905 HOSPITAL CARE AT SECOND AVENUE AND EAST 17TH STREET, NEW YORK CITY, 1894-1984 HENRY PINSKER, M.D., DAVID M. NovICK, M.D., AND BEVERLY L. RICHMAN, M.D. Beth Israel Medical Center The Mount Sinai School of Medicine of the City University of New York New York, New York B ETH Israel Medical Center's recent sale of the building that housed its Morris J. Bernstein Institute brings to an end nearly 90 years of medi- cal care at Second Avenue and East 17th Street in New York City. During this time, three separate institutions provided care to differing patient popu- lations in the handsome building at 307 Second Avenue. New York Lying- In Hospital, Manhattan General Hospital, and the Morris J. Bernstein In- stitute each contributed to medical progress in areas that at one time received little attention from the medical community. Except for the removal of two ironwork balconies that were found to be unsafe in 1979 and removal of the glass solarium from the roof in 1981, the exterior of the building is substantially as it was when opened in 1902 (Figure 1). A historical perspective of the three hospitals follows. NEW YORK LYING-IN HOPSITAL The New York Lying-In Hospital had its origins in the yellow fever epi- demic of 1798.1 Dr. David Hosack, a prominent practitioner in New York City, observed that many expectant mothers, widowed by the yellow fever, "were rendered wretched under the accumulated evils of grief and poverty." At that time there were no provisions for the medical care of women dur- ing pregnancy or confinement. Dr. Hosack secured subscriptions from many prominent people, and the hospital, located in a house at 2 Cedar Street, be- gan to receive both destitute and paying patients on August 1, 1799. Expenses were greater than funds raised, however, and the hospital closed in its sec- ond year. An arrangement was made between the governors of the Lying- Address for reprint requests: Henry Pinsker, M.D., Beth Israel Medical Center, 10 Nathan D. Perlman Place, New York, N.Y. 10003 Vol. 60, No. 9, November 1984 906 906H.H. PINSKER, AND OTHERS jiff... we. a -'it Fig. 1. The New York Lying-In Hospital Building in 1902, the year of its opening. Reproduced by permission from The Architectural Record 11:94, 1902. In Hospital and the Board of Governors of New York Hospital, then located on the west side of Broadway between Duane and Worth Streets, permit- ting the Lying-In Hospital to conduct its activity in a New York Hospital ward. Disagreement between the governing bodies about financial matters terminated the relationship in 1827. The Society of the Lying-In Hospital maintained its corporate existence without providing any service until 1855, when, still unable to afford a building, it began a program of giving money to poor women to assist with the costs of confinement at home. While there had been sentiment in the 18th and early 19th centuries that it was morally inappropriate for men to practice obstetrics, it nevertheless developed as a medical specialty during the middle of the 19th century.2 With increasing affluence, women demanded obstetrical care from physi- cians. In the latter part of the 19th century, medical schools offered only lectures, and medical students made their own arrangements to obtain clin- ical experience. At this time, midwives, many with little or no specific train- Bull. N.Y. Acad. Med. SECOND AVENUE AND EAST 17TH STREET 907 ing, assisted at half of the births in new York City.2'3 To improve instruc- tion in obstetrics for medical students and provide better service to pregnant women, a small group of physicians, organized by Dr. James Markoe and Dr. Samuel L. Lambert, opened an independent outpatient Midwifery Dis- pensary at 312 Broome Street on the Lower East Side, patterned after the one they had known as students in Munich in 1887.1 Students staffed the new dispensary, and, by not charging for their services, effectively com- peted with the midwives. Meanwhile, investments of the essentially inactive Society of the Lying- In Hospital continued to grow. When the president of the Society was in- formed about the work of young physicians and medical students in the Broome Street Dispensary, he immediately began to provide financial sup- port, and in 1892 assumed financial responsibility for the entire operation. Dr. Markoe had met financier-philanthropist J. Pierpont Morgan during the winter of 1891-92. On Christmas Eve, 1893, a mutual friend told Mr. Morgan that Dr. Markoe was about to perform a cesarean section on a des- titute rachitic dwarf who lived in a room about 10 feet square in a tene- ment on Norfolk Street. Mr. Morgan joined others in contributing $10 for expenses. The next day Mr. Morgan gave $300 to provide for rent, food, clothing, and the service of a trained nurse. Thus began Morgan's support for The Lying-In Hospital. 