Sunday, May 27, 2012

Riverside Hospital New York City North Brother Island

By Jacob A. Riis

Landing Stage and Hospital at North Brother Island
Along way up the East river, er­roneously so called, since it is not a river at all, beyond the sunken meadow where the burning Seawanhaka was beached with her cargo of perishing hu­man freight, three islands block the chan­nel that winds past the forts to the Sound. Two are barren wastes of bayweed and sand. The third juts into the channel with grass-grown bluff. Great boulders, washed by every tide, lie at its base. Upon its brow stands a lighthouse with a big fog bell in its white tower against a back­ground of green trees. The fishing boats that dot the channel keep to the windward of the island. Passengers on the decks of the big outgoing Sound steamers watch the sunset glow in the myriad windows of a group of red brick buildings on its shore, wondering what they may be, while the city's spires fade away in the distance. Presently three shrill blasts are sounded from a steamer's whistle, and at the signal, as the boat shoots behind the point, a knot of men carrying a stretcher between them are seen making their way down to the landing.

The men are orderlies from the small­pox hospital. The three blasts were sounded by the Health department's steamer coming up from the city, to tell them what it had on board. It is the official language of North Brother Island, varied to suit the particular pestilence of the trip. Two long blasts would have spelled scarlet fever; four, measles. The signal most dreaded - the long and short limp that stands for typhus fever - has been the one most frequently heard this year, and since the near shore first gave back its echoes a little graveyard that was not there before, has grown in a quiet corner of the island. For this is New York's pesthouse, better known, happily, to our day and our city by a better name: the Riverside hospital.

The bad old name that held such terror for countless thousands is set down here, not that it may be remembered, but that it may be once for all disowned and robbed of its power for evil. Time was when there was indeed a pesthouse on North Brother Island. That was in the days when Morrisania was a village not yet annexed to New York and got rid of its smallpox patients by ferrying them across the channel to the then desert island, by turns a plague-spot and a picnic ground in those times, and practically packing them off on another county in doing so.

Samllpox ferry, Franklin Edson
The jurisdiction of the island was in Queens. New York, when she took pos­session and laid down the lines of the far­sighted policy that has put our city today far in the lead of the municipalities of the world in this one respect of managing pestilent diseases, if in no other, had the grace, as a first step, to get the county lines rearranged so that the island passed under her political jurisdiction as well as into her practical keeping.

In the years that have passed since, a marvelous change has come over North Brother. South Brother, that rears its bald back just beyond, within range of the rays from the lighthouse lamp, but across the present county line, shows what it was. Today, where once was a waste of sand, are broad and shaded lawns; winding, well-kept walks, trees, shrubs and flowers; handsome, substantial build­ings and hospital pavilions or wards, ar­ranged on a plan securing perfect and ab­solute isolation with a maximum of com­fort to the patients. One result is seen in a very low death rate, considering the character of the institution. Last year, before the importation of typhus fever in the shipload of Russian exiles, it was six­teen per cent of about 900 cases.

Another result that is of even more con­sequence is in the lessened terror of the hospital among the poor and ignorant. This dread, that robbed those who stood in direst need of the benefit designed for their relief, has always been one of the greatest hardships of the poor. The mis­erable old lie about the “black bottle," out of which patients who could not re­cover were given a poison draught, has troubled a suffering world since Chris­tian charity founded its first infirmary, and is not dead yet in New York any more than it is among the poor of the old-world cities. It was only the other day that a juror at an inquest in Brooklyn put the question seriously to the coroner whether such a bottle was really kept at the hospital then in question. But such scenes as are almost daily witnessed at the Riverside hospital when the restored patients, on the eve of their return to the city and to life, crowd around their nurse, kissing her hands and feet, will go far to doing it to death at last. Last winter an Italian mother who had led the police a three weeks' chase through the tenements with her sick babe scattering the smallpox contagion right and left, turned up unex­pectedly with the child at Doctor Edson's office in Mulberry Street. The seed she sowed had had time to sprout, and the health officers, though she eluded their grasp, had come upon enough of her vic­tims and sent them to the island, where their friends had visited them. It was their report of what they saw there, as compared with the tenements they called home, that had changed her mind.

