From a Pulitzer Prize-winning historian comes a riveting history of New York's iconic public hospital that charts the turbulent rise of American medicine.
Bellevue Hospital, on New York City's East Side, occupies a colorful and horrifying place in the public imagination: a den of mangled crime victims, vicious psychopaths, assorted derelicts, lunatics, and exotic-disease sufferers. In its two and a half centuries of service, there was hardly an epidemic or social catastrophe—or groundbreaking scientific advance—that did not touch Bellevue.
David Oshinsky, whose last book, Polio: An American Story, was awarded a Pulitzer Prize, chronicles the history of America's oldest hospital and in so doing also charts the rise of New York to the nation's preeminent city, the path of American medicine from butchery and quackery to a professional and scientific endeavor, and the growth of a civic institution. From its origins in 1738 as an almshouse and pesthouse, Bellevue today is a revered public hospital bringing first-class care to anyone in need. With its diverse, ailing, and unprotesting patient population, the hospital was a natural laboratory for the nation's first clinical research. It treated tens of thousands of Civil War soldiers, launched the first civilian ambulance corps and the first nursing school for women, pioneered medical photography and psychiatric treatment, and spurred New York City to establish the country's first official Board of Health.
As medical technology advanced, "voluntary" hospitals began to seek out patients willing to pay for their care. For charity cases, it was left to Bellevue to fill the void. The latter decades of the twentieth century brought rampant crime, drug addiction, and homelessness to the nation's struggling cities—problems that called a public hospital's very survival into question. It took the AIDS crisis to cement Bellevue's enduring place as New York's ultimate safety net, the iconic hospital of last resort. Lively, page-turning, fascinating, Bellevue is essential American history.
“Bellevue is a tale of medicine’s tragedies and triumphs in the cauldron of New York City. In vivid prose, David Oshinsky portrays caregivers who, through the centuries, selflessly served the neediest and the unwanted, as well as researchers who pushed the boundaries of clinical knowledge, all the while battling bureaucrats and social indifference. This is a story of America’s most esteemed public hospital that will both enlighten and inspire.” —Jerome Groopman, MD, author of How Doctors Think
“David Oshinsky’s Bellevue reads like the screenplay for Steven Soderbergh’s The Knick—medicine at its crudest and cruelest. Yet from these gothic beginnings rises a hospital at the center of life-saving scientific breakthroughs. Bellevue describes the suffering and death that is the inevitable price for medical advances while at the same time offering hope for the better angels of medicine’s future.” —Paul A. Offit, MD, author of Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure
“In his impressive biography of Bellevue Hospital, David Oshinsky writes about much more than a building. He splendidly captures the essence of a nearly 300-year-old institution and its resolute commitment to serving those in need. He infuses his account with the history of American medicine, the growing pains of New York City, and a cadre of captivating and calamitous characters.” —Booklist, starred review
“No other hospital is as embedded in our culture as Bellevue. Oshinsky’s biography of this grand dame of America’s public hospitals is a page turner, a tale of immigrants and epidemics, politicians and physicians, natural disasters and acts of terrorism all of which shaped Bellevue, just as they shaped a city and a nation. Public policy at its best and worst comes alive. Oshinsky has captured the spirit, the resilience that is Bellevue, a quality that rubs off on the legions who have trained there. A wonderful read!” —Abraham Verghese, author of Cutting for Stone
At the southern tip of Fifth Avenue, in the heart of Greenwich Village, sits the leafy oasis known as Washington Square. A cherished landmark for New Yorkers, its iconic arch, imposing fountain, and flowered walkways provide no hint of its tumultuous past. At various times Washington Square has served as a military parade ground, a gallows, a haven for ex-slaves, and a magnet for artists, hustlers, street performers, and protesters of every stripe. After the American Revolution, it became a mass grave for the victims of epidemic disease.
