Bellevue Hospital.

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Bellevue and

Charity Hospital Reports

Bellevue Hospital



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BELLEVUE AND CHARITY HOSPITAL



REPORTS




187 0.



NEW YORK:
D. APPLETON AND COMPANY,

90, 92 A 94 QBAND STKEET.
18'70.



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Soatheni DiBtrict of New York. ^

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CONTENTS.



I.

ON AMPUTATION OF THE CEBVIX UTEBI IN CEBTAIN FORMS
OF PROCIDENTIA, AND REMARKS ON THE COMPLETE EVER-
SION OF THE CERVIX UTERI. By Uai^o E. Tatlob, M.D., . . 1

n.

ON THE ANALYTICAL STUDY OF THE PULMONARY PHYSICAL
SIGNS FURNISHED BY AUSCULTATION AND PERCUSSION.
By Austin Flint, M. D., 69

III.

ON ENTIRE EXCISION OF THE OS CALCIS. By F. A. Bubeall, Jr.,
M. D., 91

IV.

ON THE SERIOUS CONSEQUENCES WHICH RESULT FROM THE
NEGLECT OF SLIGHT INJURIES OF THE ANKLE-JOINT;
ILLUSTRATED BY CASES. By Lewis A. Satbi, M. D., . . 107

V.

A METHOD OF DRESSING FRACTURED CLAVICLE. By Lewis A.

Satbe, M. D., 129

VL

ON THE DLiGNOSTIO CHARACTERS, MECHANISM, AND PATHO-
LOGICAL SIGNIFICANCE OF THE MITRAL DIRECT, OR OB-
STRUCTIVE CARDLA.C MURMUR, AND ON THE OCCURRENCE
OF A TRICUSPID DIRECT MURMUR. By Arsrnf Flint, M. D., . 186



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IV CONTENTS.

VII.

ON THE MODE OF OBTAINING THE VENOUS HUM, AND THE
VALUE OF THIS PHYSICAL SIGN. By Auotut Fuot, M.D., . . 143

VIII.

CASES ILLUSTRATING STRANGULATED ABDOMINAL HERNIA,
WITH OTHER ABDOMINAL HERNIA, NOT STRANGULATED, OF
UNUSUAL CHARACTER, Etc., Etc., IN ALL, SEVENTY-THREE
EXAMPLES ; ACCOMPANIED WITH PRACTICAL REMARKS. By
Fbank Hastdtos Hamilton, M. D., 147

IX.

A CLINICAL REPORT BASED ON AN ANALYSIS OF ONE HUN-
DRED AND TWO CASES OF BRIGHT'S DISEASES OF THE KID- •
NEY. By Austin Flint, M. D., .227

X.

AMPUTATIONS PERFORMED AT BELLEVUE HOSPITAL. Compiled
BT F. J. MsTCALra, 809

XL

REPORT OF CASES OF ANAESTHESIA AT THE BELLEVUE HOS-
PITAL, WITH THE USE OF A NEW INHALING APPARATUS.
Bt D. H. Goodwillie, M D., D. D. S., 817

XII.

REPORT OF THE PATHOLOGICAL DEPARTMENT OF BELLEVUE
HOSPITAL. By J. W. Southack, Jb., M. D., E. G. Jankway, M. D.,
▲ND Francis Delatield, M. D., 828

XIII.

ON SOME OF THE EFFECTS OF EXCESSIVE INTELLECTUAL EX-
ERTION. By WiLLLiM A. Hammond, M. D., 879

XIV.

THE HISTORY OF NINE CASES OF OVARIOTOMY. By T. Gail-
labd Thomas, M.D., 891



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BELLEVUE HOSPITAL.

Bellbvue Hospital occupies a position on the East Eiver
which has long been famous for its beauty and healthfulness.
As early as 1786 we find it mentioned among the favorite
resorts of persons seeking pleasure and relaxation from busi-
ness.

In his " Picture of New York, or the Traveller's Guide
through the Commercial Metropolis of the United States,'' first
edition, 1807, Dr. Samuel L. Mitchel thus describes Bellevue
Hospital among the benevolent institutions of New York : '' On
the shore of the East Eiver, about three miles fi*om the City
HaD, is a delightful spot, of which our celebrated country-
man, Lindley Murray, was once the proprietor and resident. It
has been purchased by the Common Council for an occasional
infirmary ; whither, during the prevalence of sickness in the
city, it is thought advisable to remove those who languished.
A more wholesome air is found here, as well as accommoda-
tions for the sick and the convalescent. The selection of such
a spot for the reception of the inhabitants who are suffering
the violent assaults of the fever, redounds greatly to the feelings
and humanity of the Common Council. In common seasons
there are no sick persons here. This hospital is opened only
upon extraordinary occasions."

