Stephen Smith, MD, New York Pioneer of Public Health

by Paul Theerman, Director

At its Annual Meeting of the Fellows, November 12, 2020, The New York Academy of Medicine is presenting the Stephen Smith Medal for Distinguished Contributions in Public Health to the Honorable Andrew M. Cuomo, Governor of the State New York. The following appreciation of Smith is based on an exhibit that Historical Collections Librarian Arlene Shaner created in 2005 when the award was established.

Dr. Stephen Smith (1823–1922), Academy Fellow for 68 years, had a career as a Bellevue Hospital surgeon and a professor of surgery and anatomy at Bellevue Hospital Medical College and New York University. He wrote a field manual for Civil War army surgeons, was Health Commissioner of New York from 1868 to 1875, and was a founder of the American Public Health Association and its first president. Through his work the condition of the city, the state, and the nation markedly improved by the application of public health regulations for the common good.

Stephen Smith, MD, n.d. NYAM Library Carte-de-visite collection, http://dcmny.org/islandora/object/nyam%3A1012.

Stephen Smith was born on a farm in Skaneateles, New York, on February 19, 1823, the son of a cavalry officer in the Revolutionary War and his wife. [1] He first studied medicine at Geneva Medical College, where a fellow student was Elizabeth Blackwell, the first woman medical school graduate in the United States. He left Geneva for Buffalo Medical College and then relocated to New York City, where he finally received his medical degree from the College of Physicians and Surgeons in 1850. Smith completed his residency at Bellevue Hospital and became an attending surgeon there in 1854; the following year he was elected a NYAM Fellow. He served on the faculty of Bellevue Hospital Medical College from its founding in 1861 until 1874, when he joined the faculty in the medical department of New York University.

In addition to his work as a practicing physician and surgeon, Smith shared the editorial responsibilities for the New York Journal of Medicine with NYAM luminary Dr. Samuel Smith Purple and assumed the editorship completely when Purple retired in 1857. The journal changed its name to the American Medical Times three years later, and Smith continued as its editor until 1864. [2]

Mid-nineteenth-century New York City was subject to recurring outbreaks of deadly diseases. As Smith later proclaimed, “The unsanitary condition of the city prior to 1866 cannot be described so that an audience of today can fully appreciate the reality. Nuisances dangerous to life and detrimental to health existed everywhere.” [3] Smith used his investigative skill and editorial position to campaign for wide-ranging reforms, including sanitary inspections, street cleaning, garbage collection, and the regulation of tenement housing and slaughterhouses.

Stephen Smith. The City That Was (New York: Frank Allaben, 1911, frontispiece.

“[Smith] had no law on his side to begin with and he made his fight by publicity. He traced twenty individual typhus cases to one house in East Twentieth Street, which he found full of immigrant families suffering from typhus. Through the tax records he reached the owner, a wealthy and prominent man who flatly refused to do anything about it. Dr. Smith looked up the law and found that there was no way to proceed against the owner. He then went to William Cullen Bryant, then the editor of The New York Evening Post. ‘At the suggestion of Mr. Bryant,’ said Dr. Smith, ‘I finally succeeded in bringing the owner of the fever nest into court on the change of maintaining a nuisance. Bryant’s reporter, who had been instructed, so frightened the owner that he promised to close and repair the house if only the matter were kept out of the papers. Bryant agreed and the owner kept his promise.’” [3]

Smith’s work led to the noted Citizens’ Association 1865 investigation and report on sanitary conditions in the city [4] and the passage of the 1866 Metropolitan Health Law. He was appointed one of New York City’s first health commissioners, serving until 1875.

Once the Metropolitan Board of Health had been established, Smith argued for the establishment of a State Board of Health. To bolster his case, he used evidence from the success of other state boards of health and of the city’s board. He made his case in a series of publications, notably The Care of Health and Life in the State of New York and A State Board of Health. A Communication to a Member of the Legislature …, both published in 1880. [5]In the latter work he noted, “Already the agitation necessary and incident to the effort to secure the passage of this Bill has produced the most gratifying results in awakening thoughtful minds all over the State to the value of preventive medicine. Not only medical men, but laymen in every pursuit of business, have expressed their surprise at their previous apathy, and their determination now to press these questions upon the attention of the Legislature until adequate legislation is obtained.” The New York State Legislature created the State Board of Health that same year; in 1901 the board was reorganized as the State Department of Health.

