Bellevue–From Poorhouse to Hospital

Bellevue Hospital is one of the oldest medical institutions in the United States originating as an 18th century poorhouse. Hospitals were much different in the 18th and early 19th centuries as they were facilities where the poor and forgotten went to die instead of seek treatment. For those that could afford it, doctors would come to the patient instead of the patient coming to the doctor. However, this began to change in the mid-19th century as hospitals around the world became more sanitary, medical schools attached themselves to hospitals, and with the breakout of the Civil War, an influx of patients caused a change in how hospitals operated. Bellevue Hospital in New York City is part of this evolution of hospitals from places where people went to die into places of healing.

It is the nature of medicine to change and evolve as the science and applied technologies evolve as well. One of the greatest medical advancements in history is the advent of germ theory, the discovery that bacteria and microorganisms cause disease instead of bad air or “miasmas.” In the early decades of Bellevue’s history, its doctors, along with about every other doctor of the time, believed in miasma theory. It was not until after the Civil War that germ theory began making its way to America as disease killed more soldiers than bullets and artillery shells during the conflict.

Bellevue started to become well known after the Yellow Fever outbreak of 1795 where a young doctor, only 20 years old, Dr. Alexander Anderson began his medical career. The epidemic took the lives of anywhere between 3,000 and 3,500 New Yorkers and the worst cases were sent to Bellevue Hospital to be taken care of by Dr. Anderson.^[1]

By the time of the Civil War, Bellevue was already a well-known medical institution. With the advent of anesthesia in 1846 at Mass General Hospital in Boston, the number of surgeries performed across the country increased as both patients and doctors no longer needed to fear the pain of surgery.^[2] What really propelled Bellevue Hospital into the future was the establishment of the medical college by Drs. Valentine Mott, Lewis Sayre, Frank Hamilton, and Stephen Smith in 1861. The integration of the Bellevue Medical College and the Bellevue Hospital combined with the “Bone Bill” of 1854 allowed for medical students to optimize their education and make the most out of the two-year program. The “Bone Bill,” or the Act to Promote Medical Science and Protect Burial Grounds, allowed for the increase in cadavers for medical education so that medical schools did not need to resort to body snatching for educational dissections.

After the Confederate attack on Fort Sumter, the day after the medical college opened its doors, President Lincoln called for 75,000 volunteers to put down the Southern rebellion. Among these recruits were thousands of doctors and “three dozen interns would leave during the war to serve the Union cause, while fifteen would join the Confederacy… Students and interns supporting the Union received a ‘certificate of completion’ from Bellevue for their military service.”^[3] Students who went to the Confederacy did not receive a certificate from the college.

In the early months of the Civil War, the overwhelming majority of surgeons and doctors in America had seen very few traumatic injuries and therefore were not properly prepared for war. However, the students of Bellevue had encountered stabbings and penetrating wounds, shootings, and bone-crushing injuries at all levels of their education. Bellevue Hospital was, and still is, a public hospital who has a history of not turning away anyone regardless of injury or ability to pay. Members of the working class and those in the less affluent neighborhoods of New York City sought treatment or were brought to Bellevue Hospital for a variety of reasons. While the outbreak of war would put the student of Bellevue to the test mentally and physically, they had all the tools necessary for success.

The Civil War became a blessing and a curse for the medical field. On one hand, doctors and medical professionals were able to develop new techniques and revolutionize the field of medicine with the number of cases doctors were able to see. On the other hand, it overloaded the system with wounded soldiers and left some of the less experienced doctors in charge of the care of these men. Dr. Titus Coan, 25, was a new doctor beginning his medical journey at Bellevue Hospital in 1862. He wrote to his family “I have sole management unless I call in the visiting physician in cases of extreme gravity… This is the ideal place for learning medicine.”^[4] At the time, 400 patients from campaigns in Virginia and along the James River occupied the beds of Bellevue Hospital. After the Battle of Gettysburg, 613 patients arrived at Bellevue to receive treatment for their wounds suffered in battle.

Later that month in July 1863, President Lincoln issued the Conscription Act calling for all able-bodied men between the ages of twenty and thirty-five, and single men up to forty-five, to register for the draft. Many of the city’s inhabitants were upset and angry at the law as it allowed for people to pay $300 for someone to register in their place. The rich members of society were able to afford this fee. The middle and lower classes of society (workers, immigrants, African-Americans) did not have the means to do so. This caused a considerable amount of tension in the city that came to a boil on July 13.

Droves of Irish immigrants and laborers took to the streets of midtown Manhattan and ransacked buildings, burned down draft buildings, attacked the rich as well as African Americans, “The rioters’ targets initially included only military and governmental buildings, symbols of the unfairness of the draft. Mobs attacked only those individuals who interfered with their actions. But by afternoon of the first day, some of the rioters had turned to attacks on black people, and on things symbolic of black political, economic, and social power.”^[5] Chaos enveloped Manhattan and left 100 dead after several days of riots. Many of the wounded were taken to nearby Bellevue Hospital to lay next to wounded Union soldiers who had previously answered the call to service.

Bellevue would continue treating wounded soldiers and training new doctors for the remainder of the war. One medical student, who graduated in March of 1865, was Dr. Charles A. Leale. Dr. Leale joined the army after his graduation and was stationed just outside of Washington, D.C. treating wounded officers. Venturing into the city for a night, Dr. Leale took a trip to the theater to try and catch a glimpse of the President during a showing of Our American Cousin. Towards the end of the play, a shot was fired, and John Wilkes Booth leaped from the Presidential box and a cry for a doctor was heard. Dr. Leale was the first to respond to the mortally wounded President and oversaw his care for the next nine hours until his passing on April 15 at 7:22 AM. Dr. Leale credited his training with Dr. Frank Hamilton in giving him the tools he needed to make multiple attempts at trying to save the President’s life before transitioning to end-of-life care.