All large cities have a “Potter’s Field”—a cemetery for unclaimed corpses. The term comes from the New Testament: “And they took counsel and bought . . . the Potter’s Field, to bury strangers in.” New York established its Potter’s Field in 1795 in response to a devastating yellow fever outbreak. Covering 9.5 acres, it created a furor because it abutted the country homes of New York’s financial elite. “The field lies in the neighborhood of a number of Citizens who have at great expense erected dwellings . . . for the health and accommodation of their families during the summer season,” read a letter of protest signed by Alexander Hamilton, among others. But Mayor Richard Varick stood firm, ruling that a medical catastrophe trumped the interests of a few dozen landowners, who included some of his closest friends.
It’s estimated that twenty thousand people were buried in Washington Square between 1795 and 1826, when the Potter’s Field was moved farther north to Fifth Avenue and 42nd Street, where Bryant Park stands today, and then to Hart Island, in the outer reaches of the Bronx. Most of the victims were recent immigrants who lived in squalid boardinghouses near the downtown wharves. Each summer and fall—yellow fever season—their bodies would be dumped into wagons and carted uptown. “The wheels of these chariots of death rolled heavily,” a witness recalled, “the springs and timbers screeching and groaning as if chanting the requiem of friends departed.”
Over the years, workers digging in Washington Square have routinely come upon human remains. But in 2009, a construction crew encountered something odd: a three-foot grave marker with the inscription still intact. “Here lies the body of James Jackson,” it read, “who [left] this life the 22nd day of September 1799, aged 28 years, native of the county of Kildare, Ireland.” The discovery raised a pointed question: Why would someone with the means for a headstone wind up in Potter’s Field?
City records told the story. James Jackson had achieved some modest success in New York City as a grocer, leaving behind a wife, several children, and a personal estate valued at $262. He had also applied “to be a citizen of the United States.” In normal times, a man of Jackson’s standing would have been interred in a church cemetery. But New York was a city under siege in the 1790s, overwhelmed by yellow fever. In a desperate attempt to contain the disease, the dead bodies, believed by many to be contagious, were buried together in a single place. As a contemporary newspaper explained: “It is important to remark that no persons dead of fever are admitted to any other cemetery, which has not been the case heretofore.” And that is how the body of James Jackson, the Irish grocer, came to rest in Washington Square.
But Jackson was fortunate in one respect: he almost certainly died at home. Dozens of others were brought to a place specially created for yellow fever victims who had nowhere else to go. Little more than a pesthouse—a way station, truth be told, on the path to eternity—it would earn a grisly reputation as New York City’s dumping ground for the terminally ill and unwanted, taking its name from the deceivingly placid acreage on which it stood: “Bel-Vue.”
A number of cities claim the honor of establishing the first hospital in North America. The problem is one of definition. Many of the almshouses in colonial America contained a small infirmary to care for the destitute. In 1752, however, Pennsylvania Hospital in Philadelphia opened its doors to medical patients alone. Founded by Dr. Thomas Bond, with a charter from the Pennsylvania legislature and the financial support of Benjamin Franklin, it was intended for “the reception and cure of the sick poor,” not for those seeking food or shelter or a place to die. In this sense, Pennsylvania Hospital holds a very strong hand.
Some, however, consider Bellevue to be first. Citing records from the West India Company, when the Dutch ruled Manhattan Island, they trace Bellevue’s existence to a small infirmary built in the 1660s for soldiers overcome by “bad smells and filth.” Under British control, a permanent almshouse was constructed in 1736—a two-story wood-and-brick structure costing £80 for building materials and fifty gallons of rum for those who “laid the beams and raised the roof.” It contained a workspace for the able-bodied, a room for the sick and the insane, and a prison in the cellar for the “unruly and obstinate,” complete with a whipping post. Those found “to be Lousey or to have the Itch” were segregated “til perfectly Clean.” This one-room infirmary, we are told, is “the seed from which grew the mighty oak of Bellevue.”
Built on the site of today’s City Hall Park, the almshouse became a vital public institution. Serving just nineteen paupers in 1736, it housed close to eight hundred of them by 1795, as New York’s population soared. To stem the tide, city officials took to rounding up vagrants and prostitutes and paying their transportation out of town—but it barely made a dent. The almshouse commissioners demanded ever-larger budgets, blaming their costs on “the prodigious influx of indigent foreigners,” mainly from Ireland. In the 1790s the city opened a larger almshouse financed by a municipal lottery, a common money-raising device. But its infirmary was soon overwhelmed by yellow fever, which brought dozens of sick and dying victims to its door. As panic spread, the Common Council leased a vacant property along the East River, far from the city center, to house the “wretched overflow.”
