Each step along the way had its pitfalls. The police court of the 1880s was fertile ground for curious reporters, and “Nellie Brown,” an attractive, well-dressed woman with no apparent sense of who she was or what she was doing in New York City, seemed ripe for attention. “If there is anyone who can ferret out a mystery it is a reporter,” Bly recalled. Claiming to be cold and frightened, she chose a wide-brimmed hat with a black veil for her disguise. “Who Is This Insane Girl?” the New York Sun asked its readers, hoping to crack the case. Even the stodgy Times took notice. “A Mysterious Waif: Bellevue Shelters a Girl of Whom Nothing Is Known,” it declared, adding, “She gives evidence of both in her speech and manner of good breeding.”
Bly portrayed Bellevue as “the third station on my way to the island”—the boardinghouse and police court being stations one and two. She vividly described the crowded wards, the freezing temperatures, the filthy bedding and moth-eaten clothing. But a careful reading of her exposé showed Bellevue to be more of a clueless institution than a brutal one. The main problem, as Bly saw it, was the failure of its four “Lunacy Examiners” to make an informed diagnosis. “I began to have a smaller regard for the ability of doctors than I ever had before,” she reported. “I felt sure now that no doctor could tell whether people were insane or not, so long as the case was not violent.”
There was one skeptic, however. Unbeknownst to Bly, she had crossed paths in the Insane Pavilion with longtime Bellevue superintendent William B. O’Rourke, who had seen his share of mental illness over the years and was dubious of the fuss surrounding “this girl of whom nothing is known.” Speaking to reporters, O’Rourke branded Bly’s condition “humbug.” He was right, of course, but his remark struck the public as callous and self-serving.
The real focus of Bly’s exposé was the Octagon on Blackwell’s Island—the hidden expanse of sadism and neglect. Under the banner headlines “BEHIND ASYLUM BARS” and “INSIDE THE MADHOUSE,” her articles appeared in back-to-back installments of the World’s new Sunday section, another Pulitzer innovation. Bly spared no details in the telling. “My teeth chattered and my limbs were goose-fleshed and blue with cold,” she wrote at one point. “I got, one after the other, three buckets of water over my head—ice cold water, too—into my eyes, my ears, my nose, and my mouth. I think I experienced the sensation of a drowning person as they dragged me gasping, shivering, and quaking from the tub. For once I did look insane.”
Bly became an overnight celebrity, rewarded with a byline from the World and a handsome check from her publisher. Describing her as “very bright” and “very plucky,” Pulitzer called her work the very essence of the journalism he had in mind. “She thoroughly understands the profession she has chosen,” he beamed. “She has a bright future before her.”
She did, indeed. The World soon demanded an investigation of conditions at the Octagon, and two weeks later a grand jury visited Blackwell’s Island with Bly herself in tow. What they found was a place scrubbed clean of the horrors she so graphically described. The wards were spotless, the attendants were friendly, and the inmates Bly had portrayed in her articles as “appearing sane” had simply vanished—the authorities insisting that no such patients had been treated there. “I had hardly expected the grand jury to sustain me, after they saw everything different from what it had been while I was there,” Bly reported. “Yet they did.”
When the city voted a record-breaking budget increase for the Department of Public Charities and Corrections, which included Bellevue Hospital and the Octagon, Bly naturally took the credit. “I have one consolation,” she wrote of her brief tribulations. “On the strength of my story the committee of appropriations [provided] $1,000,000 more than was ever before given, for the benefit of the insane.”
This wasn’t exactly true. Just before Bly’s exposé appeared, the Board of Estimate had received a budget from the Department of Charities requesting $1.5 million in additional funds for various improvements. And the Board, a few weeks later, had responded more favorably than anyone could have imagined—with Bly’s exposé playing a crucial role. In the end, the city would approve an $850,000 increase for the entire department, not simply for the insane. The Octagon received a $60,000 increase, with Bellevue getting somewhat less. Hype aside, Nellie Bly had modestly served her cause.