"Here he is," she said, taking her baby to the doctor, "if that is the way with you, take him!" And the core of that fell scourge was reached at last.

Samllpox Pavilion at Riverside Hospital
The old pesthouse is still there, but even that has lost its terror. Become a harm­less measles pavilion, it stands upon the northeast shore of the island at one end of a half circle of one-story frame build­ings, seven in number now, but so planned as to be capable of indefinite extension as the needs of the growing city may de­mand. Indefinite, that is, until the island is filled up; but that time is not expected to come while this generation has a live interest in smallpox and measles. The island itself has grown under the hands of the builders. Low places have been filled in, the half-score acres of avail­able ground have become thirteen, and in place of the sandy beach, of which the winter storms claimed their share year by year, has come a strong sea wall against which the breakers rage in vain. Secure behind this strong barrier the substantial buildings laugh at wintry blasts, and the young trees bend before them, know­ing that springtime will come. There were doubting Thomases enough to pre­dict the failure of the attempt to make a garden of the sandy island when they were set out. But the event has more than justified the confidence of the gar­dener who offered to forfeit twenty-five cents for each tree that died, if one cent were allowed him for each that lived. Not one has been lost. Today spring seems to come earlier here; certainly the grass is green and the flowering shrubs are in bud before even the small boy has heralded its approach with his hoop and his marbles in the stony streets across the river. It may be the sea air that does it, or a kindly desire on the part of nature to soothe the misery of which the island gets more than its share, If so, she has done well. Certainly, on a mild, sunshiny day, in its spring dress of tender green, the island is the very ideal of the restfulness and peace that go a long way toward mak­ing whole a soul and body racked by the pain of a long sickbed.

Miss Kate Holden
The frame buildings are the fever wards. They are not conspicuous as the island is seen from the passing steamers, from the deck of which most New Yorkers get their only view of it, barring those that are tak­en there against their desire; but these are not given much to travelling. The great mass of them come from the tenements of the poor, where our city's epidemics are hatched. Scar­let fever and mea­sles claim most of the pavilions in times of compara­tive peace.  This year the typhus fever has invaded them. In the sud­den rush their ca­pacity was quite ex­hausted, and a camp of tents was pitched on the lawn to shel­ter the overflow. It was while the weather was yet cold, and a cry went up against the sup­posed outrage. As a matter of fact these tents have board floors and a stove that make them very comfortable abodes and much pref­erable in the eyes of the physicians to the wooden houses, partly because the venti­lation in them is perfect, partly because not much is lost in destroying them when the scourge has had its day. Even the pavilions are built on the modern hos­pital plan with this end in view. It is the easiest way to get rid of a malig­nant contagion. Flame is a great pu­rifier. Still, one hesitates to burn up a house, while a tent is touched off without a pang.

Evidently the smallpox does not rate as high on North Brother isl­and as it did with our fathers, for the building set apart for its exclusive oc­cupancy is certain­ly not intended to be burned upon any pretext. It is the one large, almost im­posing hospital structure on the island. Standing next the steamboat pier over against the north shore, its red brick front suggests a roomy schoolhouse with big playrooms for romping children.

Scarlet Fever Ward at Riverside Hospital
The rooms are there, and sometimes, as during the recent outbreak of the small­pox when there were many convalescent little ones, they are that in fact; but most of the time they are quiet enough. Small­pox has been a rare disease in New York in the last ten years. No single case has been hatched here. But when a romp is on there is no lack of opportunity. The nurses are glad of the chance in dull times, and the charity of children's friends in the city has supplied toys of all sorts and in generous measure, from sheep that baa when their noses are pulled - sure cure for scarlet fever - to scups and swings and gorgeous railroad trains of painted tin, condemned to run ever in a circle under the quarantine regulations of the island that prescribe the limits between wards, which none of its imitates may overstep. For this reason also the woolly sheep are assigned to perpetual pasture in the lot once set apart for them. Even the aristo­cratic doll in the blue sash and demitrain is not allowed to visit front ward to ward, or the old-woman-who-lived-in-a-shoe to go gossiping among neighbors. The only person on the island besides the doctor to whom this privilege is granted is the rub­ber doll, and the etiquette of the island demands that she take oft' her woolen jacket and submit to a scrubbing before she crosses the line. Even then she cannot take her only garment with her.

