Medical America in the Nineteenth Century: Readings from the Literature

The Comparative Results of Operations in Bellevue Hospital

STEPHEN SMITH THE COMPARATIVE RESULTS OF OPERATIONS IN BELLEVUE HOSPITAL Editor's Note Stephen Smith's life (1823-1922) spanned the great epochs of anesthesia and antisepsis. Anesthesia had barely been introduced when he began to study medicine in 1847, and he himself was one of the early American champions of antisepsis. The author of numerous surgical papers and three surgical textbooks, Smith was an active member of Bellevue's staff for fifty years. During the Civil War years he edited a weekly medical journal through which he championed several reform causes. (See section on Hygiene.) In his later life he was active in lunacy reform in New York, serving as the State's Commissioner in Lunacy from 1882 until 1888 and on the State Board of Charities until he resigned, at the age of ninety-five, in 1918. Smith was very interested in medical history and wrote several papers and two historical sections for surgical texts. The following paper is an example of what we would call contemporary history. It is informative because Smith describes the conditions he and his colleagues faced until Lister's system came into regular use. Smith seems to understand the underlying rationale of Lister's method, the germ theory, but is careful to leave open the "final conclusion of scientific students as to the cause of putrefaction in wounds." He leaves no doubt that the earlier surgeons dressed their wounds expecting suppuration, but by 1885 they expected primary healing. It is interesting, too, that Smith specifically pointed out that "no bystander [is] invited to put his finger in the wound, but scarcely an attendant at Bellevue would allow such an intrusion." This, we must remember , is only four years after President Garfield was shot in Washington's Baltimore and Potomac Station, and his wound subsequently examined frequently by probe and finger. Some of the medical reports of the President's progress indicated that "Listerism was used throughout." Yet we know this could not have been the case. Had Garfield been admitted to Bellevue a short four years later, he might have had less secondary infection if what Smith tells us in this paper was indeed the universal practice in 1885. As we drift with current events, we but imperfectly estimate the real advance which any art or science with which we are daily familiar has made within a limited period. It is only when we considerately pause and deliberately compare, in detail, past methods and results with those now practiced and obtained that Med. Record 28 (1885): 427-31. 201 202 SURGERY we fully appreciate the vast changes which have so insidiously and imperceptibly taken place. Perhaps there is no better place in which to test the progress of practical and operative surgery than the wards of Bellevue Hospital. This ancient institution has within its walls and its immediate environments all the conditions that in modern times are regarded as unhealthful and unsanitary. It was built between the years 1811-16, on the made lands of a cove of East River, without drainage, or adequate sewerage, and without regard to ventilation. During nearly threefourths of a century the sluggish tides have ebbed and flowed through the sodden soil of its foundation, depositing far more filth than they have removed. Since its occupation it has been used for a prison, an almshouse, and a hospital. Its wards have, from time to time, been crowded with patients suffering from all forms of contagious and infectious diseases. It has been the common receptacle of typhus and typhoid fevers, small-pox, puerperal fever, cholera, and yellow fever. Although many changes have been made in its interior, yet the great and most serious defects of location and construction have remained unaltered and may be regarded as permanent. Bellevue may be regarded as having been a surgical hospital only since 1850, a period of about thirty-five years, during most of which period I have been personally very familiar with the practice in the several surgical divisions. The amount of surgery in the wards of Bellevue has been a gradual increase. With the removal of the New York Hospital, and during the long interval of its nonexistence , the surgical practice of Bellevue became large and important and has remained so to the present time. The surgeons of Bellevue have always ranked among the best in the city, and, as much of their practice in the hospital has been public and clinical, it must be assumed that they have endeavored to...