For Bellevue, however, great damage had been done. “ALL THE DOCTORS FOOLED,” screamed the headlines. Bly’s dramatic narrative had made no real attempt to separate one stop from another in her ten-day descent into hell. Bellevue and Blackwell’s Island were fused together—two snake pits, equally culpable, equally dark. The stories played perfectly upon Bellevue’s reputation as the Grim Reaper of American hospitals, ignoring its primacy in public health, medical research, nursing care, clinical instruction, and so much more. From this point forward, the name “Bellevue” would be linked, above all, to a particular strand of illness: insanity.
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New York’s fascination with the exposé soon became an obsession. Bellevue’s medical wards may have been for the poorer classes, but the Insane Pavilion had a wider reach. Anyone acting oddly could be sent there involuntarily for observation, making it a human-interest bonanza. A sampling of newspaper headlines in a single year—1897—showed the results:
“Imagines Himself a Mosquito—Now an Inmate at Bellevue”
“Crazed by Smoking: Victim of Cigarettes and Worry Goes Insane, Taken to Bellevue”
“Wealthy Woman Is Insane: Mania for Shopping Lands Her in Bellevue”
“Chased Mother with a Knife: She Escaped…He Was Sent to Bellevue”
“Rich Man’s Son in Insane Ward: Secretly Taken to Bellevue”
“She Raves of a Beast: Sent to Bellevue”
In this new age of muckraking and circulation wars, some stories had a rougher edge. There were reports of dangerous maniacs roaming Bellevue’s halls (“Hospital Patient Slain: Woman in a Straight-Jacket Strangles Another”), staffers snapping under pressure (“Nurse for Insane Goes Crazy Herself”), and botched diagnoses (“Sane Man Held as Crazy at Bellevue”). But the most damaging pieces alleged the sadistic treatment of patients, and no publication took more pride in uncovering it than Pulitzer’s New York World.
In 1900, the paper decided to secretly revisit the Octagon—Nellie Bly Redux. The plan was virtually identical to the one she had employed thirteen years before. A young reporter, Thomas Minnock, would feign insanity, go to police court, fool the doctors at Bellevue, and wind up on Blackwell’s Island. But Minnock never made it that far; the story he found—big enough to dwarf even the Nellie Bly caper—unfolded at Bellevue, where he claimed to have witnessed the murder of an elderly French mental patient at the hands of three sadistic male nurses.
In Minnock’s telling, the three men, enraged by the patient’s refusal to eat, had pummeled him before placing a knotted sheet around his neck. Under the banner headline “SHOCKING BRUTALITY OF MALE NURSES IN INSANE PAVILION AT BELLEVUE,” he wrote: “I was horrified. No big, strong, healthy man could have lived under that awful strangling. The patient was weak and feeble.”
Murder charges followed. The trial judge had to change courtrooms to accommodate the overflow crowds. In his opening remarks, the prosecutor called the crime “the most terrible treatment that was ever given to an insane man,” adding: “No writer of fiction could have put them in a book. They would appear so improbable and monstrous that his manuscript would have been rejected as soon as offered to a publisher.” The press dubbed it “The Case of the Garroted Frenchman.”
The trial grew wilder by the day. The prosecution’s only witnesses beyond Thomas Minnock were two Bellevue mental patients who claimed to have seen the assault. While acknowledging that New York state had never before allowed an “admittedly insane” person to testify under oath in a criminal proceeding, the judge swore them in anyway, ruling that “in a lunatic asylum, the patients are often the only witnesses to outrages upon themselves and others.”
Under cro
ss-examination, both witnesses were pressed about their mental conditions. “Why did you go to Bellevue?” the defense lawyer asked the first man. “Why, because I was crazy,” came the reply. “What cause did your wife have to put you in an asylum?” the lawyer asked the second man. “That’s a personal matter,” the witness replied, “and I decline to answer.” The judge dutifully entered both diagnoses into the record: paranoia and dementia.
Still, the evidence seemed compelling. The coroner’s report spoke of an apparent strangling, and the key witness in the case, reporter Thomas Minnock, could hardly be accused of insanity. Well-spoken and college-educated, a rarity in this era, he had the press solidly on his side.
