Founded four decades before the United States was formed, New York City’s Bellevue is the nation’s oldest public hospital, built even before the medical profession existed.
It famously sits along a stretch of First Avenue now, but it first opened on the site where City Hall now stands, a six-bed almshouse whose history would reflect the ongoing changes in the city itself, and serve as a record of medical education in America.
“More than a hundred languages are translated at Bellevue,” writes medical-historian David Oshinsky in his sweeping survey, Bellevue: Three centuries of Medicine and Mayhem at America’s Most Storied Hospital. At this layered crossroads of illness, medical research, and pioneering treatments, interpreters of these languages work as intermediaries between patients and doctors, while multilingual signs fill the blocks-long compound, the entire operation continuing to behave the way it has since American medicine’s first days: as an accurate model of New York residents’ health at any given time, offering a comprehensive sample of both diseases and patients for the medical profession to observe and treat.
When it comes to illness, much of American public health policy is traceable straight back to here.
The name Bellevue is most famous for the horrors of mental health treatment and mistreatment, but the hospital has always cared for more physically evident ailments. Often the last, and repeat, destination for the most desperate, the hospital has weathered epidemics of tuberculosis, pneumonia, typhus, yellow fever, polio, the flu, and HIV, carried by the “indigent sick” who amassed at the hospital.
New York played a key role in the way hospitals are run today, it being an entry point for the waves of immigration to the new nation. When thousands of Irish farmers fleeing starvation in their homeland arrived to New York City in the mid-19th century, they brought with them fatal illnesses and poverty, a combination that pointed straight to Bellevue, where, following hospital procedure of the days, they were housed alongside everyone else, the “lunatics, paupers, orphans, and criminals,” writes Oshinsky. A large population plus contagious fatal disease — one that took down doctors and fellow patients alike — required immediate attention. Medical treatment reforms were made in order to prevent further outbreaks, most notably including the separation of patients into wards specific to their diagnoses.
Nineteenth-century immigration provided Bellevue with a large samplings of patients with specific illnesses, making New York City the perfect place for teaching the new profession of doctors. Bellevue’s own medical college was established then, as was the University Medical College (which would become the NYU School of Medicine), adding top medical students to those at the already existing College of Physicians and Surgeons. With its reputation for accepting all patients, along with the fact that other city hospitals regularly practice sent their sickest patients there, Bellevue remained the center of the schools’ research.
As understanding of contagion and public health grew, reforms continued, and Bellevue was a place to enact them all. In a set of changes written into law in 1852, patient selection became key: “No person shall be admitted whose case is judged to be incurable nor shall any who [are] judged insane or who shall have the smallpox or measles, or any malignant or contagious fever, to be received,” decreed the reforming board populated by medical activists and doctors. Bellevue’s days as pesthouse and almshouse were over.
But the College, established at Bellevue itself along with a new morgue and with an ongoing program of dissection, made another hospital problem clear: the high rate of death among patients. Desperate for answers, some doctors attributed the high mortality rate across wards as disparate as maternity and surgical to suicidal impulses among those patients: the guilty feelings of unwed mothers, the despair of already poor patients now forced to look for work after an amputation.
With a population of more than 1,200 beds Bellevue was the ideal place to test out European notions of germ theory: slowly, Louis Pasteur’s recent discovery of bacteria and English surgeon Joseph Lister’s notions of an antiseptic environment would inspire American doctors at Bellevue: via funding from the newly philanthropic steel magnate Andrew Carnegie the United State’s first pathology laboratory was founded — on Bellevue grounds.
Pristine, well-funded, clean, polished, sun-drenched, and respectable. These words were often used to described New York Hospital (now part of New York Presbyterian), a private institution founded in 1771 with a charter from King George III. The hospital was the counterpoint in an 1872 Harper’s New Monthly magazine story on the state of the city’s healthcare. In contrast, Bellevue was a “ponderous dull gray mass of granite,” the article claimed, adding that it drew to U.S. shores Europe’s poorest, “the dregs of society, the semi-criminal, starving” masses. Meanwhile, Bellevue continued to be a top research center, filled with the city’s best medical students and professors, including those from Columbia University’s College of Physicians and Surgeons, who would remain there well into the 20th century.
