INTERN SERVICE IN THE OLD DAYS AT CHAMBERS STREET HOSPITAL, N. Y By J. B. CUTTER, M.D.

SAN FRANCISCO, CALIF.

ERVICE at “Chambers Street” To the student and to the young Hospital in the early nineties physician, his preceptor embodied was unique. I look baek upon those winning qualities so well de- the experience as an out-stand- scribed by that rare Scot, Robert ing epoch in a life that has been Louis Stevenson, of whom he said and Smarked by many unusual turns in of his kind, “He is the Hower of our the wheel of fortune. There was a civilization, and exhibits the virtues poetic touch in the pathos and humor of the race, embodying those qualities of many of the scenes enacted there, of generosity peculiar to those who and there was a wealth of medical and practice an art and never to those surgical experience of that sort pecu- who drive a trade, discretion, (tact, liar to an Emergency Hospital serving perhaps the fairest fruit of character) the densely populated region in the with cheerfulness and courage, bring- heart of the commercial shipping and ing cheer and air into the sick room, industrial districts of a great city, such and healing when he can.” a great city as is only represented by Is not that romance of the truest London, Paris, Chicago and New sort that is built on the cornerstone York. of love, greater than which is known It was romantic, as that may apply to no man more than to the physician, to the thrilling adventures in the and in the period of which I write early days of the study and practice the period of “the Family Doctor” of medicine, to that rare taste of he had mounted the highest peak in life which came to the medical student that interrelationship of friends, the of that heroic period when he was doctor and the patient, since which the apprentice as well as the com- he has often against his inclination, panion of his preceptor, and closely yet never the less moving forward wrapped in all the interests and with the tide of inevitable change in responsibilities which he assumed and the onward stream of civilization, which were thrust upon him in this begun the descent from that eminence unique relationship. into the valley of material rather It was. also an important period in than spiritual relationships. the character-forming years of the Old “Chambers Street,” as it was young physician, when the budding known throughout the world, through love of humanity and the love of pro- that amazing epoch of the history of fession slowly unfolded and bloomed American medicine was perhaps the together. And it was interesting be- most noteworthy school in this coun- cause the atmosphere of medicine in try for the education and training that gay period was charged with the of that type of physician to which 1 spirit of adventure, with the high have referred and during the decade purpose of achievement, with a sense of the nineties this was largely due of devotion and with the charm of to the dominating personality, the idealism. noble qualities, the shining example of that master surgeon, Lewis A. tion over this two-months’ period, Stimson. as a rule. “Chambers Street” Hospital was a Who then among the eager, hopeful law unto itself in the peculiar field medical fraternity of that time would of medicine which it served, occupying not receive a thrill of joyful satisfac- a strategic position in the lower end tion after the painful grinding years of Manhattan Island, between the of preparation in medical school, espe- shipping district of Christopher Street cially if arriving in New York from on the North River as far as Grand a small university in a far Western Street on the East, including between metropolis, to find himself in this them the commercial and industrial long coveted position as a member of sections centering around South the house staff in the most active Broadway, (two blocks west from acute surgical service in New York, which on Chambers Street it occupied numbered among the illustrious names an old brown-stone English basement which grace the list of the House dwelling, not too highly adapted to Surgeons of the House Of Relief its multifarious purposes), an area of the New York Hospital, headed extending as far as “The Battery” by Charles B. Kelsey and William T. on the south. It performed indeed Bull, dating back to the historic an important function in the daily period of 1875. life of the City of New York. Such was the experience of the “Chambers Street” Hospital or as writer, when after the two-months’ its official title was, “The House Of Dispensary service, followed by a Relief Of The New York Hospital,” voyage to Lisbon and The Azores took the place of the Emergency Islands as ship’s surgeon of the S. S. Hospital for the Municipality of New Vega of the Empressa Insulana de York, for all that territory south of Navegacon, he landed in New York Canal