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in 1736 by a two-story almshouse that served 19 paupers, included a prison, and had a room for the sick and insane. By
1795, the almshouse had become home to 800 people. Bellevue
Hospital opened on its present site-30th Street and the East
River-in 1816 and contained an almshouse, orphanage, lunatic
asylum, prison, and inﬁrmary.
The hospital then and still today serves what a 1900 city
oﬃcial said were the "dregs of society"-a dumping ground for
poor patients who could not pay and for those who were dying. Through every major epidemic, Bellevue has provided free
care to the medically indigent. From the yellow fever outbreak
at the end of the 19th century to the AIDS epidemic of the
1980s, when Bellevue treated more AIDS patients than any
other hospital in America, the hospital "has borne witness to
every imaginable public health scare, every economic swing and
population surge, every medical breakthrough and controversy."
During the great inﬂuenza epidemic of 1918-1919, no one was
turned away, "forcing the patient overﬂow to sleep on doors
ripped from hinges and piles of damp, fetid straw."
"What set Bellevue apart, even in the worst of times,"
Oshinsky writes, "was its powerful connection to New York
City's top medical schools." By the mid-19th century, Columbia
College of Physicians and Surgeons and the Medical College of
New York (later New York University [NYU]) sent their students to Bellevue. The city's "elite physicians for whom the lure
of interesting patients outweighed the fear of deadly miasmas
and physician blight" were applying for visiting positions. Soon
after it opened in 1898, Cornell Medical School joined Columbia and NYU in sending its medical students to Bellevue. The
training the young physicians received in the early 1960s may
have been the best any physician could receive, largely for two
reasons: the dedication of many faculty members and the fact
that the hospital was "a virtual war zone." Because the patient
population came largely from New York City's foreign-born
residents and its underclass-immigrants, derelicts, alcoholics,
addicts, the homeless, the mad, and the discards and dying
sent from other hospitals-students became familiar with a
wide range of illnesses few other medical students would ever
see elsewhere.
The students and young houseoﬃcers worked under abysmal conditions. More than 100 tuberculosis patients were
often stacked in corridors awaiting beds. Operations were routinely canceled during heat waves because there was no airconditioning. Stray cats roamed the doctors' basement dining
rooms to ease the invasion from the hospital's maze of ratinfested underground tunnels.
By the time of the Civil War (1861-1865), Bellevue
"had become both our nation's largest hospital and its most
important medical training ground." Medical training could
be summed up in a single word: immigration. Early waves of
immigrants were mostly Irish and Germans; after them came
Italians and Jews; and then Hispanics, Haitians, Africans,
South Asians, and Chinese. Most of Bellevue's patients-the
poor, the mad, and the despised-have been those who had
nowhere else to go. In its >280 years of existence, Bellevue
has never turned away a patient! Just as Irish immigrants were
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considered dangerous foreigners inﬂicting a typhus epidemic
on New York in the mid-19th century, so Jewish immigrants
were later thought to have a "tailor's disease" that was causing
an epidemic of tuberculosis. In recent times, gays, blacks, Hispanics, drug addicts, and homeless people have been viliﬁed as
carriers of AIDS. No matter which ethnic group is alleged to
spread disease in New York, Bellevue has not only persisted in
providing medical care for generations of the city's residents,
but has served as a model of how a public hospital can survive
and give excellent care. Bellevue handles nearly 670,000 nonemergency clinic visits and nearly 116,000 emergency visits
each year. Approximately 80% of those it serves are either
uninsured or poor enough to be covered by Medicaid.
More than 3 million of New York City's 8.5 million residents are foreign-born, many of whom are undocumented. As
many as 800 languages are spoken in New York, making it the
most linguistically diverse city in the world, and at Bellevue
>100 languages are translated. Among them are Mandarin,
Cantonese, Polish, Bengali, French, Spanish, and Haitian
Creole. As Oshinsky writes, "Doctors and patients communicate on dual telephones through an interpreter trained in the
nuances of regional dialects. The directional signs that guide
visitors through the hospital are multilingual-the destinations
now include a Muslim prayer room and a clinic for the survivors
of political torture."
During its 300-year history, Bellevue Hospital has always
been short of funds. Somehow Bellevue has always survived,
probably because of the quality of its medical care, the fact
that it provides unique services to the city (e.g., the medical
examiner's oﬃce and forensic labs), and its ongoing relation to
NYU Medical School, an aﬃliation that has served both well for
over 100 years. It is unlikely that Bellevue will go away. NYU's
physicians, medical students, residents, and attendees train and
work at Bellevue. And Bellevue pays NYU an annual sum for
these services. Bellevue's increasing lack of funds remains a major
concern for the city presently.
There was never a time when Bellevue appeared to be even
remotely trouble free. Yet, while caring for millions of patients
other hospitals turned away and often on the verge of being
closed down by the city, it was also among the nation's leaders
in medical research and innovation. Bellevue, for example, was
the ﬁrst American hospital to establish a maternity ward (1799),
a nursing school (1873), a children's clinic (1874), an emergency
department (1876), a psychiatric ward (1879), an ambulance
corps (1869), a pathology laboratory (1884), and a medical
photography department. It produced lasting innovations in
amputations, anesthesia, antisepsis, and the treatment of tuberculosis, heart disease, and AIDS. Throughout its history, its
physicians constantly demanded that the city provide decent
conditions for their patients and humane conditions for the
city's poor and underserved citizens.
Bellevue's faculty and graduates read like a "Who's Who" of
modern American medicine: Hermann Biggs, a pioneer in the
prevention of tuberculosis; Walter Reed and William Gorgas,
who tamed the ravages of yellow fever; William Hallock Park,
who brought the lifesaving diphtheria antitoxin to the US;

Baylor University Medical Center Proceedings

Volume 30, Number 2

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