The land they chose had a checkered past. Once prized for its lush gardens and freshwater breezes, it had first belonged to a prominent Dutch settler named Jacobus Kip, who built a house there in 1641—the Kip’s Bay Estate—using bricks imported from Holland. In the 1700s, Kip’s heirs had divided the land, selling one parcel to a local merchant who named it Bel-Vue for its rolling fields and river vistas. A grander home was soon constructed—one so impressive that it played host to both the fleeing General George Washington and his British pursuer, General William Howe, during the darkest moments of the Revolutionary War. Shortly thereafter, it passed into the hands of Lindley Murray, an eccentric scholar whose popular books about the English language had made him a spectacularly rich man. Murray wrote lovingly of a mansion “delightfully situated” on rolling farmland overlooking “a grand expanse of water.” In truth, he barely set foot there before sailing off to London—the proper place, he believed, for “the father of English grammar.”
An advertisement soon appeared:
For SALE or to be LET. That beautiful COUNTRY SEAT called Bel-Vue, situated on the banks of the East River, about 3 miles from the city, and as its properties in point of health and other advantages are well known, it is unnecessary to describe them.
The price being steep, it didn’t sell quickly. Five years passed before Henry Brockholst Livingston, a prominent New York attorney and future U.S. Supreme Court justice, paid £2,000 for the six-acre estate.
Livingston, it turned out, had no intention of living there, either. The property—referred to interchangeably as “Bel-Vue,” “Belle-Vue,” and, finally, “Bellevue”—passed from one renter to the next before the Common Council leased it in 1795 “to serve as a hospital for the accommodation and relief of such persons afflicted with contagious distempers”—or yellow fever. Described by nervous officials as “a proper distance from the inhabited part of this city,” it was accessible by road and river, with a dock already in place. The plans called for hiring a steward, a matron, a resident physician, and “as many nurses as may be wanted.” There would be “two men to transport the sick to Bellevue” in wagons and “a Boat with good oars-men” to ship in needed supplies. Port, brandy, and “assorted spirits” headed that list, with detailed instructions for the doctor. “Sherry wine, the most natural stimulus, should be given freely,” he was told, and “beer, for those who are accustomed to its use, is a very valuable remedy.”
New York City had seen its share of epidemic disease. From the Dutch settlement forward, infectious outbreaks were a common part of daily life. The first Europeans had praised New Amsterdam’s “sweet and wholesome climate”—more forgiving than the brutal cold to the north in Boston, less treacherous than the fetid swampland to the south in Jamestown. But Manhattan’s bustling harbor soon became a magnet for the world’s microbes and maladies. Periodic eruptions of measles, influenza, scarlet fever, and “throat distemper” (diphtheria) killed untold numbers in the colonial era, especially children. Barely a decade went by in the 1700s without a serious outbreak of smallpox. New York recorded more than five hundred deaths from this disease in 1731, a staggering total in a city of barely ten thousand people. While the threat of smallpox would recede by the early 1800s—due mainly to the introduction of Edward Jenner’s revolutionary vaccine—other diseases proved more difficult to contain. The most frightening one, by far, was yellow fever.
It seemed odd that a disease associated with the tropics would find a home this far north. Yellow fever—commonly known as “Yellow Jack” for the warning flags flown on infected ships—is transmitted by the bite of the female Aedes aegypti mosquito. In mild cases, the symptoms include a headache and moderate fever, similar to the flu. But the more severe ones can produce delirium, jaundice (lending skin a yellow tinge), and massive bleeding from the mouth, nose, and ears. Most early accounts of yellow fever refer to the victim’s horrifying “black vomit,” the discharge of blood-soaked material from the stomach. Case mortality in a serious epidemic can reach upward of 50 percent. The only good news is that the surviving victims are rewarded with immunity for life.