Street, and for years it held after a tempestuous voyage near the these front line trenches practically first of February (date of the assign- unsupported, save for Bellevue on ment) and after a trembling inter- the east at Twenty-sixth Street, and view with the august Chief, he was St. Vincent’s Hospital on the west. confirmed in this sixteen-months’ It was indeed a far-flung battleground. appointment. Appointment on the House Staff of The subsequent early adventurous “Chambers Street” Hospital in the years in medical experience, including early nineties was a coveted honor, army service during the Spanish which was dispensed through the American War; railway service in favor of its chief, usually after a the frontier state of New Mexico (we probationary service of two months have no frontier states now but in the Dispensary or Out-Patient we did have in those days), mining Department as it would be called practice in the wilds of Idaho; and today. This appointment was not on the Mexican frontier in the hotbed open to competitive examination as of banditry and outlawry of the in the case of the other hospitals famous copper mines of Cannanea, in New York. Doctor Stimson reserved did not compare in charm and interest judgment on its applicants, after with that Old “Chambers Street” careful scrutiny and personal examina- internship in 1895. Still in memory resounds the clang tion common to such scenes, making of the ambulance bell as the ambu- gangway at first sight of the ambu- lance swung around the corner, driven lance surgeon who with white coat

by a Jehu in the cap and uniform and cap, bearing the insignia of the of the hospital. Making a dash for Hospital was a privileged personage the rear end with hand grasping at on all such occasions and felt the the brass side rail, foot catching he dignity and importance of his position low swung step behind, and with a where his slightest word or nod was dextrous and characteristic swing of law. the body, throwing both legs over Hurriedly unbuttoning the coat so the seat occupying the back of this as to open the vest and shirt for the unique vehicle, they were ofl. application of the stethoscope above The first ambulance call might be the heart, he found the patient as he to an outpost somewhere in the appeared to be, quite dead; but the “ Bowery” where case in hand the am- mingled feelings of the surgeon may bulance surgeon drops off at the be imagined as on placing his car arrival of the ambulance at the curb, against the chest to detect if possible to find his patient seated on the pave- the slightest motion of the heart, he ment in semi-reclining position, sup- is startled by the sudden appearance ported by the building against which of a tiny chameleon darting forth he leaned. Around were the congrega- from beneath the lapel of the vest, to which it was attached by a miniature to the “Chambers Street” service. gold chain and collar around the Of the 3600 ambulance cases brought throat. Would not this episode fix for in 1200 were transferred to other all time the memory of that first hospitals, so that this number must be ambulance call? added to the number of calls credited, Grappling with a delirium tremens making a grand total of over 5000 patient all the way to Bellevue would ambulance calls a year. provide athletic exercise as well as Among the cases brought in by professional interest. Such “pick-ups” ambulance were many of unusual were immediately transferred there. pathological interest, and Doctor The long drive back from Bellevue Stimson was ready to respond to the seemed often brief in the varied con- house surgeon’s call at any hour of templative interest that the drive af- the day or night to see fractures and forded. Passing down the lower end of luxations of such a character. One Fifth Avenue through what is known such case, a thyroid luxation of the as “Greenwich Village,” through the thigh (the second one ever seen by purlieus of Hester, Pell and Mott Doctor Stimson in a life long experi- Streets, the ambulance surgeon found ence as a world authority in fractures fruitful themes for study in the motley and luxations) proved to be a case maze of sociological medium where celebre. The house surgeon in charge, a mixture of Oriental color (and odor), who was the writer of this article, was varied hues of dress from the Mediter- directed to reduce the dislocation ranean, swarthy visages from the under the direction of Doctor Stimson. Balkans and from the steppes of Following is the official record of the Russia, formed ever-changing pictures case. before his eyes. That the ambulance service at Ferdinand Giersch, age forty-two, Ger- man, 314 Grand Ave., Hoboken. Long- “Chambers Street” was an important shoreman. Brought in by ambulance and heavy part of the service may surgeon Sanger. Was easily diagnosed as well be judged by the record