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Minnock’s story had opened a window into a little-known aspect of hospital care: the role of the male nurse. The Victorian world of late-nineteenth-century America placed a premium on sexual modesty. Even a progressive thinker like Bellevue’s Abraham Jacobi, the father of American pediatrics, believed that some hospital procedures offended both a female nurse’s “sense of chastity” and a male patient’s “sense of decency.” Furthermore, certain parts of Bellevue, including the Insane Pavilion, were said to require a strong male presence to maintain physical order. The best solution, it appeared, was to open a training school for male nurses.
Bellevue did just that in 1887 with a gift from Darius Ogden Mills, a prominent philanthropist, but the school faced problems from the start. Recruitment lagged; the stigma of men working in a female profession took an obvious toll. Applications to the Mills School were never very high, and those who came rarely stayed for long. Some simply quit; others were expelled for a long list of personal failings: “too nervous,” “too childish,” “too slow,” “dishonest,” “neglect of duty,” “insubordinate,” “disobedient,” “intoxication,” “cocaine,” “an uncontrollable temper.” One student was “unable to stand the odor of ether,” another was described as looking “too much like a colored man.” Those who graduated, however, found quick employment in the male wards at Bellevue and other institutions.
The three nurses on trial were Mills graduates. They claimed that the Frenchman’s death had been unavoidable—“a wild melee by a crazy man.” The patient had become violent, they said, sprinting down the hall and crashing into tables before striking his head on the floor. One nurse had put his knee on the patient’s chest to restrain him. The other two had picked him up and put him in bed, where he died in his sleep.
Fearing for the school’s future, Darius Ogden Mills hired one of New York’s top attorneys, Francis Lewis Wellman, to defend the nurses in court. A master of cross-examination, Wellman got Minnock to admit that he had lied freely about his past, written stories for other newspapers that turned out to be untrue, and placed himself at events he had never, in fact, attended. Minnock left the witness stand in tears. The nurses were acquitted.
The verdict, however, did little to build confidence in the Mills School. The Bellevue superintendent publicly complained that too many of the students were “rough, unkind, dishonest, addicted to the use of alcohol, or neglectful.” He personally thought them more trouble than they were worth. Then, in 1909, came the final indignity: a male patient at Bellevue accused a Mills trainee of “unnatural advances and acts,” leading to the young man’s “resignation.” The incident triggered a chaotic student meeting at which charges of “effeminate practices” flew back and forth. And that led the trustees to hold closed-door hearings of their own.
Minutes taken but never released showed a variety of student “confessions”—one admitting to an affair with a man he “loved very much.” A trustee privately described his colleagues as “ready to puke.” “The details of the investigation are of such a nature that I do not think you would care to hear them,” he wrote New York’s mayor William Jay Gaynor, adding: “The evil appears to have been pretty well eradicated.”
Twenty-seven of the sixty-five students at Mills either resigned or were dismissed. The official who ran the day-to-day operations was discharged “on grounds of economy.” And there was talk of closing down the school. “Nursing is essentially a woman’s work,” a trustee argued. “[It] is very closely allied to the domestic life and the more nearly we approach the domestic and home atmosphere in our hospital wards, the better the results for us all.” The director of the Insane Pavilion went a step further. “The average man does not select the profession of nurse,” he declared, “unless there is something wrong with him.”
Darius Ogden Mills lived just long enough to learn of the accusations. He had recently agreed to donate four building lots near Bellevue for a new men’s dormitory. At his death, his family members voted with the other trustees to graduate the remaining students and accept no more. As a substitute, Bellevue agreed to recruit and train a group of male “attendants” for tasks that men might do more effectively than women. The trustees were quite specific about what they had in mind: “the care of alcoholics, the insane,” and men with “rectal” diseases.
Fortunately for Bellevue, the details of the Mills episode were never released. But the previous decades had been extremely unkind to its image—the Bly exposé and the Minnock spectacle serving as bookends to a relentless flogging in the press. Fairly or not, America’s largest hospital entered the twentieth century under a pile of bad news, shaken by charges of brutality, incompetence, and neglect.