In between, Smith’s ambitions reached the national scene. In 1872, he was one of the founders of the country’s premier professional public health organization, the American Public Health Association. He served as its first president up to 1875. [6]

From the book presented to Smith at a dinner in his honor, February 18, 1911. MS [Stephen Smith], a token of profound esteem and high regard from his many friends. [New York], Tiffany Co., 1911.

In later life, Smith was widely honored for his work in American public health. [7] He took time to reflect on the changes that his efforts achieved. His best-known book, The City That Was (1911), tells the story of the deplorable public health conditions that existed in New York City at the beginning of the 19th century and the measures he recommended to remedy those conditions, including regular sanitary inspections. [8]

Smith’s intertwined initials, from the book presented to him at a dinner in his honor, February 18, 1911. MS [Stephen Smith], a token of profound esteem and high regard from his many friends. [New York], Tiffany Co., 1911.

Smith believed man’s natural lifespan to be one hundred years, based on his contention that most animals live for five times the number of years required for the complete formation of their bones. He died on August 27,1922, some six months short of his 100th birthday. [3]

_____

Notes

[1] Jay H. Glasser, PhD, Elizabeth Fee, PhD, and Theodore M. Brown, PhD. “Stephen Smith (1823–1922): Founder of the American Public Health Association,” American Journal of Public Health, 2011 November; 101 (11): 2058. https://ajph.aphapublications.org/doi/10.2105/AJPH.2009.188920, accessed November 2, 2020.

[2] During the Civil War, he wrote Hand-book of Surgical Operations, with many printings in New York in 1862 and 1863. Its preface announced:

“This Hand-Book of Surgical Operations has been prepared at the suggestion of several professional friends, who early entered the medical staff of the Volunteer Army.”

After the war, Smith produced another surgical work: Manual of the principles and practice of operative surgery, which went through numerous editions between 1879 and 1887.

[3] “Dr. Stephen Smith Dies in 100th Year.” The New York Times, August 27, 1922, p. 28.

[4] Citizens’ Association of New York, Council of Hygiene and Public Health, Report of the Council of Hygiene and Public Health of the Citizens’ Association of New York Upon the Sanitary Conditions of the City (New York, NY: Appleton, 1865).

[5] Stephen Smith, The Care of Health and Life in the State of New York (New York, 1880)and idem, A State Board of Health. A Communication to a Member of the Legislature on Sanitary Organization and Administration in the State of New York (New York, 1880).

[6] “APHA Past Presidents.” https://www.apha.org/about-apha/executive-board-and-staff/apha-executive-board/apha-past-presidents, accessed November 2, 2020.

[7] Two examples:

On February 18, 1911, a dinner in honor of Smith’s 88th birthday took place at the Hotel Plaza. The Library holds both the program for the dinner and the speeches:

  • Dinner in honor of Doctor Stephen Smith and in celebration of his eighty-eighth birthday on Saturday evening, the eighteenth of February, one thousand, nine hundred and eleven at the Hotel Plaza (New York: Tiffany & Co., 1911).
  • Addresses in recognition of his public services, on the occasion of his eighty-eighth birthday, Feb. 19, 1911 (s.l., 1911).

Ten years later, the American Public Health Association published A Half Century of Public Health Jubilee Historical Volume of the American Public Health Association in Commemoration of the Fiftieth Anniversary Celebration of its Foundation, New York City, November 14–18, 1921 (New York, 1921). The work began with Smith’s historical overview of public health. The commemorative medal has Smith’s portrait on the front, with this legend on the reverse:

To Commemorate the Semicentennial Meeting of the American Public Health Association 1872 – New York – 1922 Noteworthy because of the Participation of its Founder Dr. Stephen Smith Born Feb. 19, 1823.

[8] Stephen Smith. The City That Was (New York: Frank Allaben, 1911).

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