The early history of the hospital, and the progressive
changes in its management down to the year 1857, were very
accurately detailed in an address delivered on the opening of
the new wing of Bellevue Hospital, at the request of the



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VI BELLEVUE HOSPITAL.

Medical Board, by B. W. McCready, M. D. "We quote from
this address the following interesting historical facts :

" Up to a very recent period, the history of the charity hos-
pital of this city is confounded with that of the almshouse ;
the sick were received under the same roof with those who
were unable to provide for their own necessities, and the wants
of both were cared for by the same officers. According to in-
formation furnished me by Mr. David T. Valentine, the excel-
lent clerk of the Common Council, and the industrious chroni-
cler of by-gone times in New Amsterdam, as far back as the
year 1699, when the population of the city did not exceed six
thousand souls, the poor received partial relief in their own
houses, or in lodgings provided for them by the vestry. About
fifteen years later, an almshouse was erected on the spot
where the City Hall now stands, and where the poor were
maintained, partly out of what was then termed the minister's
fund, partly by a small tax upon the inhabitants, and by vol-
untary contributions. After the "War of the Revolution had
broken out, and previous to the occupation of the city by the
British, the poor were removed, first to Westchester County
and afterward to Poughkeepsie. On the conclusion of peace,
tbey again returned to the city, where additions were made to
the former buildings to accommodate their augmented num-
bers. The rapid increase of the population, and the immi-
gration which poured in from abroad soon, rendered additional
accommodation necessary ; a new almshouse was accordingly
erected in the rear of the former one, constituting the range
of buildings fronting on Chambers Street, and since known
as the New City Hall ; these were burned down about two
years since. The new building was opened for the reception
of patients in the year 1795 ; the same causes that had given
rise to the previous changes were still at work, and in fifteen
years' time it became necessary to make arrangements for the
enlarged accommodation of those who were thrown upon the
charities of the city. At that time, the groimds now occupied
by the hospital, three miles distant from the city, were destitute
of buildings ; the neighborhood hilly, varied in surface, and
well wooded ; the shore bold ; the river, unconfined by wharves
and bulkheads, ran two hundred feet nearer in shore than it



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BELLEVUE HOSPITAL. Vll

now does. "Well might the wanderer from the distant city, as
he saw the bank of the East River, trending away in a grace-
full sweep toward the north, with Blackwell's Island, still
sufficiently wooded, shutting in the view, and the low shores
of Long Island, as yet undeformed by factories and buildings
in his front — ^well, I say, might he name the place Bellevue 1

" It was this site which was now pitched upon as suitable
for the eleemosynary institutions of New York. Between
twenty-five and thirty acres were purchased or taken by com-
missioners from the Kipp and Cruger estates. The first stone
of the building which constitutes the present hospital was
laid on the 1st of August, 1811. During the War of 1812-'15,
with an enemy's fieet blockading the harbor, and an enemy's
army at one time threatening a descent upon the city, the
work progressed slowly but steadily ; finally, in the beginning
of 1816, the new buildings were oi)ened for the reception of
their inmates ; they consisted of the present hospital, three
hundred and twenty-five feet in length, fifty-five in depth and
three stories in height, with two projecting wings, which was
designed as an almshouse, and of a large edifice, some hun-
dred feet in the rear, which was occupied as a penitentiary.
The stone which was employed in the buildings was quarried
upon the grounds, and their whole cost was, as the record in-
forms us, four hundred and eighteen thousand seven hundred
and ninety-four dollars and thirty-four cents.

" The hospital proper was not as yet separated from the
almshouse and the penitentiary, but in each of those build-
ings wards were set apart for the accommodation of those
suffering from illness or injury. The medical supervision of
the establishment was committed to a visiting or consulting
physician, who visited it as often as he deemed necessary, while
the immediate attendance upon the sick was intrusted to one
or two young physicians who resided in the establishment ;
thus matters continued imiil early in the spring of 1825.

" At that time, o^Hng to the neglect of proper sanitary meas-
ures, a malignant typhus or jail fever broke out in the peniten-
tiary ; the pestilence made rapid progress ; the visiting physi-
cian. Dr. Charles Drake, contracted the fever and was a long
time confined to his house in the city ; the two young resident



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Vlll BELLEVUE HOSPITAL.

