PEDIATRICS IN THE PAST

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HISTORY

OF

THE

NEW

YORK

FOUNDLING

HOSPITAL

Alfred J. Vignec, M.D.

Medical Director, Pediatrician-in-Chief, New York Foundling Hospital

PEDIATRICS

IN

THE

PAST

T

HE NEW Yomc Foundling Hospital, now

located in a new, modern building

(

Fig. 1) has been in continuous operation

for over 90 years. The New York Foundling

Asylum, as it was originally known, opened

its doors on October 11, 1869; it was the first

institution in the United States devoted

ex-clusively to the care of abandoned,

neg-lected or dependent infants, regardless of

race or creed. It preceded, by only 2 years,

Chicago’s Foundling Home, which was

or-ganized in 1871 by Dr. George Elias

Ship-man, a well-known New York physician

who had migrated to Chicago.

The New York Foundling Asylum was

founded by tile Roman Catholic Order of

the Sisters of Charity of St. Vincent de Paul;

it had, as its primary objective, the

reduc-tion of the appalling rate of infanticide in

New York City, most of these deaths being

attributable to exposure. In the first year of

operation, 61% of tile infants admitted were

in extremis. While it may be an

exaggera-tion to say that the streets of New York were

covered witll dead and dying infants, it

cer-tainly would not be an exaggeration to say

that it was commonplace. Indeed as late as

1892, according to Thomas Knox,1 200

foundlings and 100 dead infants were found

in New York City streets.

The first residence of the New York

Foundling Asylum was a modest, 4-story

brownstone building at 17 East 12th Street

(Fig. 2). This building was situated on the

north side of the street between Fifth Avenue

and University Place-a site now occupied

by the Aristocrat Garage. The adjoining

building, No. 15, partially visible in the

photograph, is still standing and in use.

It was not long before the quarters at

12th Street proved totally inadequate, and

in 1870 the Foundling Asylum was moved to

ADDRESS: 1175 Third Avenue, New York 21, New York.

139

a more commodious building at 3

Washing-ton Square North (Fig. 3). This building,

looking over Washington Square Park, is at

present a well-preserved private residence.

In less than a year the new quarters proved

inadequate, and in 1872 plans were drawn

for the construction of a group of buildings

on the block bounded on the north and

south by 68th and 69th Streets and on the

east and west by Third and Lexington

Aye-nues (Fig. 4). This move “so distant from

the center of the City” was looked upon by

many with great misgivings, but the

Found-ling was to be housed here for the next 85

years. Geography was not the only problem

faced by the venturesome sisters at that

time, however, for the Panic of 1873 was in

the making and money was extremely

diffi-cult to raise; the treasurer’s report on

Janu-ary 1, 1872, revealed a balance of 52 cents.

Financial stringency was to prove to be a

chronic condition, and the work was

sup-ported over the years by a sort of economic

legerdemain that was a masterpiece of

defi-cit financing. Nonetheless by 1873 the main

center buildings and the two connecting

wings were ready for occupancy. These

were followed in 1880 by St. Ann’s

Mater-nity Hospital and in 1882 by the Children’s

Hospital (Fig. 4). These same buildings,

with interior alterations to meet the

chang-ing times, and three additional structures,

the Chapel, St. Irene’s and the Hillyer

Audi-torium remained in use until 1958 (Fig. 5).

The increase in physical facilities was more

than welcomed, although the Foundling

Hospital was destined never to find itself

with adequate room to meet the need.

In 90 years of its existence, the Foundling

has sheltered 107,286 infants. For many

years the most important problem faced by

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lIC. 1. Tl Nc’ ‘turk 1()IIIl(lliI1g Ilospital.

FIG. 2. The New York Foundling Asylum, 17 East 12th Street, 1869-1870.

one of infant survival, for exposure to the

elements was only one of the many hazards that faced the homeless infants. Acute

in-testinal disorders as well as the contagious diseases reaped a heavy toll (Table I).

