Bellevue No One Was Ever Turned Away

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Bellevue Hospital, the oldest hospital in the United States, turned 250 last year. It started as a six-bed ward for the poor, part of an almshouse on lower Broadway, back in 1736, when New York had a population of about nine thousand. As the city grew, Bellevue grew. By 1810 the population of New York was 96,373 and the city fathers were looking for a place to build a real hospital. They purchased a part of what was then Kip’s Bay Farm, between what is now Second Avenue and the East River, around Twenty-eighth Street. The gentleman who originally owned the adjoining land in 1772 had called it Belle View. By 1793 the name had changed to Belle Vue, and in 1825, when the hospital was well established, it was called Bellevue, the name it has had ever since.

 

By 1870 Bellevue could hold twelve hundred beds and was one of the biggest hospitals in the world. The rich supply of patients had prompted the city fathers to establish Bellevue Hospital Medical College in 1861, so that students could benefit from the wide clinical experience the hospital afforded. It was never the tidiest hospital in the world—how could it be, when its policy was always to accept those patients who could with some justice be called the dregs of humanity? At times it was so loaded with victims of typhus, cholera, and yellow fever that, within minutes of a patient’s death, the body was in a coffin and a new patient in the bed. The record shows that on April 20, 1818, a certain Job Young lay grievously ill, obviously about to die of typhus. When he had, supposedly, expired, his body immediately was loaded into a nearby coffin. A half hour later, several people, wandering through a corridor where coffins were stacked, heard a groan emanating from one of the coffins. A hatchet was used to free Mr. Young, who was, indeed, still alive, and he was reassigned to a bed. Valiant attempts were then made to keep him going, but “he lived an hour and a half longer and returned to his narrow house.” This led to one of many subsequent reforms of medical practices in Bellevue: “It was ordered that thereafter no body should be removed until the physicians had first pronounced the person dead.”

 
 

Between 1827 and 1847 mortality rates at Bellevue averaged 20 percent, with a high in one year of 33 percent. When William Stewart Halsted—who devised the residency training program that is still the basis for surgical training everywhere in the world—was an attending surgeon at Bellevue (1883–87), he often operated in a tent set up behind the hospital, because he considered the hospital too filthy for his patients. (Incidentally, while at Bellevue, experimenting with cocaine as an anesthetic, Halsted also became a cocaine addict, an addiction he eventually conquered.) In 1888 Halsted moved to Johns Hopkins Hospital, where he had a long and distinguished career. In the United States he is still considered the father of modern surgery.

In 1897 the medical-school part of Bellevue was destroyed by fire. Between 1906 and 1939 the hospital was rebuilt a bit at a time, since it wasn’t feasible to shut down a section completely while its replacement was being added. The great firm of McKim, Mead & White was the prime architect. By the 1950s Bellevue stretched from Twenty-fifth to Thirtieth streets on First Avenue, with the nurses’ residence and school at the south end and the morgue and pathology building and the psychiatric wards at the other. The various wings of the main hospital were all more or less attached to each other, with the A and B buildings (the medical wards) at the south end and the L and M buildings (the surgical wards built in 1913) at the north end. Wards C through K were aligned in sequence and housed neurology, pediatrics, orthopedics, genitourinary—all the subspecialties one would expect to find in a major hospital.

In 1953, when—fresh from Tufts medical school—I began my residency at Bellevue, three medical schools were closely affiliated with the hospital: Columbia, Cornell, and NYU. There was also a fourth division—Post-Graduate—established for those doctors who had been out in practice and wanted to return for specialty training. Each division had approximately 125 medical beds and 100 surgical beds, and the subspecialty divisions were distributed in more or less random fashion, though NYU, Cornell, and Columbia controlled the lion’s share of these divisions. Cornell, which was the division to which I had applied and been accepted (each medical school was responsible for recruiting its own house staff), had a genitourinary division and neurological and neurosurgery divisions. NYU controlled pediatrics and orthopedics.

Columbia ran the tubercular wards. Between 1908 and 1938 some TB patients had their beds on a boat; the first boat had once been part of the fleet of Staten Island ferries, and it was tied to a dock in the East River, just behind the F and G wards. For that era it was an eminently sensible arrangement. The basic treatment for TB until the Second World War was fresh air and rest, and that was much easier to find on a boat on the East River than in the main hospital itself. With the advent of the antibiotic treatment of TB, the boat was taken out of use and all TB patients were returned to the main hospital.