmen, and anti-immigrant groups successfully lobbied the governor to overturn the ban.
On July 12, a sweltering day, the Orangemen began their march surrounded by 1,500 city policemen, most o
f them Irish Catholic, and four companies of largely Protestant state militia. Trouble came quickly. Angry Catholics showered the marchers with rocks, bottles, crockery, animal waste, and occasional gunfire. The militia responded with point-blank rifle volleys, while policemen waded into the crowds, clubs flying. By the time the bloodshed ended at least sixty people were dead, and hundreds more were injured. It was, in terms of civilian casualties, the bloodiest confrontation in the city’s history, exceeding the worst single day of the recent Draft Riots of 1863.
Bellevue overflowed with the dead and the wounded. “The scene [there] was a sad and painful one,” an observer noted, with “ambulances discharging their bloody loads at the door.” No one could recall a day when more surgeries were performed and more patients were lost. “Shot while watching Parade—Died at Bellevue”; “Leg Shattered by Musket Ball—Amputated at Bellevue”; “Shot in Back by the Militia—Died at Bellevue”; “Shot by Musket in Thigh—Treated at Bellevue”; “Jaw Shot Off—Died at Bellevue”; “Pistol Shot in Chest—Treated at Bellevue”; “Musket Balls in Wrist and Abdomen—Died at Bellevue.” It took several pages of single-spaced entries to document the carnage. The following day, a sea of mourners, estimated at twenty thousand, gathered at the hospital gates to accompany a shimmering line of hearses to the Greenpoint ferry and on to Calvary Cemetery, the area’s largest Catholic burial ground.
The great irony of the so-called Orange Riot of 1871 was that it seemed to achieve what Dr. Stephen Smith and other reformers had been unable to: the removal of Boss Tweed. While a fair number of well-off New Yorkers had benefited immensely from Tweed’s various schemes, many more had relied on him to maintain the peace. When he failed once again to do so, his usefulness came to an end. Within weeks of the Orange Riot, newspaper reports of the Tweed Ring’s staggering corruption—hardly a secret—led to feverish calls for an investigation and, ultimately, to Tweed’s demise. Many viewed his fall in terms of the political and economic excesses of the times, and this, no doubt, is true. But others saw it in simpler terms, as the failure of a political boss to carry out the most basic of his tasks. “That saving grace was gone,” note the authors of Gotham, the leading history of New York City. “Tweed could not keep the Irish in line.”
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In 1869, Bellevue’s two ambulances had responded to 74 emergencies. A decade later, its fleet of seven would answer more than 1,900 calls, the number peaking at close to 4,400 in the early 1890s. Before long, Presbyterian, St. Vincent’s, Roosevelt, and New York Hospital all had ambulances on the streets. The key difference, noted the New York Tribune, was that “by law, private hospitals are permitted to unload free cases upon Bellevue, and the latter institution is required to receive them.”
The ambulance played a dual role in this process. Crews from private hospitals were ordered to ignore street calls involving ragged-looking victims with serious injuries. And they routinely transported “problem” patients—those “likely to die”—to the one place that couldn’t say no. Early on, the newspapers had reported these practices without criticism. “Patrick Carey, a horseshoer, 33, suffering from delirium tremens, was transferred to Bellevue…too far gone for any remedy to save him,” read a typical entry in the 1880s. But as medical emergencies became more common, a different story line emerged. “THE PATIENT DIED: A Young Lad Carted from One Hospital to Another,” read a New York Times headline in 1896. “The father, a porter in a linen house, literally gasped when he learned of the boy’s death. He had not known of his removal to Bellevue.”
A handful of these transfers were “nuisance” cases: Bellevue received one ambulance patient with the bizarre diagnosis of “Rheumatism and Insubordination.” But most involved wounds and illnesses increasingly tied to modern city life—construction mishaps, traffic accidents, and violent crimes, with the victims invariably coming from the “lower classes.” “Open your books and show me one man of wealth who has ever been transferred,” a reformer fumed. The practice—known today as “patient dumping”—involved just about every ambulance corps in the city, though Bellevue’s superintendent accused one in particular (almost certainly New York Hospital’s) of unloading “dozens of critically ill patients each week.”
This was no exaggeration. In 1900, a city health official estimated that more than a hundred of Bellevue’s recorded deaths the previous year had occurred within a day of the patient’s transfer from another hospital. There was no medical justification, the official conceded. These hospitals were “sending the poor, dying patient to Bellevue in order to lessen their [own] death rates”—pure and simple.
