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]

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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).

“The Pest at the Gate”: Typhoid, Sanitation, and Fear in NYC

By Lisa O’Sullivan, Director, Center for the History of Medicine and Public Health

The relationship between medicine and public health could be a complex one at the turn of the last century. In particular, the question of how to deal with infectious disease epidemics demanded that medical professionals and city officials grapple with sanitation and cleanliness, city infrastructure, water supplies, and garbage and sewage. Epidemics also raised questions of individual autonomy and the proper role of government. In response to these issues, Boards of Health emerged in many American cities in the second half of the 19th century. The New York Metropolitan Board of Health was the first, founded in 1866 after a campaign by Dr. Stephen Smith and The New York Academy of Medicine.

Poultney Bigelow, The Pest at Our Gates, ([New York] : Merchants’ Association of New York, [1908])

Bigelow Poultney, The Pest at Our Gates, (New York: Merchants’ Association of New York, 1908)

Relations were often fraught between the different groups responsible for the city’s health. Many physicians resented the interference of city-nominated health officials (many of whom they considered corrupt and/or incompetent) into the medical domain; health officials blamed doctors for failing to report cases of infectious diseases; and families regarded hospitals with suspicion and did their best to keep their ill relatives out of them.

The diseases most feared by New Yorkers included cholera, typhus, and typhoid fever. Between 1898 and 1907, at least 635 New Yorkers died from typhoid, with cases of the disease in the thousands.1 Typhoid spreads through water supplies contaminated with infected fecal matter. It can be transmitted via contaminated food or water, and more rarely, through direct contact with someone infected with the disease. As such, sources of the illness in late 19th-century New York were many and largely invisible, as the investigative journalist and author Poultney Bigelow described in 1908 in “The Pest at Our Gates”: typhoid sources ranged from the “placid, perilous Potomac” to “the deadly house fly,” “the fish and oyster menace” and the “perils that lurk in ice.”2 Fear of typhoid pushed public health initiatives and legislation to ensure safe water and food, adequate plumbing, and proper sewage control.

The specters of cholera, yellow fever, and smallpox recoil in fear as their way through the Port of New York is blocked by a barrier on which is written "quarantine" and by an angel holding a sword and shield on which is written "cleanliness." Courtesy of the National Library of Medicine.

Cholera, yellow fever, and smallpox recoil in fear as a quarantine barrier and an angel holding bearing a shield of cleanliness blocks their way through the Port of New York. Image courtesy of the National Library of Medicine.

Fear of infectious disease often overlapped with fears about the changing face of the city and nation. As Alan M. Kraut explores in Silent Travelers: Germs, Genes and the Immigrant Menace, the relationship between immigration and public health in the United States has historically been informed by nativist debates about the identity of the nation and its ethnic makeup, fears about the potential limitations of scientific medicine, and the public health impact of immigration.3 As the gateway to America for hundreds of thousands of new immigrants, New York City became a focus for questions of quarantine and infectious disease. Epidemics, particularly of cholera, prompted many public health reforms in the city, especially increased scrutiny of immigrant arrivals at quarantine stations, including Ellis Island, where officials assessed arriving immigrants for their physical and mental health between 1892 and 1924.

In the case of typhoid, the specter of the foreigner as the reservoir of disease came to be personified by the Irish-born Mary Mallon, so-called “Typhoid Mary.” Mallon was a cook whose employment history in the kitchens of wealthy New Yorkers matched a spate of typhoid outbreaks in those same households in 1906. Mallon was a healthy carrier of typhoid, and was put under enforced quarantine by the Board of Health, which she vigorously resisted. On her release in 1909 she took multiple aliases and continued to work as a cook until 1915, when she was again detained and kept in isolation until her death in 1932. To some, Mallon was “the most dangerous woman in America”; to others, she was a symbol of the undermining of individual liberties by the government.4

In the case of typhoid fever, a combination of new vaccine technology and improved sanitation measures (particularly water chlorination) saw cases in the United States drop dramatically in the early 20th century. However, as is the case for many preventable infectious diseases, typhoid remains a problem in parts of the world with less developed public health infrastructure. On a global scale, medical and governmental responses to public health issues continue to exist in an uneasy tension with broader political and social concerns.

References

1. John Duffy,  A history of public health in New York City (New York: Russell Sage Foundation, 1968), p566

2. Poultney Bigelow, The Pest at Our Gates, (New York: Merchants’ Association of New York, 1908)

3. Alan M. Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (New York: Basic Books, 1994), pp 1-9

4. Judith Walzer Leavitt, Typhoid Mary: captive to the public’s health (Boston: Beacon Press, 1996); Alan M. Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (Baltimore: Johns Hopkins University Press, 1995), 97-104.