A VISION OF HOPE: The 200-Year History of the New York Eye and Ear Infirmary 1820-2020

CHAPTER 1

1820-1865

"SO WIDE A FIELD OF USEFULNESS"

“It was here [at the London Dispensary for Curing Diseases of the Ear and Eye] that Dr. Rodgers, Dr. Edward Reynolds, of Boston, and the writer of these pages, first learned their own ignorance of these diseases, and seized the opportunity of studying a subject which opened to them so wide a field of usefulness.”

—Dr. Edward Delafield

The Future Coming into View

The year was 1818 and two young medical men, Dr. Edward Delafield, age 22, and Dr. John Kearny Rodgers, age 23, stepped onto the New York harbor dock after an arduous transatlantic crossing from Great Britain. Happy to be home, the arrivals were poised to begin the next phase of their medical careers. Two years prior, following their graduations from the New York College of Physicians and Surgeons, Delafield and Rodgers had been eager to deepen their professional understanding and sailed to London with the express intention of matriculating at the Guy’s and St. Thomas’ Hospital, one of Europe’s most prestigious centers of medical knowledge.

As Delafield’s and Rodgers’s carriages zigzagged their way through New York’s bustling thoroughfares to their respective homes, much looked and smelled familiar. New York’s population was approaching 124,000 and the city was already becoming a “great and growing capital,” eclipsing, some said, Boston and Philadelphia. Horse-drawn wagons, carriages, and pushcarts competed for the right-of-way in the unpaved and often-muddy streets. A medley of buildings—some shabby, wooden, and fire-prone, others of stately, solid masonry—met the eye, depending on the route. Commerce ruled and the thrum of business kept the docks, factories, shopkeepers, and workers buzzing. Civic-minded citizens, religious reformers, and upper-class philanthropists, men and women alike, sought to temper the city’s mercantile reputation with cultural activities, practical and social improvements, and goodwill. The numbers of newspapers, booksellers, bustling reading rooms, refined eateries, theaters, parks, and literary societies were expanding at a bewildering rate, as were organizations promoting religious and moral reforms, women’s rights, charitable giving, and medical and scientific progress.

A belief that change for the better was possible drove their energetic endeavors. But so did the darker realities of New York City life. Absent a municipal sewage system, the fetid stench of human and animal waste hung in the dusty, ash-polluted air. Decaying carcasses of dogs and cats often remained by the roadside for days or weeks, with no dependable trash collection to remove them. Rats ran largely unchecked. Less obvious at first glance were rising ethnic and racial tensions, rousing Abolitionist meetings, persistent labor strikes, abhorrent working conditions, rampant social displacement, soaring crime rates, and abject destitution. Ever-lurking, too, were the grave threats of epidemics, disease, and infection.

At the time, most affluent New Yorkers in poor health received treatment and surgery at home. The indigent were left to seek help where they could find it, often in an almshouse. Organized efforts for the public good targeted the health and well-being of the poor, such as the Relief of Poor Widows with Small Children, the New York House of Refuge, and the Humane Society, to name three of many. But these, as well as other stopgap measures, did little to staunch the appalling lack of institutional health care. The New York Dispensary, founded by concerned members of the city’s Medical Society in 1791, was perpetually inundated by the needy, as was the New York Hospital. Originally founded in 1770, New York Hospital had been shuttered by fire soon thereafter and remained closed until 1791, when the institution was designated as “the public hospital” and mandated to care for the “respectable poor.” Roughly 25 years later, it was there that Delafield and Rodgers had received much of their early doctoring experience.

By 1818, when Delafield and Rodgers returned to New York, the city’s medical landscape was also beginning to change. In addition to the New York Hospital, Bellevue Hospital, dedicated in 1816, was the city’s only other major medical facility, if one of last resort, for those deemed “dangerous or morally reprehensible.” But during this era of successive epidemics, many impoverished patients of good character ended up there, too, in part because New York Hospital began turning patients away to reduce overcrowding and mortality rates. As the only alternative, Bellevue’s patient population soared at a frightening rate, its wards overflowing with patients who were disproportionately chronically, contagiously, or terminally ill.

Grim as these conditions were, it is unlikely they were top of mind for Delafield or Rodgers, who arrived home filled with optimism and ambitious plans. Their 2-year tenure at Guy’s and St. Thomas’ Hospital and, almost more importantly, at the London Dispensary for Curing Diseases of the Ear and Eye, had exposed significant gaps in their New York College of Physicians and Surgeons training. The College’s shortcomings were attributable to several reasons. Even in the best of times, the flow of advancing medical and scientific ideas from Europe to America was glacial. The Napoleonic Wars and the War of 1812 both disrupted whatever trickle there was. Moreover, the College trained generalists; subspecialties were yet to be recognized or formally practiced.

However, that the College’s curriculum failed to include any instruction related to eye anatomy, pathology, or therapeutics was hardly unusual. With little or no training or experience, most surgeons tended to shy away from highly technical and risky ocular procedures, given their high rates of infection and low rates of success. Consequently, the treatment of eye ailments routinely fell to “oculists,” who were untrained, unlicensed, lay practitioners touting cures utilizing “certain mechanical appliances” or “prescribing patent medicines of their own making.” Even Delafield, in one of his later speeches, called attention to a celebrated quack who “. . . pretended to possess the secret of ‘drawing off the effete and turbid humors of the eyes of old people and replacing them with fresh and youthful fluids.’”