physicians both sickened ; the disease spread to the turnkeys
and officers of the house, and general alarm was excited. Un-
der these circumstances, Drs. Jos. Bailey, Jos. M. Smith, and
Isaac "Wood, were appointed a committe to visit the peniten-
tiary and report upon its condition. They were received by
one of the young men, Dr. Belden, who left his bed for the
last time to meet them ; he died a few days afterward. They
found the prison in a dreadful condition, filthy, neglected,
without medical attendance. . On reporting to Mr. Elisha W.
King, the chairman of the committee of the Common Coun-
cil, he requested the doctors to take the medical charge of the
establishment, and to do what was necessary for its renovation.
Dr. Bailey at once, from prudential considerations, declined,
and the task was undertaken by Drs. Smith and "Wood. It
was necessary for the penitentiary to be cleared out, but there
was a difficulty in the way of this measure. The prisoners
were committed for crime, and there was no power in the
Common Council to authorize their removal from the peni-
tentiary. Application was at once made to Albany, and an
act hurried through the Legislature, authorizing the temporary
removal of the prisoners. The building lately occupied as
the House of Refuge, but originally erected, on the recom-
mendation of Dr. David Hosack, as a fever hospital, was then
nearly finished. It was hastily fitted up, and the prisoners,
washed, cleansed, and new clothed, were one by one trans-
ported to it; no want of ventilation there, for the rooms
were still unceiled ; some of the windows boarded up, some
imperfectly glazed ; air found ready admittance through
many a crevice, while guard was regularly mounted over the
prisoners, to prevent their running away when convalescent.
In a month the pestilence was at an end. Over sixty prisoners
were attacked by it, after Drs. Smith and "Wood took charge
of them ; of these only five died, but the keepers, the turnkeys,
the nurses, and the medical assistants, fell victims in far larger
proportions, and for a long time dropping cases occurred
through the city, which could be traced to the jail fever of
the penitentiary.

" This occurrence led to a change in the medical depart-
ment of the almshouse, and Dr. Isaac Wood, who, on the res-



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BELLEVUE HOSPITAL, IX

ignation of Dr. Drake, served during the remainder of the
year as visiting or consulting physician, was, in January,
1826, appointed resident physician. With Dr. Wood's ap-
pointment commenced the permanent separation of the hos-
pital from the almshouse; indeed, the number of the sick
poor had now so increased as to demand a separate establish-
ment. The fever hospital, finished and properly fitted up,
was appropriated exclusively to those requiring medical or
surgical treatment. For seven years, from January, 1826, to
the same month in 1833, Dr. Wood ably, and to the satisfac-
tion of the authorities and the public, discharged the duties of
his office. He then resigned, and was succeeded by Dr. Ste-
venson, a gentleman of liberal education and large attainment,
but ignorant of hospital duty. Dr. S. served but a year, and
then gave place to a gentleman whom we all know and esteem
— ^Dr. Benj. Ogden. In 1837 Dr. Ogden was removed on po-
litical grounds, and Dr. Van Hovenberg was resident physician
for two years. In 1839 Dr. Van Hovenburg, having been re-
moved, was again succeeded by Dr. Ogden, who finally re-
signed his office in 1840. The next seven years saw a rapid
change of physicians ; the office having become a prize for po-
litical partisans, every fluctuation of party-power brought with
it a change of residents. Old abuses, some of them incident
to the character of many of the inmates of the establishment,
where the details of the administration were chiefly intrusted
to young men, repressed with a strong hand during the firm
and enlightened administrations of Drs. Wood and Ogden,
broke out with fresh virulence. Licentiousness, disorder, and
filth, reached a disgraceful height. While stating the facts, let
us not blame too harshly the various residents ; for the most
part, without experience of hospital duty, they found them-
selves at the head of an immense establishment, the govern-
ment of which was too much for one person, even of the high-
est administrative and professional ability. Under them were
placed the young men, advanced students, or newly-graduated
physicians, who obtained their appointments by paying a fee
to the resident. The latter became bewildered by the weight
and magnitude of their duties, and, after perhaps an ineffectual
struggle, acquiesced in a state of things they were powerless



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X BELLEVUE HOSPITAL.

to prevent, or, if they continued to struggle on, the disorder
was too deeply rooted to be extirpated during the short time
they continued in oflSce. A thorough change in the mode of
governing the establishment was needed, and it came at a time
when the epidemic occurrence of typhus fever raised the exist-
ing evils of the establishment to a culminating height. A
committee of the Common Council, consisting of James D.
Oliver, "Washington Smith, and George H. Purser, to whom
the subject of the reorganization of the medical department of
the public charities was referred, called to their aid a number
of prominent medical men, and with their assistance drew up
a plan for its future government. With the exception that
the office for resident physician was retained, this is the plan
which is stni in force, and with it a new era commences in
the history of our institution. In 1849 the office of resident
physician was abolished by the Board of Governors of the
almshouse, to whom the control of the establishment had
passed, and the administration of the medical department
given over entirely to the Medical Board. A few words will
complete the sketch I have attenapted of the history of our in-
stitution. On the completion of the penitentiary on Black-
well's Island, the convicts were transferred from ihe building
in the rear of the present edifice, and this last was occupied as
a hospital. In 1848 the almshouse was removed to the build-
ing erected for it on the island, and the hospital took its place ;
the extensive grounds of Bellevue were cut up, and the larger
portion sold. The old penitentiary and fever hospital can now
scarce be recognized, and in a few years no trace of them will
remain ; let us hope that the hospital may here be permanent ;
a more convenient, beautiful, and salubrious site could scarcely
be obtained.