4 In 1893 the Society of the New York Lying-In Hospital paid $200,000 for the mansion of Hamilton Fish at East 17th Street and Second Avenue. Fish had been governor of New York, a United States senator, and secre- tary of state during the Grant administration.5 Alterations were made dur- ing the summer of 1894, and the house, equipped as a hospital, opened on November 1, 1894 (Figure 2). The new facility, named New York Lying- In Hospital, had accommodations for 32 patients, an operating room, a deliv- ery room, and quarters for the intern staff and students.' Just a few years after beginning to provide service in the converted Hamil- ton Fish mansion, the hospital was turning away more applicants for con- finement than it could accommodate. Morgan agreed to contribute $1,350,000 for construction of a new building, with the stipulation that oper- ating funds be raised from the public. In 1899 the mansion was razed and construction of the new hospital began. The staff continued to provide home care while hospital service was suspended. Before the plans for the New York Lying-In Hospital were completed, Morgan sent Dr. Markoe to Europe to survey modern hospitals there. 4 The information obtained was given to Robert H. Robertson, the architect re- Vol. 60, No. 9, November 1984 908 908 H. PISEPINSKER, ADOHRAND OTHERS '. lM Fig. 2. The Hamilton Fish Mansion at the corner of Second Avenue and East 17th Street. The New York Lying-In Hospital was situated here from 1894 to 1899, at which time it was razed so that a larger facility could be built. Reproduced from Harrar, J. A.: The Story of the Lying-In Hospital ofthe City ofNew York. New York, The Society of the Lying-In Hospi- tal, 1938. Courtesy of the Medical Archives, New York Hospital-Cornell Medical Center. tained by Morgan to design the new building. Robertson had previously designed many churches, houses, mansions, railroad stations, and office buildings, including the Corn Exchange Bank Building on William Street and the 27 Park Row building.6 Despite numberous construction delays, the new facility opened its doors on January 22, 1902. The structure was described in the February 15, 1902 issue of Harper's Weekly: Unquestionably the most complete, the most modern, and the most comprehensive structure for the benefit of maternity patients yet built in this or any other coun- try.. But the greatest importance of the building itself, aside from its origin and its practical usefulness, is the epoch which it marks in hospital construction ... No Eu- ropean structure compares with it for they all have been studied by the doctors and architects, and the best ideas they could offer have been adopted.7 The eight-story hospital building occupied the entire block between East 17th and East 18th Streets on the west side of Second Avenue. Stuyvesant Park is directly south of the building. Bull. N.Y. Acad. Med. SECOND AVENUE AND EAST 17TH STREET 909 The top floor contained an operating amphitheater, rooms for sterilizing equipment, laboratories, and a kitchen. Elsewhere were located a lecture room, library, museum, printing plant, extensive heating and lighting sys- tems, sleeping accommodations for male and female medical students, and nurses' quarters. In the basement were offices, examining rooms, a chapel, a mortuary, and a "stable for the electric ambulance ... [which] embodies new features, in opening from the side and being lighted from the top. Its great weight lessens jars and swaying."3 The interior design of the building was notable. The wards had 171/2 foot ceilings, quite high even in 1902, and contained eight to 20 beds. In some places, duplex suites provided staff quarters close to clinical units. Each ward had an isolation room. An overriding concern in the design was to be im- maculate. Sharp angles, seams, and joints were eliminated, and the junc- tions of the floors and ceilings with the walls were curved to permit easy cleaning. Even the upper corners of doors and windows were rounded. To prevent dust accumulation, radiators were boxed in, the window shades ran on the outside of the windows (to avoid shaking dust into the wards), and the doors had no trim or framing. The flooring, constructed from lignolith, a composition of cement and sawdust, in one unbroken surface, had a glazed appearance which radiated cleanliness. The furnishings were of glass and iron, easy to clean, although stark in appearance. Illumination was by in- direct lighting. In addition to an electric elevator, a white marble stairway circled from the entrance to the roof, where there was a glass walled solar- ium (Figure 3).