Yellow fever came to the Americas from Africa, carried by slave ships that docked in the West Indies. Water barrels on board provided an ideal breeding ground for the Aedes aegypti. Over time, as trade routes expanded, yellow fever reached North America’s eastern ports. In the summer of 1793 it struck Philadelphia, the young nation’s capital, with a fury that shook the national government to its core. By November, the streets were deserted and more than 10 percent of the city’s fifty thousand residents were dead. Most of Congress was gone, along with President George Washington and Secretary of State Thomas Jefferson, who fled to their native Virginia. For Jefferson, a defender of rural values, the epidemic was a mixed blessing, with a powerful lesson attached. “The yellow fever will discourage the growth of great cities in our nation,” he confidently wrote a friend, “& I view great cities as pestilential to the morals, the health and the liberties of man.”
Jefferson was wrong, of course, though the enormous damage done to Philadelphia did dramatically slow its growth. Yellow fever reached New York City in the summer of 1795 on a brig from Haiti with a very sick crew. A port officer who boarded the infected vessel died a few days later, the first of many to come. While hardly matching the carnage of Philadelphia, the disease proved deadlier than anything the city had seen before.
What caused yellow fever was a matter of debate. Medical opinion in this era endorsed the so-called Miasma Theory, which blamed illnesses on chemical agents from decayed matter—corpses, rotting fruits and vegetables, swamp and sewer gases—that formed dangerous airborne clouds. Those who studied disease spent much of their time minutely analyzing atmospheric conditions: sunlight, humidity, temperature, rainfall, lightning, cloud cover, and wind direction. As late as 1888, Bellevue’s specialist in childhood diseases insisted that diphtheria, a deadly bacterial infection, resulted mainly from inhaling the damp gases that rose from the sewers. (He also warned against the danger of kissing a cat.)
Yellow fever split the medical community into warring factions. One saw it as a contagious disease, much like smallpox or influenza, which could spread from person to person through the victim’s breath or clothing—or corpse. How this occurred was still a mystery; one physician described the process as “effluvia arising directly from the body of a man under a particular disease, and exciting the same kinds of disease in the body of the person to whom they are applied.” This camp viewed yellow fever as an imported illness, reaching New York harbor on West Indian ships. The solution, therefore, was to quarantine arriving vessels in order to isolate the carriers—an expensive process that severely restricted trade.
The competing group blamed local conditions for the disease, especially the “noxious smells and vapors” along the wharves. Person-to-person contact made little sense, these doctors argued, because they “continually touched the sick, lived in the midst of them, and breathed the same air” without personally contracting yellow fever. Their solution was to destroy the noxious miasma clouds by scrubbing the city clean; they saw no reason to quarantine its vital harbor.
On one point, however, both sides seemed to agree: poor New Yorkers were more susceptible to the disease. Contagious or not, yellow fever appeared most often in the flophouse waterfront districts catering to sailors, dockworkers, and recent arrivals. Valentine Seaman, a leading New York physician, drew a map of these yellow fever cases—a forerunner of John Snow’s legendary cholera “Ghost Map”—to show the epidemic’s concentrated path. Noting the large number of sickened Irish immigrants, Seaman thought this more than coincidental. Hard drinking and filth had weakened their constitutions, he believed, while their heavy “vegetable diet” had left them vulnerable to the rigors of American life. As further proof, New York officials claimed that only “five or six” native-born merchants and a lone minister—a questionable sort—had died in the epidemic. He was, the Episcopalian Seaman lamented, a Methodist.
The fact that shipborne mosquitoes thrived along the waterfront was not then a matter of concern. The very idea that a tiny vector like the Aedes aegypti could cause such an immense catastrophe was simply beyond scientific understanding. Still, what is striking about the writings of New Yorkers in the summer of 1795 is the constant notice of mosquitoes: swarming, biting, relentless, and inescapable. Valentine Seaman remarked that he had never seen as many people “covered with blisters from their venomous operations.” His good friend, Dr. Elihu Hubbard Smith, recorded these words in his diary: “Thursday, September 6—Passed a restless and perturbed night tormented with mosquitoes and incongruous dreams.”