" The same causes which have led to such repeated changes
in the location of our charitable establishments, to such re-
peated calls for their enlargement, are still in operation. As
our population increases, vice and destitution increase in a
much greater ratio. For several years back the hospital has
been at times so crowded that it has been necessary annually
to open the garrets for the accommodation of patients ; dark,
low, unceiled, ill-ventilated, stifling in summer, freezing cold



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BELLEVUE HOSPITAL. XI

in winter, they were never intended for habitation, and the
measure was only had recourse to when forced upon us by
necessity. But the Governors have felt that we have no right
to poison our patients by confined air, or injure them by un-
necessary exposure ; that economy ceases to be a virtue when
it leads to needless suffering and loss of life ; that the tax-
payers of our city, heavily as they may be burdened, would
sustain them in an expenditure necessary for the well-being of
the sick poor. A new wing has been provided, plain, but well
adapted to the purposes which it is to subserve, with admirable
arhtngements for the comfort and cleanliness of the patients.
Another year wiU behold the complete renovation of the old
btulding: Oroton water, gas, and proper heating apparatus
will be introduced, and the addition of another story wiU give
us ample room for the classification and treatment of our
patients ; thus the spread of puerperal fever, erysipelas, and
typhus, will be stayed, and Ihe mortality and average duration
of the illness of the patients be diminished.

" And let us here observe. New York is peculiarly situated
in regard to hospital accommodation. Within a comparatively
short period, from the size of a provincial town, she has grown
to the proportions of a metropolis ; her population, in the time
allotted to the life of man, has swollen from thirty thousand to
eight hundred thousand, and she. has had, within a compara-
tively short time, to provide institutions and public buildings
which, in other countries, have been the growth of centuries.
She has far less hospital accommodation than any European
city approaching her in size. There, hospitals have been the
growth for centuries of the union of private charity with the
fostering care of government. In 1840, over fifteen million
francs, or three million dollajre, were expended by the ad-
ministration of the hoq)itals of Paris, and a large portion of
this sum was derived from the revenue of real estate belonging
to the hospitals, and from bequests by charitable individuals.
Dublin has eight considerable hospitals, some of them richly
endowed by private charity, and yet this year the Government
of Great Britain aids them with a grant of sixteen thousand
pounds, or eighty thousand dollars. In London, Guy, the
founder of Guy's Hospital, after spending one hundred thou-



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XU BELLEVUE HOSPITAL.

Band dollars in erecting the bmlding, bequeathed it over a mil-
lion dollars. Here our rich men have not yet had time to die
and endow hospitals, and yet the need for them exists and must
be met ; the sick poor cry aloud to us to aid them, or they
perish ; and whatever, in other respects, may be our short-
comings, as a New-Yorker, I am proud to say that here such
an appeal has never been made in vain. Let the public be
convinced of its truth, and it will demand that it be answered.
This necessity for increased hospital accommodation in the city
has indeed been felt for some time, and the additions to the
City Hospital, St. Vincent's Hospital, that of the Jews, and
the noble building of St. Luke's, have been products of its
manifestation. These last may, and probably will, like the City
Hospital, become the germs of magnificent institutions. They
will absorb a portion of the destitution which increases with
our wealth and population; but we cannot wait until the
death or suffering of thousands awakens private charity from
its slumbers. The need was upon us, was felt now, and the
Governors of the Almshouse have met it.

" On first entering on their duties atBellevue, the Medical
Board at once aimed at rendering the institution serviceable
for the clinical teaching of medicine ; they believed that they
would thus elevate the character of the institution ; make it
an honor to be connected with it ; secure the best attainable
professional services for its inmates, and partly repay the pub-
lic for the cost of its maintenance, by improving the education
of the rising generation of mddical men. These views have
since undergone no change; on the contrary, every year
strengthens and confirms them. Last winter three hundred
students were present at one time, to witness an operation per-
formed by one of the visiting surgeons, in the theatre of the
hospital. Could such an audience have been drawn together
by mediocrity ? or, if drawn together by fortuitous circum-
stances, would mediocrity and ignorance have dared to face it ?
"Would they not blush in the presence of those who, to a great
extent, are able to appreciate their acts ? Would they not
tremble and shrink under the indignant criticism they would
excite ? Things are not done here in a comer, and the veil of
silence and oblivion drawn over our mistakes. Discussion,



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BELLEVUE HOSPITAL. XUl

inquiry, and remarks are invited, challenged, and we must be
prepared to meet the criticism we provoke. If not impelled
by a higher motive, a sacred regard for that most precious of
all precious things — ^human life — a regard that underlies the
character of every true physician — would not the care of their



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