Over the next two decades, and in the face of an end-of century scandal over treatment of the mentally ill, administrators realized the need for another reform, this time one architecturally driven.
In 1902, the elite architectural firm of McKim, Mead & White, responsible for much of the now robust and glamorous city’s Gilded Age buildings, took on their first hospital. Bellevue, now a model of the medical practices it had been central in establishing, would remain firmly in the city center, eschewing other hospitals’ escapes to less crowded neighborhoods. Plans for the new compound were drawn up: Corinthian columns, tennis courts and swimming pool, wards equipped with terraces allowing tuberculosis sufferers to take in fresh East River breezes for long-term stays, and facilities for quicker treatments for substance abuse and mental illness were all proposed — and soon stricken from plans under outcry from the city over the expense.
In the end, by 1910, the building would take up three city blocks and offer 2,000 beds, in what may be McKim, Mead & White’s most humble, and atypical structure. It opened just in time for new immigrants, this time from Southern and Eastern Europe, Italians and Jews escaping new land-owning legislation and anti-Semitic pogroms and arriving in New York, poor and ill just as Western and Northern Europeans had done in the decades before. Bellevue remained a vital provider and record of the nation’s public health; a necessary city fixture.
As it has been to another enduring population in New York: writers, musicians, painters, and other artists, many of whom would become household names, have been hospitalized there, too. Norman Mailer recorded his two and a half weeks there, after attacking his wife with a knife, in his diary, though not elsewhere in his work. Others like Eugene O’Neill, Saul Bellow and Allen Ginsberg wrote about their Bellevue stays more publicly. “To me Bellevue was like the Bowery: it gave negative testimony. Brutal Wall Street stood for power, and the Bowery, so near it, was the accusing symbol of weakness. And so with Bellevue, where the poor and busted went,” says the narrator in Bellow’s Humboldt’s Gift. Ginsberg’s Howl notes “who talked continuously seventy hours from park to / pad to bar to Bellevue to museum to the Brooklyn Bridge.” Charlie Parker, Charlie Mingus, William Burroughs, and Sylvia Plath all made their way there too.
In the 1980s, Bellevue became the national center for yet another American health crisis: a new, rapidly spreading, and deadly disease, for which Bellevue housed more, and more diverse, AIDS patients than any other U.S. hospital. This medical mystery, surrounded by fear, rumors, and misinformation, along with ethical concerns over how to prevent a fatal sexually transmitted disease, gave rise to new aspects of public health policy. What to do about New York’s gay bathhouses, how to respond to writer and activist Larry Kramer’s outspoken calls for acknowledgement and treatment of the illness, whether to provide clean needles to intravenous drug users, how to test slowly developing treatments: meanwhile thousands of patients with AIDS came to, and died at, Bellevue. Slowly, new treatments and policies took hold, and worked. In 2012, Bellevue shuttered its AIDS Unit, now no longer necessary.
Oshinsky’s book is a purposeful wandering through Bellevue’s halls, for a seemingly firsthand look at the ever-changing history of modern medicine. The details are packed in: Doctors William Welch and William Halsted’s work to bring antiseptic practices to American medicine; the devastating chapter of convulsive therapy, or electric shock treatment, that Dr. Lauretta Bender infamously ran through her children’s unit at the hospital in the forties and fifties; the heartbreakingly empty rooms and ambulances on September 11, 2001; the structural destruction and river waste brought by Hurricane Sandy; Dr. Craig Spencer successfully cured of Ebola, and the subsequent stress on the hospital’s infrastructure. Continuing its role at the forefront of research and policy, Bellevue now has a notable change from much of its past history: “A visitor to Bellevue in any era might see much the same thing: a well-schooled physician treating a charity patient against a backdrop of bleakness and disrepair,” Oshinsky writes in his book’s first pages.
While public-hospital funding continues to be a struggle in today’s New York City, the poorhouse built 300 years ago is now a state-of-the art rendition of a crucial public place: in an appropriately proud introduction on the hospital’s website, Bellevue “defines the very best traditions of public medicine as a public service vital to the well being of our civil society.”