The original ambulance corps, based quite literally on “horsepower,” didn’t survive long into the twentieth century. One by one, New York’s hospitals retired the horse-drawn vehicles, though not without some regret. When a huge snowstorm blanketed the city in 1915, the new gas engine ambulances proved “helpless in the drifts,” while the old ones easily pulled through. “The time should never come,” said one nervous official, “when the horse will be entirely discarded.”
But that time did arrive. In 1924, Bellevue, the lone holdout, closed its stables for good. Only two horses remained, and they were “retired” in a poignant ceremony attended by a small crowd of doctors and nurses and retired ambulance men. “The horses, Joe and Jim, for twenty years stall mates, had tears in their eyes, according to their driver John O’Neill, who stood with bowed head as they were hitched to a wagon and driven away.” Their destination was listed as “a farm Upstate…where their shoes will be removed and they will be permitted to graze until they die.”
The horses, it turned out, had a brighter future than Mr. O’Neill. Unable to drive an automobile, and apparently too old and nervous to learn, he received a different sort of transfer—leaving Bellevue for a lesser city job as a common laborer.
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Edward Dalton’s time in New York City was marred by tragedy. He lost his only child to disease in 1868, and his wife in childbirth the following year. Weakened by chest pain and a hacking cough, a likely victim of tuberculosis, he moved to California in a futile attempt to regain his health. “During all this time,” it was noted, “nothing could exceed the fortitude and cheerfulness with which he bore the succession of his trials.” Dalton died in 1872, far from home and remaining family, at the age of thirty-seven. “Probably no inventor has ever been more completely forgotten, or has received less credit for his work, than the New York surgeon who designed the city ambulance,” an admirer wrote in 1901. “It is not likely that more than fifty persons in the country know even his name.”
8
BELLEVUE VENUS
In 1867, a brief paragraph appeared in the Bellevue Annual Report stating that $281.12 had been spent on supplies for a new “Photographic Department.” And it contained an explanation from the ubiquitous Stephen Smith about the importance of this infant field to the medical profession. “In all the large Military Hospitals photography is [now] regarded as an indispensable feature of the records of the sick,” Smith wrote of the still-fresh Civil War experience, “and it will prove no less important in a large [civilian] Hospital.”
Smith was right on both counts. Medical photography had grown immensely during the Civil War, and would continue to thrive. While much of it involved portraits of limbless veterans or scenes of corpse-covered battlefields, some photographers had boldly entered the forbidding world of the surgical tent to capture operations actually under way. The impetus came largely from Surgeon General William A. Hammond, whose order creating the Army Medical Museum in 1862 had directed field officers to collect “all specimens of morbid anatomy…which may be regarded as valuable…in the study of military medicine or surgery.” A flood of material soon arrived, including photographs, instruments, bone fragments, and a small coffin containing the amputated right leg of General Daniel Sickles, lost to a Confederate cannonball at Gettysburg.
Bellevue’s photographic department was another first for the hospital in the post–Civil War
years. To run it, Smith wisely recommended the man who suggested the idea—a thirty-seven-year-old portrait photographer named Oscar G. Mason, with an encyclopedic knowledge of his craft. Mason’s first task was to convince the skeptics that medical photography was something more than a frivolous expense for a hospital serving the poor. He did so by striking an ingenious deal with City Hall. For a small fee, Mason agreed to photograph the face of every unclaimed corpse sent to the municipal morgue at Bellevue, and to post the images on the wall just outside.
It couldn’t have worked out better. As New York’s population surged, so, too, did the number of anonymous corpses. Day and night, people wandered through Bellevue’s dead house to inspect remains stretched out on stone tables. “A stream of cold water, from a movable jet, falls over the lifeless face, warding off decay until the last moment…in the hope that someone…will claim the body,” a reporter noted, adding that “nearly all go to the Potter’s Field.”
Mason’s “Wall of the Unknown Dead” was an instant sensation. A body might be gone within a day or two but the facial image remained there for a full year, meaning that hundreds of corpses buried in Potter’s Field might be identified later, and possibly reclaimed, thanks to the magic of photography. The “unmistakable records of this gallery of death give ample proof of the humane forethought which prompted [its] establishment,” Mason explained. “It is gratifying to know that public sentiment and the press continue to highly commend this feature of the department.”
Though rarely given credit, Mason also played a role in creating the first criminal “mug shot,” popularized by the New York City Police Department in the 1870s and modeled on Bellevue’s “Wall of the Unknown Dead.” Mason thought photography the perfect tool for identification. There were no embellishments, no flawed recollections, no “might be,” “could be,” or “perhaps.” He even claimed that his photos had a “restraining influence” on violent crime, because those who were murdered could no longer be “quietly hidden from sight or easily forgotten. Their faces are always visible, waiting for recognition and testimony.”
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