AITlOIlg the latter, diphtheria, pertussis and

syphilis played a leading role, and, despite the efforts of the “vaccination physician”

supplied by the Board of Health, smallpox

was not unknown. Acute ocular conditions

added greatly to the morbidity (Table II)

and were a source of much concern.

Medi-cal problems were by no means alleviated

by the overcrowding because of the heavy

demands made on the institution. This was

relieved in some measure by placing infants

at nurse outside of tile institution-the

beginning of foster-home placements. The

nursing homes supplied the advantages of

personal care and a home environment.

Tilen, as now, foster homes absorbed tile

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.--- ii I

MATERNITY HOSPITAL. WEST WING. ADMINISTRATIVE BUILDING. FANi VIIG. CHILDREN’S HOSPITAL.

-1880---- 1 1873 1

-1882-PEDIATRICS IN THE PAST 141

FIG. 4. The New York Foundling Hospital.

Fic. 3. The New York Foundling Asylum, 3

\Vashington Square North, 1870-1873.

time, some 2,000 infants and children are in

foster homes supervised by the New York

Foundling.

Social work was unheard of in those

early years, and the supervision of the in-fants at nurse was undertaken by the men of the Society of St. Vincent de Paul, a lay

Catholic organization dedicated to the care

of the sick poor. In addition to these

chant-able gentlemen, “a detective, kindly lent us by the Board of Police,” rounded out the Social Service Department. At the present

time 117 social workers are engaged in the

supervision and placement of infants and

children in foster homes. A further problem

also beset the sisters in their work, that of the homeless mothers who appeared at the

doors of tile institution with their infants.

This facet of the work continued, and the

Shelter now has facilities for 36 mothers,

annually providing services for about 355.

In the early years, instead of being

adopted, children were indentured. The

sisters and the foundlings, heeding the

ad-vice of Horace Greeley, “went west.” In

bands of 50, accompanied by two sisters, the

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Da-FIG. 5. The New lork Foundling Hospital, 175 East 68th Street, 1873-1958.

kotas, Minnesota, Wisconsin and the

Mid-west. This was a daring enterprise; there

were only 37 states in the Union; the

In-dians were still a threat; indeed, Custer’s

last stand at the Battle of the Little Big

Horn was fought in 1876, and the Union

Pacific had been only a few years in

opera-tion (1869) with single track most of the way

beyond St. Louis. Contact and supervision

of these children was maintained by the

sisters on subsequent trips, by local priests

and by prominent citizens.

Adoption succeeded indenture, and the

Foundling Adoption Service, one of the

largest in the country, if not the largest, now

consummates approximately 300 adoptions

yearly. From this brief account it is apparent

that the work that started with the avowed

intention of providing shelter for unwanted

infants expanded in many directions,

pro-viding medical and well-baby care,

adop-tion and foster-home services and a shelter

for mothers. All of these services had as

their unifying goal the care of the

aban-doned, dependent and neglected infant.

Despite the development of these

ancil-lary services which were to make the

found-ling a multifunctioning organization .

nior-tality in the early years remained

distress-ingly high. Sixty-five and sometimes 70% of

the infants admitted yearly were in a poor

or dying condition. The niortalitv in the

in-stitution during 1874-1876 was 45%. This

tin-justly resulted in a long-held condemnation

of institutions for children. A fact seldom

stressed and indeed ignored was tilat tile

mortality of infants placed at nurse outside

the institution was 55%. This disparity in

mortality was to continue for some time, and

the chairman of the Medical Staff,

J.

B.

