Medical Advances

In the 19th century the most important advance in medical science was called (at the time) Listerism.  Simply put, Joseph Lister, working with  Louis Pasteur’s advances in microbiology and the discovery that bacteria cause putrefaction and infection, came to a conclusion:  In a medical setting the first line of defense is to keep the patient isolated from all such bacterial agents. There were two ways to achieve this: Antisepsis (using chemicals, usually carbolic) or asepsis (using heat) to sterilize.  In 1881 John Tyndall wrote

Living germs  … are the causes of putrefaction. Lister extended the generalization of Schwann from dead matter to living matter, and by this apparently simple step revolutionized the art of surgery. He changed it, in fact, from an art into a science (Tyndall).

In 1876 Lister came to the U.S. to lecture about his findings.

In 1878, Dr. Lewis Stimson performed the first public demonstration of an antiseptic surgery in the United States, using Baron Joseph Lister’s antiseptic technique while amputating a leg.

In 1881 President Garfield died not from the bullet fired by an assassin  but because the physicians treating him rejected Listerism and caused massive, systemic infection by probing his wounds with unsterilized instruments and dirty hands.

As the summer waned, Garfield was suffering from a scorching fever, relentless chills, and increasing confusion. The doctors tortured the president with more digital probing and many surgical attempts to widen the three-inch deep wound into a 20-inch-long incision, beginning at his ribs and extending to his groin. It soon became a super-infected, pus-ridden, gash of human flesh.

This assault and its aftercare probably led to an overwhelming infection known as sepsis, from the Greek verb, “to rot.” It is a total body inflammatory response to an overwhelming infection that almost always ends badly — the organs of the body simply quit working. The doctors’ dirty hands and fingers are often blamed as the vehicle that imported the infection into the body. But given that Garfield was a surgical and gunshot-wound patient in the germ-ridden, dirty Gilded Age, a period when many doctors still laughed at germ theory, there might have been many other sources of infection as well (Markel).

At least some people were paying attention, because in 1883 Dr. Stimson was asked to operate on former President Grant’s leg.

This photo was taken in the surgical amphitheater  at Bellevue in the early 1880s.  By modern standards it’s shocking (note especially the bloody floor), but it should have also been shocking to physicians in 1880.  I’m sure medical historians have written about the factors that led American physicians to reject the findings of Pasteur and Lister, but my guess is that it was simple hubris.

Because there were physicians and surgeons who accepted scientific findings and practiced antisepsis and asepsis, I felt justified in having Anna and Sophie act like sensible human beings and wash their hands. And instruments. And everything else. In carbolic.


Cheyne, W. W.  Antiseptic surgery: its principles, practice, history and results, London 1882.

Kessin, Richard H.  and Kenneth A. Forde. “How Antiseptic Surgery Arrived in America.” P&S 2007.  link.

Markel, Howard. The dirty, painful death of President James A. Garfield. PBS,  September 16, 2016. link

Pennington, T. H. “Listerism, its Decline and its Persistence: The introduction of aseptic surgical techniques in three British teaching hospitals, 1890–99.” Medical history 39.01 (1995): 35-60.

Tyndall, J. Essays on the floating-matter of the  air. London, 1881.

 

Bellevue Hospital

As seen from the East River

Bellevue, located  on First Avenue in the Kips Bay neighborhood of Manhattan, is the oldest public hospital in the country. It was founded in 1736 and built in what was then wilderness, almost two miles north of the settled region of Manhattan as a quarantine hospital.

Bellevue Ambulance Service ca 1890
Bellevue Ambulance Service ca 1890

Teaching Hospital

In 1819, New York University faculty began to conduct clinical instruction at Bellevue Hospital. In 1849, an amphitheatre for clinical teaching and surgery opened. In 1861, the Bellevue Hospital Medical College, the first medical college in New York with connections to a hospital, was founded.

By 1873, the nation’s first nursing school based on Florence Nightingale’s principles opened at Bellevue, followed by the nation’s first children’s clinic in 1874 and the nation’s first emergency pavilion in 1876; a pavilion for the insane—an approach considered revolutionary at the time—was erected within hospital grounds in 1879. Bellevue initiated a residency training program in 1883; it is still the model for surgical training worldwide. The Carnegie Laboratory, the nation’s first pathology and bacteriology laboratory, was founded there a year later, followed by the nation’s first men’s nursing school in 1888.

Multiple firsts were performed at Bellevue in its early years. In 1799, it opened the first maternity ward in the United States. By 1808, the world’s first ligation of the femoral artery for an aneurysm was performed there, followed by the first ligation of the innominate artery ten years later.

Bellevue physicians promoted the “Bone Bill” in 1854, which legalized dissection of cadavers for anatomical studies; two years later they started to also popularize the use of the hypodermic syringe. In 1862, the Austin Flint murmur was named for Austin Flint, prominent Bellevue Hospital cardiologist.