13
THE NEW METROPOLIS
We cannot have too much of New York City,” a local politician boasted near the turn of the twentieth century, and it was easy to see why. Hard times had passed. The brutal depression of 1893 had run its course. New York was on the move, with a robust economy, record-breaking immigration, and the merger of Brooklyn, Manhattan, Queens, the Bronx, and Staten Island into a single behemoth of 303 square miles and 3,437,000 people. Massive construction defined its frenetic pace—a subway system; enormous bridges connecting the boroughs; elegant hotels, museums, athletic venues, railroad stations, and boulevards. New York now ranked second to London in population among Western cities, having overtaken Berlin, Paris, and Vienna. Once mocked by the caustic Washington Irving as a vast wasteland called “Gotham,” it entered the new century at a pace unrivaled in the world.
The city’s look was molded in no small part by the architectural firm of Charles McKim, William Mead, and Stanford White. A survey of its work would include Gilded Age masterpieces like Pennsylvania Station, the old Madison Square Garden, the Columbia University campus, the ultraexclusive Harvard and Century Clubs, the north and south wings of the Metropolitan Museum of Art, and the iconic Washington Square Arch. In 1902, however, the city paid McKim, Mead & White a $75,000 retainer for a master plan that caught many by surprise: a new hospital complex on the Bellevue grounds. The firm had no track record in that field, after all, and Bellevue seemed an odd choice for an elaborate makeover. The plan called for the demolition and replacement of the current buildings at a huge price. “COST OF NEW BELLEVUE WILL BE $11,000,000,” the Times declared. “World’s Greatest Hospital Will Shelter 3,000 Patients—To Cover Three City Blocks.”
The initial design was stunning. By 1900, Manhattan’s better hospitals had moved north to larger plots in less congested neighborhoods. Bellevue, though, had stayed put. The master plan envisioned a phalanx of brick-and-granite structures surrounding an Administration Building with an elegant glass dome atop a marble rotunda—not unlike the one in Penn Station. All construction north of the rotunda (the uptown side) would be for “surgical use,” and south of it (the downtown side) for “medical use.” The wards facing east (the river) would house patients “undergoing continued treatment,” while those looking west (First Avenue) would contain the units for short-termers, including alcoholics and the mentally ill.
The plan included a gymnasium, tennis courts, and a swimming pool to keep the doctors in “good health.” There would be Corinthian columns, marble floors, and winding staircases with wrought iron railings in the public areas; imposing
fireplaces and oak-paneled libraries in the living quarters for house officers. Each ward had a full-length balcony for patients (often with tuberculosis) to catch the fresh river breezes. Medical waste would be channeled through a series of pneumatic tubes to a proposed crematory. The new morgue contained a 240-body cold storage unit, with more space for “the public inspection of the unidentified dead.”
The internal memos of McKim, Mead & White show a firm determined to win the final bid—and socially positioned to get it. “Dear Charlie,” Stanford White wrote his partner in 1904. “Do you think it advisable to pull any wires with Tammany on the hospital? I am sure…we could get hosts of help if you thought it best to make a fight.” McKim told him not to worry: all was going well. “Dear Stanford,” he replied. “As we are on the best terms with the trustees of the hospital, it would be most unfortunate to risk any disturbance.” Should “the situation alter,” McKim added, there’d be “time enough to call to our aid the men you speak of.”
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Why the sudden interest in upgrading a public hospital that had been neglected for decades? It was no accident that calls for change had resounded during the sensational trial of the three male nurses in 1901. “Grand Jury Denounces Bellevue Management,” read a typical headline feeding the flames. As a result, Mayor Seth Low, an anti-Tammany progressive, had replaced the patronage-driven Board of Charities and Corrections with the newly created Department of Bellevue and Allied Hospitals, run by seven unpaid trustees from the city’s medical and civic ranks. It was, observers noted, about as decent a body as New York could muster. And among its top priorities were the expansion and makeover of the city’s flagship hospital.
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