of the thyroid luxation of the right thigh, show- work done during the sixteen-months’ ing the classical deformity of abduction, period referred to. In the year, 3623 eversion and outward rotation. The posi- calls or an average of ten in the tion quite characteristic is seen from the twenty-four hours, at least one-third photograph taken at the time and later of which occurred between seven at included in Doctor Stimson’s textbook night and seven in the morning, were (“Fractures and Dislocations,” by Lewis made and the three assistants to the A. Stimson). As many as possible were House Surgeon divided this work called in to witness the unusual deformity, between them. This however did not and the further record of the case shows those present to have been, Dr. C. C. mean uninterrupted sleep for the Carmault, Dr. John Rogers, Dr. H. S. remaining nights, for the night dis- Leake, Dr. Fielding Lewis Taylor and pensary service was also heavy and Drs. Barstow, Howell, Grandy, Ford and divided. The average number of visits Sanger. to the dispensary was more than 110,000 in the year, and a good Dr. Stimson’s operation of mediate proportion of night calls was the rule. ligation in fracture of the patella had Restful nights were not an inducement ample opportunity for trial on the service of the writer, as 12 cases were ture, at right angles ancl serving as a operated upon between February and sort of splint to prevent upward tilt- April. The outstanding features of the ing of the fragments.

operation, widely done at this period It has been the writer’s privilege when the treatment of this injury was to perform this operation many times still a matter of surgical controversy, following my service at “Chambers as we were just emerging from the Street” Hospital with almost uni- long drawn-out expectant treatment, formly good results, yet have I rarely inclined plane in bed, strapping and ever seen the name of Doctor Stimson hoping for the osseous union which associated with the operation which never came, a band of elastic fibrous was a distinct step forward in the tissue connecting the fragments being treatment of this very serious injury. the best result obtainable under this Another case of unique importance method, were, free incision above the luxation of the ulna alone without line of fracture, thorough clearing of involvement of the radius was seen the joint of debris clots and shreds, for the first time in the annals of careful apposition of the fragments injuries here by Doctor Stimson and bone to bone, suturing the torn perios- was reported as follows: John Shea, teum and retention, not by drill and age thirty-five brought in by ambu- wire but by strong catgut ligatures, lance, March 13 1895, reduced by after closing the torn periosteum, one manipulation and retained by rec- a purse-string ligature round the tangular splint. broken patella and the other a very In searching for the record of a heavy retaining ligature through the case of this rare dislocation, as re- ligamentum patellae and the quadri- corded by Sir Astley Cooper, in The ceps tendon, crossing the line of frac- British Medical Museum, Dr. Stimson found the case to be one of mistaken curiosity, pique or spite, or sometimes diagnosis, the callus in the unreduced to gather material for a Sunday luxation being mistaken for the head morning write-up in the Daily Whirl, of the bone. The case reported re- as the leading yellow journal was then mained unique in traumatic medical dubbed. annals at that time. That unholy love of exploiting Many cases of perforating ulcer of hospitals in the daily press which at the duodenum, depressed fractures that time was so common, often of the skull, operations for appendi- brought embarrassment to the staff citis, in various stages, are reported because of the sensitiveness of “the in the sixteen-months’ service referred Chief” who took these attacks as a to. At that time the present high reflection on his personal service at the percentage of recoveries in operations hospital. Any enterprising reporter, on the appendix was not usual as now. man or woman who really wanted to Indeed this operation like operation see the inside of the Receiving Ward on the patella was a subject of dispute, of “Chambers Street” Hospital at two and there were then the two schools o’clock in the morning, situated as it of treatment, one the conservative, was in the midst of that downtown advocating the medical treatment of district where hold-ups, murders and the appendix, the other, the radical, all sorts of crime were only common beginning courageously to fight for experience, was pretty sure to have his its position. ambition gratified and find material On the ambulance service at enough for thrills for the front page “Chambers Street” there was a if he happened to drop in after an sportsman’s thrill of adventure in the