Public Health

By 1867, Bellevue physicians were instrumental in developing New York City’s sanitary code, the first in the world. One of the nation’s first outpatient departments connected to a hospital (the “Bureau of Medical and Surgical Relief for the Out of Door Poor”) was established at Bellevue that year. In 1868, Bellevue physician Stephen Smith became first commissioner of public health in New York City; he initiated a national campaign for health vaccinations. A year later, Bellevue established the second hospital-based, emergency ambulance service in the United States.

Bellevue Hospital Medical College

Extracted from the NYU Archives

The Bellevue Hospital Medical College opened in 1861 and in 1898 was merged  with the University Medical College of New York University.
In the spring of 1861 the following physicians as the faculty: Stephen Smith, Frank H. Hamilton, James R. Wood, Alexander B. Mott, Lewis A. Sayre, Isaac E. Taylor, Fordyce Barker, George T. Elliot, Jr., Benjamin W. McCready, J.W. S. Gouley, Austin Flint, Austin Flint, Jr., and Robert O. Doremus.

The original building was on the grounds of Bellevue Hospital, but the school soon realized they needed a larger building, and in 1865-66, a larger building, also on the hospital grounds, was erected at 419-21 East 26th Street. In addition to serving as the home for the College, the facility was also used by the Bureau of Medical and Surgical Relief for the Out-door Poor.

During the Civil War, physicians from Bellevue Hospital Medical College , under the auspices of the United States Sanitary Commission, published several monographs for Army surgeons, such as Stephen Smith’s piece on “Amputations.” Faculty members also played significant roles on New York City ‘s Council of Hygiene and Public Health, whose landmark report on the sanitary condition of the city led to the establishment in 1866 of the New York City Department of Health.

The surgery department of the college was strong, and included prominent doctors such as Lewis Sayre, who was the first professor of orthopedic surgery in the country. In 1854 he performed the first successful resection of the hip joint in the United States . Frank Hamilton was an authority on fractures, and wrote the first complete and comprehensive treatise in English on the subject.

In the 1880’s Andrew Carnegie donated a large sum of money to the college, and the Carnegie Laboratory, the first in the country established for teaching and investigation in bacteriology and pathology, opened for the 1884-85 school year. (An event which is mentioned in Where the Light Enters)

Physicians

Bellevue Physicians 1890
Bellevue House Physicians 1890: Note the lack of women. Click for a larger version.

In 1889, Bellevue physicians were the first to report that tuberculosis is a preventable disease; five years later was the successful operation of the abdomen for a pistol shot wound.

Bellevue operating room, 1880s. Though antiseptic theory was understood at this point, it was not always practiced.

Reading

Bellevue Hospital Pioneered Care for Presidents and Paupers. National Public Radio.

A tour of Bellevue.  Signature.

 

 

 

Anna Savard

Summary

 

Full Name | Also Known AsLiliane Mathilde Savard
RolePrimary
Appears inGH
Family TreeLink
Birth Date & Place
Race/Ethnicity
EducationElementary school for children of faculty at the Cooper Union, Rutger’s Female College, Woman’s Medical School, post graduate work in Vienna, Berlin and London
OccupationPhysician and surgeon
DescriptionPhysically, Anna was inspired by Beatrice Offer, a British artist, and Maria Spartalli Stillman, another British painter of Greek descent who many consider to be arguably the greatest female artist of the Pre-Raphaelite movement. Stillman and Offer were advocates for artistic dress.

Notes

Liliane Mathilde Savard, called Anna by friends and family, is 27 years old when the story opens in 1883. She is the first daughter and second child of Henry and Curiosity (Birdie) Savard, both physicians. Anna is orphaned at age three. Her Aunt Quinlan takes her into her home on Waverly Place in Manhattan to be raised.

The Civil War takes a terrible toll on the Savard, Bonner and Quinlan families. Among the fallen are Anna’s brother and her Uncle Quinlan. The war has also orphaned Sophie Savard, a second cousin from New Orleans. Sophie comes to live with Aunt Quinlan, and a strong bond is formed between Anna, Sophie, and Anna’s close friend, Cap Verhoeven.

Offor was a British painter. She is one of the primary visual references for Anna.
Offor was a British painter. She is one of the primary visual references for Anna.

The three children attend elementary school in a special class for the children of Cooper Union faculty. Anna and Sophie go on to study at the Rutgers College for Women on Fifth Avenue, and then enroll as students at the Woman’s Medical College. They both come from many generations of doctors and healers, and medicine is the only future they can envision for themselves. Cap studies as Columbia College, and then enters Yale Law School.

At age 24 Anna is fully qualified as a physician, but she studies another year to qualify as a surgeon. By the summer of 1883 she is well established on the staff of the New Amsterdam Charity Hospital.

Anna’s costume for the Vanderbilt costume ball was inspired by the portrait below.

portraits-anna-costume

Quotes

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Continuity Issues

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New Amsterdam Charity Hospital

(fictional) A hospital serving the poor women and children of New York City.  Anna Savard and Sophie Savard are both on the staff at the New Amsterdam.