In spite of those drawbacks, the conva­lescent children manage to make the most out of' life on the island. It is not a rare thing - I myself have witnessed it once - to see a little one, that came thither to die, kick and scream with all his might in the arms of the nurse against being carried to the steamer that is to take him back to home and friends, and stand wailing at the rail of the boat, an unwilling captive, un­til it sails out of sound and sight. It is an episode the merit of thick lies in the application of it - to the tenement or to the hospital. In any event the compar­ison is in favor of the latter: which, if not always saying much, is, as I have pointed out, doing the poor the greatest service that could be done them at the time when it is most needed.

Fever corner of North Brother Island
These children are the only picnickers on the island nowadays. The others long since ceased to come and the light-housekeeper's wife lost a source of profit as well as the freedom of the island. Only the little green plot upon which the lighthouse stands is her own and Uncle Sam's. Callers are infrequent. All travel to and from North Brother Island is re­stricted to two routes, that by the depart­ment steamer from the reception hospital at Sixteenth Street, which is preempted for the sick, and the other via the 138th street ferry. This latter line is rep­resented by a single yawl propelled by a sphinx-like boatman who answers calls on the drum telephone at the shore end of the ferry. On visiting days, twice a week, a few scattered callers come some­times to see friends in the hospital. With the exception of an occasional inspector of the Health department, these are the only new faces ever seen on the island —literally faces only, for no visitor is permitted to go far beyond the ferry dock without having enveloped him or herself in the ugly Mother Hubbard gown and high rubber overshoes that are the uni­form of the island, worn always in the sick wards.

Though the island is connected with the city by cable and telephone the little hos­pital staff of nurses spend their lives there in virtual banishment from the world. It has happened that a whole winter has passed without any one of them crossing over to the mainland. The doctor may travel on the steamer, and does when he has time, but the nurses not. Their duty is on the island and there is always enough for them to do; for whether there be two or twenty patients in a pavilion they must have their own nurse. No other will do lest the pests get mixed up and the end become worse than the beginning. There are six women nurses, young girls all of them, who with rare devotion and courage have put away from them all that makes life sweet and taken upon them this dan­gerous duty. Their chief is the matron, Miss Kate Holden, who for ten long years has led this life of solitude and sacrifice. She is a southern girl whose people lost their all in defense of the Lost Cause - so the tradition of the department runs. It was little less than a lost cause she es­poused when, having finished her course in the Charity Hospital training school, she offered herself to the Board of Health. A typhus outbreak had then decimated the staff of the old Riverside hospital on Blackwell's island and the authorities were at their wits end where to get other nurses. They looked aghast at this frail young girl and asked her, almost harshly, if she knew that she was courting almost certain death. She replied calmly that she knew; it was her chosen work. So they took her, and the doctors soon learned to trust her as their chief support in the unequal fight. Before it was won she too succumbed, and for weeks the city across the river, that had heard the story of her devotion and her suffering, listened anxiously day by day to the bulletins from her sickbed. She recovered and was made matron in the course of years at the munificent salary of sixty dollars a month. Ever since, she has been the mainstay and guardian angel of the island, coup­ling with her duties as matron and nurse now those of hospital apothecary as well. Having passed the requisite examination she has been duly commissioned to mix the medicines as well as to care for the sick. No black-bottle poison draught has ever issued forth from her little drug shop. When, last February, in a single day fifty-seven Russian exiles were found in half a dozen lodging houses suffering from typhus fever and were packed off to River­side hospital, followed by a procession that swelled their number to 100 before the week had passed, Miss Holden spent forty hours among them, without sleep and almost without food, arranging, soothing and cutting the hair from their fevered brows, until, literally worn out, she had to be carried to her bed.