In 1869, Bellevue Hospital would lay claim to house the nation’s first hospital-based civilian ambulance service. However, Commercial Hospital in Cincinnati, Ohio was the first to do so in 1865. The Bellevue ambulance service was created by Dr. Edward Dalton, born in Lowell, Massachusetts, and a graduate of Harvard and the College of Physicians and Surgeons. He received an internship at Bellevue Hospital before joining the war effort as a regimental surgeon. It was this experience and later working with the United States Ambulance Corps that inspired him to bring the idea of an ambulance service into the civilian world. What made the Bellevue ambulance service unique is that it used established telegraph dispatch lines used by the police. Patient information such as location was relayed to the station and a doctor accompanied by a driver would make their way to the scene. These ambulances were equipped with a variety of tools and medical supplies including a stomach pump.^[6]

One of the leading causes of death throughout the Civil War and across the medical world was infection and disease. This was in part due to a lack of knowledge of antiseptic procedures. In the years after the Civil War, Dr. Joseph Lister traveled America preaching the use of antiseptic practices which were not fully embraced or often ignored by doctors. Bellevue Hospital was one of the facilities that did not listen to the words of Dr. Lister and suffered a great deal of post-surgical infections and death because of it. So much so that the women working in the obstetrics wards threatened to go public with information that Bellevue knew how to stem the high infant mortality rates but would not do anything about it. A decision was made by the hospital to open a new facility for birthing in an adjacent building where “hands were to be washed thoroughly in a chlorine solution.”^[7]

Despite solid evidence brought by Dr. Lister and through the practices of the nurses in the Bellevue maternity wards, germ theory and antiseptic practices did not catch on until after the assassination and death of President James Garfield. Dr. Hamilton was asked to attend and assist to the President’s wound, which even for the time was not fatal. Dr. Hamilton, a firm non-believer in germ theory, operated as he normally would which included not washing hands, using the finger as a probe, and believing that pus was part of the healing process instead of a sign of an infection which killed the President.[8] Had the doctors listened to the studies and lectures on germ theory spread by Dr. Joseph Lister in the years after the Civil War, Garfield’s medical team could have very likely avoided the infection leading to his death. Shortly after the death of President Garfield, the old ways of miasma theory were pushed aside by new antiseptic practices and germ theory.

Fast forward 100 years to the early 1980s. New York City, San Francisco, and the rest of the nation was coming to terms with the AIDs epidemic. Doctors initially did not know how the disease spread, only that it primarily affected gay men and intravenous drug users. Across the nation, doctors and nurses would refuse to treat those sick and dying of AIDs for fear of getting it themselves. Bellevue Hospital was right in the middle of this crisis, and being a public hospital, they could not turn people away from getting a bed. Doctors were learning how to treat, identify, and educate both themselves and others about this new disease. Bellevue even had a section dedicated to the treatment of AIDs patients called “17 West.” There was another ward with a much more somber tone to it, the ward known as “12 East” was dedicated to palliative care for AIDs patients who would die soon.[9]

Bellevue Hospital is one of the most recognizable names in American medical history for all of its innovation and some of the titans of medicine who occupied its halls and surgical theaters. When the Bellevue Medical College opened its doors, it was at the forefront of medical innovation which continued into the 20th century. Bellevue Hospital’s role during the Civil War put it and other hospitals in unique positions to lead the way in applying innovative technologies and methods to the medical field for the improvement of patient care. Our medical infrastructure today is very well developed and continues to improve every day because of the lessons learned from hospitals like Bellevue during the Civil War.

About the Author

Michael Mahr is the Education Specialist at the National Museum of Civil War Medicine. He is a graduate of Gettysburg College Class of 2022 with a degree in History and double minor in Public History and Civil War Era Studies. He was the Brian C. Pohanka intern as part of the Gettysburg College Civil War Institute for the museum in the summer of 2021. He is currently pursuing a Masters in American History from Gettysburg College and the Gilder Lehrman Institute.

Sources

^[1] Eastman, Carolyn. “The Fever That Struck New York.” Smithsonian.com. Smithsonian Institution, March 2021. https://www.smithsonianmag.com/science-nature/fever-struck-new-york-180976997/. Within a few years, Dr. Anderson would hang up his scalpel and take to illustrating children’s books.

^[2] Oshinsky, David. Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital. New York, NY: Anchor Books, 2016. Pg. 81

^[3] Oshinsky, David. Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital. New York, NY: Anchor Books, 2016. Pg. 86

^[4] Oshinsky, David. Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital. New York, NY: Anchor Books, 2016. Pg. 90

^[5] Harris, Leslie. The New York City draft riots of 1863, n.d. https://press.uchicago.edu/Misc/Chicago/317749.html&title=The+New+York+City+Draft+Riots+of+1863&desc=.

^[6] Erich, John. “EMS Hall of Fame: The Pioneers of Prehospital Care—Dalton.” Hmpgloballearningnetwork.com, July 2021.

^[7] Oshinsky, David. Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital. New York, NY: Anchor Books, 2016. Pg. 139

[8] Jarrow, Gail. Ambushed!: The Assassination Plot against President Garfield. New York: Calkins Creek, an imprint of Boyds Mills & Kane, 2021.

[9] Oshinsky, David. Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital. New York, NY: Anchor Books, 2016. Pg. 272.