ambulance call to “Cat Alley” or anticipation of the kind of case that “Double Cat” Alley or Cherry Street would result from a “hurry call” after one of the “mixed-ale” parties which was not uncommon every day. of the evening. If the need for the While there was nothing tame about call to that aristocratic neighborhood struggling with a delirium tremens happened to be the result of an argu- patient all the way up to Bellevue ment between Mary Ann O’FIarity Hospital, or a moment’s dullness in and Bridget O’Hoolihan about the bringing the head successfully over ingredients of the “mixed-ale,” then the perineum while the patient was there was apt to follow in the Receiv- lying against the curbstone or on the ing Ward a scene not only interesting floor of a public building as occasion- from a medical point of view but one ally happened, or even while holding apt to raise the hair on the head of the up the sailing of the Fall River boat enterprising reporter. at seven in the morning, while the toilet As in the experience of the writer of a precipitate labor was consum- the following Sunday Whirl came out mated to the satisfaction of the young in glaring colors on the front page surgeon’s high standard at the time, describing the experiences of being there was a peculiar and added zest brought into the hospital and paint- in the encounter with those bizarre ing a vivid picture of the reception and grotesque specimens of humanity that had been offered on arrival, who took an ambulance call as a the puzzled ambulance surgeon would means of gratifying a peculiar form of suddenly recall that the night before he had had a call to City Hall Park, ing experiences, but they were part of had found a lady lying on a park the human ensemble and fairly de- bench, apparently in great pain, that scribe the real atmosphere of the Re-

he had tenderly examined her as best ceiving Ward at “Chambers Street” he could in the circumstances, brought Hospital at two in the morning in the her to the hospital where she was given early nineties. the best hospitality possible at such Frequent testimony at the police a time and in such a place, and he courts of the district was another would begin to gather a glimmer of of the diversions of the ambulance understanding of her reference to surgeon and one upon which he looked “the coffin” that stood in the end of back in later years as an experience the ward on end as the portable bathtub that served for the ablutions and education in the matter of medi- of our delirium tremens cases at that cal jurisprudence not to be duplicated. time, and the wild sounds that ema- These adventures in the courts of law nated from the adjoining room sug- often gave spice and flourish to his gesting the murder of an inmate; as otherwise at times somewhat sordid the unearthly yells from the throat existence. Certainly the ambulance of a delirious “mixed-ale” victim or surgeon could do no less than respond a wild man perhaps from the jungles when called upon to testify as to of Hester Street, who had escaped whether the wound which was the from the clutches of his adversary result of an attack upon the witness but still imagined himself pursued. during one of the frequent “mixed- These were not mellowing or comfort- ale” parties at the hands of Mary Ann O’FIarity was a bite (not infrequent) he was as safe as in the precincts of or produced by some blunt instrument. the hospital. Ambulance calls covered the most Serious criminal cases sometimes out of the way districts in the neigh- dragged along in the courts for weeks borhood of the Brooklyn Bridge, the and each morning it was necessary to East River water front, and the Bat- report to the Tombs or to General tery, and the docks and dark and Sessions to give testimony. gloomy alleyways were visited in the In the strange case of Miss Fuller who was found in the office of her dead of night under the somber glare employer Lawyer McGee, by the of the ambulance head light, as the ambulance surgeon, dying from a only means of illumination, all else gunshot wound, the testimony of being as dark as the depths of Erebus. myself as the first person to touch the “Steve Brodey’s” saloon down in body after the shooting, was vital on the Bowery was a place of celebrated the point as to whether the victim fame, and was a sort of headquarters could herself have inflicted the fatal for the dressing of scalp wounds and shot or not, as the evidence was the taking care of simple injuries when brought forth by the prosecuting the patient was then turned loose or attorney that she could not have repaired to the nearest police station. discharged the pistol for the reason This old rendezvous was given a that the glove on her right hand was peculiar charm and romance through found pulled down over the hand the personal slant of one of our most in such a way that to hold or