For Delafield and Rodgers, the London Dispensary for Curing Diseases of the Ear and Eye was the ideal incubator for nurturing new ideas, clinical experiences, and inspiration. Not a day was wasted under the tutelage of Sir William Lawrence, Dr. Benjamin Travers, Dr. John Richard Farre, and Sir Astley Cooper. Delafield later recalled, referring to himself and Rodgers in the third person, “The thought flashed upon them that here was an open field in which they might work, an almost untrodden path in which they might walk, and in the ardor of youth, they devoted themselves to this new branch of knowledge.”

Pursuing A Compassionate Mission

Back on their home turf, Delafield and Rodgers conducted a groundbreaking survey to assess where and from whom “feeble” New Yorkers suffering from eye diseases received care. The results were hardly surprising. Because the New York Hospital routinely turned away those seeking care for blindness or other eye pathologies, they found that Bellevue became the default option for warehousing not just criminals and “paupers” but also a significant number of the “useful class” whose vision deficits rendered them unfit to work. Formerly, many had been productive men and women of meager means who simply could not afford competent medical advice and were too prideful or independent to apply for aid from a hospital or dispensary. Why, Delafield and Rodgers asked, must these formerly industrious patients fall through the cracks?

Based on these results, Delafield and Rodgers proposed a threefold opportunity. Establishing a medical organization devoted exclusively to treating the poor with eye ailments, they proposed, would “serve the interests of humanity.” Doing so, they reasoned, also might enable more of the afflicted to return to work, thereby reducing their dependency on public support. And not least, an ophthalmic clinic would provide a venue where inquisitive surgeons could learn new techniques and treatments related to eye diseases, as well as provide a collection point for much-needed data on the emerging field of ophthalmology.

Compelling as these benefits sounded to the two young surgeons, neither the New York City authorities nor the medical profession warmed to their proposition. Undeterred, Delafield and Rodgers decided to take matters into their own hands and prove the worthiness of their ideas, pledging that before soliciting public assistance a second time, they would start a fledgling clinic and expand their private medical practices to fund their dream.

A First Home

Public notices were circulated city-wide announcing the August 14, 1820, opening of the New York Eye Infirmary, located at 45 Chatham Square, now Park Row, diagonally across from City Hall. That the first permanent eye hospital in the Western Hemisphere began in a two-room rented suite on the second floor of an unassuming brick house is hard to imagine. Yet modest though the clinic was, the founders’ intentions stated on the handbill were anything but: “The primary object in establishing the New York Eye Infirmary was to contribute toward the relief of the poor who, by a diseased state of one of the most important organs of the human body, are deprived of the means of gaining a livelihood.”

As the story goes, the first officially registered patient was a young man suffering with a fistula of the lacrimal sac who, for undisclosed reasons, disappeared before he could be treated. Not the auspicious beginning Delafield and Rodgers had hoped for. But from that patient forward, word of the Infirmary’s free care and medicines spread quickly. Within a short time, an ever-increasing surge of needy patients began to pass through the Infirmary’s doors every Monday, Wednesday, and Friday from 12:00 to 1:00 pm. So many prospective patients visited that the building’s landlord was soon recruited to become the clinic’s superintendent, in charge of keeping order in the cramped waiting area. The only trained surgeons on the staff, Delafield and Rodgers, saw patients back to back, prescribing treatments compounded by a handful of medical students enlisted from the College of Physicians and Surgeons who were trained in the apothecary arts. By the end of the clinic’s first 7 months, even with this skeleton crew and restricted hours, 436 patients had been treated. Among them were three patients, “born blind,” possibly with congenital cataracts, whose sight had been restored by what may have been the first successful cases of cataract needling in America.

Yet as gratifying as the Infirmary’s success was, it was also financially worrisome. Clearly, the swelling demand for services was outstripping the clinic’s resources and draining the founders’ pocketbooks. Securing outside funding was the logical solution. At the urging of Drs. Samuel Borrowe and Wright Post, Delafield and Rodgers’s respective mentors, a public meeting was convened to pursue the idea on March 9, 1821, in a free assembly room donated by the City Hotel, “long remembered for the excellence and variety of its wine cellar.”

Among the many prominent attendees were Dr. David Hosack; Philip Hone, soon to become the “gentleman mayor of New York”; and Benjamin Strong, president of the New York Sugar Refining Company and one of the founders of the first Bank for Savings in New York. A committee to draw up a set of institutional bylaws was formed, anchored by Colonel William Few, a cosigner of the U.S. Constitution, founder of the University of Georgia, and Delafield’s commander in the Georgia State Militia during the Revolutionary War. By April 21, 1821, the Board of Directors, known as “The Society of the New York Eye and Ear Infirmary,” was established. Two hundred members signed on and elected Colonel Few its first President.

According to the Society’s by-laws, an individual could become a Governor for Life by donating at least $40, which entitled him to free treatment for two patients at any time, for life. The same privileges applied to an annual subscription of $5.00, but only for as long as the contribution fee was paid. An annual subscription of $3.00 allowed a donor free treatment for one patient at any one time. A strict set of rules governing the Society and the comportment of its staff and officers was put into place, with its two surgeons and two consulting surgeons, as well as its officers, held to the highest standards of behavior. Should an individual or his duties prove unfit, formal consequences were to be imposed. With the Society established, the charity was officially incorporated as “The New York Eye Infirmary” by the New York State Legislature on March 22, 1822. Even though the enterprise had been treating patients with diseases of the ear, recorded as “anomalous diseases,” since its inception, it was known as the New York Eye Infirmary for the next 42 years, until the name was officially changed to The New York Eye and Ear Infirmary (NYEE) in 1864.