S A project that never came to fruition was the

suggestion made in the Annual Report of 1885 that

an Industrial Home be established for foundlings

who, “on account of personal deformity,

wayward-ness of disposition, etc. cannot be provided for on-der the system of indenture. For these, after they

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‘294 100 18 8 12 3 10 8 44 1 1 2 6 508 TABLE II

REPORT OF THE OPHTHALMIC AND AURAL SURGEONS

Eye Case8 Treated

Trachoma

Catarrhal conjunctivitis

Purulent ophthalmia

Ophthalmia neonatorurn Blepharitis marginalis

Abscess of eyelids

Hordeolum

Chalazion

Keratitis

Staphyloma of the cornea

Leucoma

Cataract

Strabismus

Dacryocystitis

Total

Operations on the Eye

Canthoplasty

Incision of hordeolum

Enucleation of chalazion

Incision for abscess of eyelid Paracentesis of the cornea Tattooing cornea

Abscission of cornea for staphyloma

Iridectomy

Strabismus

Total

S For same f-year period as in Table I.

Reynolds, M.D., seriously questioned the

advisability of sending the infants out to

nurse. Crowding in the institution, however,

was so great that this means of caring for

the overflow continued.

The development of hospital facilities,

beginning with St. Ann’s Maternity

Hos-pital in 1880, attracted some of the

fore-most physicians of the day. An interesting

fact brought to light in a perusal of old

medical reports was the cost of obstetric

care in the final quarter of the last century.

For private cases a “reception fee” of $50

was charged. This covered the doctors’ and

nurses’ fees-The Corporate Practice of

Medicine! The weekly rate for private

rooms was $6 to $15. The “reception fee”

for service cases was $25 and the weekly

rate was $3. Because of the increasing

de-mand for services to dependent infants, the

maternity hospital was discontinued in

1945.

Many outstanding pediatricians gave

their time and attention to the Children’s

Hospital facility of the institution. Space

permits only a partial list, with the years

served:

J.

Lewis Smith (served 1874-1897), with

Jacobi, was the first to practice pediatrics

as a specialty; he served on the staff

through-out his lifetime. He was Chairman of the

Founders’ Committee of the American

Pedi-atric Society and was the second president

of the Society.

J.

O’Dwyer (served 1874-1898) introduced

and perfected the technique of intubation

for diphtheritic laryngitis, by means of

which hundreds of lives were saved.

Austin Flint (served 1877-1886) was

8 widely known for his skill as a cardiologist.

2

J.

Henry Fruitnight (served 1879-1881)

50 was one of the founders of the American

Pediatric Society.

5 W. P. Northrop (sel’Ved 1881-1893) was

2 Professor of Pediatrics at Bellevue.

- Ronald

J.

Freeman (served 1893-1899)

succeeded Northrop at Bellevue.

L. Emmett Holt, Sr., Professor of

Dis-eases of Children at Columbia’s School of

Phyiscians and Surgeons, served as an

at-tending physician and subsequently as a

consultant. For many years he gave

bi-weekly clinics for medical students from

Columbia.

J

ohn lowland served on the staff in

van-ous capacities from 1899 to 1910, when he

left for Washington University in St. Louis

to become Professor of Pediatrics. Shortly

thereafter he became Professor of Pediatrics

at Johns Hopkins. He was successively a

resident, the bacteriologist and finally the

pathologist of the institution.

Philip Van Ingen, who was subsequently

to become a Professor of Pediatrics at

Phys-icians and Surgeons, served a residency at

the Foundling, as did Mathias Nicholl,

Pro-fessor of Infectious Diseases at Bellevue,

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PEDIATRICS IN THE PAST

Professor of Pediatrics at Johns Hopkins.

In the initial decades of the Foundling,

the emphasis was on treatment and literally

lifesaving nursing care. Currently, the

em-phasis is on preventive medicine,

refine-ments in infant nutrition and more concern

for the effects of emotional deprivation of

our charges-hence, our interest in better

immunization techniques, superior milk

preparations and the establishment of

de-145

velopmental and child-guidance clinics.

This is not to say that we are neglecting

methods of treatment and the quality of

nursing but rather that we .have expanded

the scope of our interests and aims.

REFERENCE

1. Campbell, H., Know, T. W., and Byrnes, T.:

Darkness and Daylight; or Lights and

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1961;28;139

Pediatrics

Alfred J. Vignec

HOSPITAL