discharge beloved members of the staff, O. D. F. the weapon would have been impossi- as he was familiarly known, or “Old ble, and so it remained for my testi- Doc Ford” as we affectionately called mony that I had myself so left the him. A bond of friendship had been glove, in my effort to reach the formed, of his peculiar type, and the wrist to take the pulse to show that famous “Steve”, bridge jumper and she might have shot herself, and thus all-around sport, was the avowed the point that she must have been friend of what to him was “The murdered was not proved. Ambulance Surgeon Fraternity.” All As already mentioned, at the time ambulance surgeons were given signal of the writer’s service at “Chambers attention by “Steve”, when they Street” the reputation of being the appeared in Steve’s neighborhood. most active acute surgical service in The Ambulance surgeon in any of New York was easily sustained and these strange and out of the way the following reference to the record places of the city was the first one on of the Out-Patient Department during the scene after murders and crimes of the year 1900 will add verisimilitude to all descriptions, as the call for the this statement. ambulance usually preceded the call Taken at random the outstanding for the police. His arrival was there- list of cases reported were classified as: fore of prime importance in the Operations. jurisprudence of the case, and even Amputations...... 211 in the depths of those lower town hells Foreign bodies removed. . 597 where the Chinese and whites lived in Incisions...... 1142 promiscuous profusion, and where Tenorrhaphies...... 29 human life was held in light esteem, Wounds, blank cartridge . 27 Luxations. or a too long detention on a frosty Humerus subcor...... 44 morning, it was “do the best you can” Radius and ulna...... 19 unless as sometimes happened our Radius and ulna backward 4 kind and humane superintendent of Phalanges...... 28 nurses had ready on our return a Fractures. dainty poached egg, crisp toast and Head and trunk...... 258 a cup of tea. These tender bits of Upper extremity...... 399 romance will remain while perhaps Lower...... 156 more serious episodes will fade from A total of 813 fractures, 119 luxa- memory forever. tions, 2088 operations, and a grand If the professional training with its total in the Out-Patient Department wealth of material and the best of alone, of 17,594 injuries, 11,348 sur- bedside teaching was an asset in the gical diseases, 13,033 medical diseases, summing up of the medical capital and a total number of visits to the gathered through these very busy and Out-Patient Department of 110,597. intensive years of work, there were Ambulance calls 3623, transfers to too certain fundamental principles in- other hospitals, 1206 stalled which “time will never wither In addition to these, there were nor custom stale.” These were bred 2386 patients admitted, to the wards into the professional bone and marrow during the year, so that in this out- of the young surgeon during those standing service of sixteen months in eighteen months and the precepts of the In-Patient and two months in the Lewis A. Stimson and Lewis A. Con- Out-Patient Departments, eighteen nor, Chicf-in-Medicinc during the lat- months in all, there was a fund of ter part of the service, became the work done and seen uncqualcd in any guiding star to all future discoveries. hospital in this country at that time I may say that simplicity and within that period. direction of action were the outstand- Domestic life, if that necessary ing characteristics with Doctor Stim- provision for food and shelter may son in all surgical procedures. An thus be designated, at “Chambers armamentarium reduced to its lowest Street” was sufficiently provided for, terms, a technic above suspicion (anti- but for any thing more than the sepsis rather than asepsis was the rule assurance of three good meals a day, in the early nineties), Surgery had not and a bed (two in a room) on which yet (strange as it may seem today) to throw one’s tired limbs, it certainly reached that pinnacle of scientific was not expected. We did look forward exactitude of which modern surgery to Thursday night, when our house is the symbol today. Hospital proce- officer gave us raw oysters at dinner, dure then participated in the realm this the one great treat of the week; of experimental medicine. but the meals were good and whole- The practical extent to which the some, and we were ready for them tenets to which 1 have referred were when the hour arrived. The active life carried and that they were no mere (much of it spent out of doors) gave us platitudes may be judged by the fact hearty appetites. If it so happened that all our surgical and operating that the regular meal hour had passed room preparations were marked by while on a hurry call to the Bowcry certainly