Microbe crematory at Riverside Hospital
In the hallway of the administration building, the ivy-covered brick cottage in the middle of the island, a bronze tablet, set in the wall, tells of the death of Doctor Armistead Randolph Mott, resi­dent physician, "in the discharge of his duty," during the typhus epidemic that preceded this last outbreak. The nurses pass it daily on their way from their pret­ty rooms upstairs. They have a library there, given by thoughtful friends, and even a music room that is evidently not neglected under the pressure of life's sterner cares. They cross the threshold of this their refuge only to take up their never-ceasing round of duties. The rooms of the physician in charge, the autocrat of the island, are on the main floor. His little principality embraces two score sub­jects, male nurses, helpers and attend­ants of all kinds. His rule extends to the boiler house next door, where the steam is generated that heats all the hospital build­ings, and whence the very complete fire-extinguishing apparatus of the island is directed in time of need. At the door of the kitchen, in the building on the other side, it stops short. There the matron takes charge, weighs out all the groceries, and sees the food for the sick and the well-cooked. It is the very best that can be bought for money, though none is asked or exacted for it. Any patient who can afford it, and so wishes, can pay for his board, but he gets the same as all the rest. Champagne is frequently on the doctor's prescription and may be said to be an item of steady diet on the island, though served neither on ice nor by the small bottle. A pay pavilion is in the plan of the hospital plant, but so far is only yet on paper. The general government is the only paying customer of the department. It sends the cases of scarlet fever and measles that reach quarantine to River­side, paying a fixed sum for their care. Yellow Jack and cholera it deals with at quarantine itself. Its diphtheria patients go to the Willard Parker hospital, in Six­teenth Street, where the Health depart­ment keeps its own as well. Diphtheria, unless complicated with other diseases, is not admitted to the island.

Upon the main shore also are the disin­fecting furnaces or crematories, through which all infected clothing must pass be­fore readmitted into the community as safe. The clothing of typhus fever pa­tients never returns. It is fed to the flames as the surest way of rendering it harmless.

Of sorrow and suffering the island has enough. It has had its modest romance too. Love that laughs at locksmiths crossed even the smallpox ferry. There has been courtship and taking in mar­riage. Children have been born there. The three little ones of orderly Richard O'Toole are natives of the hospital island. Curiously enough, none of them has ever had any of the contagious diseases that are rampant there, while their father has had them all. It has come to be a proverb in the department that nothing can kill O'Toole. The mother, too, is employed on the island.

Russian typhus subject at North Brother Island
As an institution North Brother island is unique. There is nothing like it anywhere in the world. In the great cities of Europe they have floating hospitals for smallpox, and more or less perfectly isolated "contagious wards" in their ordi­nary hospitals. The isolation secured in New York is absolute. It must ever be the chief defense of our city against this enemy that is forever knocking. Disin­fecting in tenement houses is good as far as it goes; quarantine better, but in such localities next to impossible. Summary removal of the patient removes at once also the danger of further infection. The power to effect it is vested in the health officers. Of how great importance this is in a city constantly exposed, as New York is, to the importation of pestilence by sea and land, and where the packing of the pop­ulation in the poor quarters is wholly un­precedented, with consequent conditions most favorable to the spread of a plague, was shown in the last outbreak of typhus fever among Russian immigrants who had passed through quarantine unchallenged. But for the Riverside hospital, as the strongest link in a splendidly organized sanitary service, a disastrous epidemic could not have been averted. The cost of such a preventive is not to be considered for a moment, were it three times the $50,000 Riverside costs a year. That sum, doubled and trebled many times over, would not have made up to New York as the commercial metropolis of the western world the losses she would have suffered from one bad epidemic, leaving the waste of life entirely out of the reckoning.

Originally printed in Cosmopolitan Magazine in July of 1902.

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