the extremest simplicity and lack of consequentially, if this will matter, how shall we compare from express what I have in mind. Interns any standpoint the experiences of spent their spare hours which were then and now? few and far between, in the prepara- Where is old “Chambers Street” tion of catgut ligatures and sutures. today? Alas, it is no more. It remains The raw catgut was procured in preserved in memory among the most bulk, immersed in ether, wound on valued traditions in the hearts of that glass spools, dropped into a small generation that flourished there during glass jar of alcohol and boiled in a that epochal period of some fifty water bath the requisite number of years between the end of our Civil minutes to insure asepsis. Horse hair War and the end of the Great World sutures, very favorite material for the War. Its immense service to the closing of scalp wound and small developing medical profession of that incisions, were procured by robbing formative period and to the public in the horses’ tails in our own ambulance the municipality of New York which it stables. Washed and aseptisized they served so unselfishly and so faithfully were ready for use in large quantities. can hardly be overestimated. Its ser- Gauze was also procured in bulk cut vice was without money and without into large sponge sizes and sterilized price. The New York Hospital, the en masse. Bandages were torn and second hospital established in the rolled from bleached muslin, (gauze United States by Royal Charter from bandages were a luxury not tolerated George the Third, granted to “the at “Chambers Street,”) and were Society of the Hospital In The City kept immersed in solution ready for Of New York” in 1771, maintained dispensary or ambulance use in large the service gratuitously at an annual quantities. expenditure of some $35,000. I am certain that to the eye of the The “House Of Relief” as it was present generation in medicine these officially designated was so important references to our homely practices a part of the great charity of the New seem rather crude and perhaps unnec- York Hospital, that it was delegated essarily primitive. They were however to the care and oversight, practically the reflection of that pure and noble without restriction, to one man, (being character, of our Chief who went the history of many if not most of the without deflection to the point desired. great enterprises in the realm of If with Cicero we believed that medicine, nursing and the most not- “The great things of the world were able benevolences). For many years not achieved by activity, exercise or that great master of surgery, Lewis nimbleness of body, but by delibera- A. Stimson, was the benevolent auto- tion, character and the expression of crat of “Chambers Street” Hospital. opinion,” certainly we had not arrived At near the close of the service of during our active professional appren- the writer in June, 1895, the old ticeship at “Chambers Street,” at building with its sweet as well as its that contemplative age and we found unsavory remembrances was closed the former attributes of much service and “The House Of Relief, or “Hud- in our year and a half at least of this son Street” Hospital as it was after- stage of medicine, but in contemplat- ward known, took up its quarters in ing from this later day the whole a new and thoroughly modern hos- pital building especially arranged and Receiving Ward, and from its track erected for the purpose by the Society was suspended a hammock and this of the New York Hospital on the was let down by an automatic switch corner of Jay and Hudson Streets. first into the tub of ice water then Here were installed many of those con- onto the table and lastly on the bed. veniences thought most suitable to the During the latter part of the World peculiar need of that downtown emer- War the “Hudson Street” Hospital gency service. During the “Heated was appropriated by the Government, Term” as it was always called in for the use of its Public Health Service New York there were many calls in the City of New York. It is now on account of sunstroke or insolation. the permanent possession of the gov- As many as twenty calls in the ernment who found the plant so well twenty-four hours were responded adapted to their important work that to by the ambulances. The treatment the Government induced The Society was vigorous, consisting principally of the New York Hospital to turn the in alternate immersion in ice water property over to them which they did, and flagellation, stimulation and the only in the presence of the fact that course repeated. To make this unique other downtown hospitals had in method more easily managed an over- recent years been established for the head crane operated by electricity emergency service in the lower end of was installed along the ceiling of the Manhattan Island.