Stephen Smith (February 19, 1823 – August 26, 1922) was a New York City surgeon and civic leader who made important contributions to medical education, nursing education, public health, housing improvement, mental health reform, charity oversight, and urban environmentalism. Smith maintained an active medical practice, was an attending physician at Bellevue Hospital for thirty-seven years, and authored three surgical texts, but he was best known for his public service. Three mayors, seven governors, and two U.S. presidents appointed Smith to almost fifty years of public responsibilities. Shortly before Smith's death in 1922, Columbia University President Nicholas Murray Butler awarded him the school's highest honor and pronounced Smith, “the most interesting figure in American medicine and in American public service today.” The New York Academy of Medicine initiated the annual Stephen Smith Medal for lifetime achievement in public health in 2005.
Family history, early life, and education Stephen Smith was raised in Spafford, New York, a central New York State farming village, but he was influenced by the social dynamism of the surrounding Burned-over District. His paternal grandfather, Job, was a Continental Army officer during the Revolutionary War. Job moved from Connecticut to New York after the war and settled on lot 74 of central New York's newly created Military Tract in 1806. His son, Lewis, (born in 1786 or 1787) served in the New York militia during the War of 1812. Lewis taught school in Skaneateles, marrying one of his students, Chloe Benson, in 1813. They built a log house next to Job, and Lewis served as a county supervisor, justice of the peace, and sheriff. He was also elected to the New York legislature for three terms. He and Chloe had five children who were born on the family farm near Spafford: Sidney in 1815, Mary in 1816, William in 1819, Stephen in 1823, and Job Lewis in 1827.
Lewis Smith died in 1829 when Stephen was six years old, most likely from typhoid fever and Chloe raised the family with the help of the Thorn Hill Baptist Church and the local common school. These conservative institutions reflected their New England roots; however, Smith was surrounded by the religious upheaval of the Second Great Awakening, the economic and transportation revolutions spawned by the nearby Erie Canal (1825), and the social energies of the abolitionist movement. Smith later recalled that many of his childhood friends left Spafford to become successful politicians, ministers, and teachers. Smith used the Spafford library to teach himself mathematics, geometry, surveying, some trigonometry, then Latin and Greek.
Smith saw Frederick Douglass on a visit to Thorn Hill and joined the anti-slavery Liberty Party in 1844, running for the office of Inspector of Elections. He received two votes, which settled him on politics and rural life: "I left the farm and town soon after and the popular cry, 'Back to the farm,' finds no favorable response on my part."
He took his first steps off the farm in 1845–1846, at age twenty-two, traveling twenty miles south to attend two winter terms at Cortland Academy (later Homer Academy) in Homer, New York. There he met Cortland's young physician lecturer on anatomy and physiology, Caleb Green.
Medical education and training Smith had a more thorough medical education than the typical apprenticeship and (sometimes) two four-month sessions at a medical college. The reason he usually gave for his career choice, as late as age ninety-five, was that he was too sickly as a youth to do the work of a farmer, making medicine the only option. An alternative explanation from a contemporary was that his elder brother Sidney encouraged him to pursue medicine.
Smith asked Caleb Green to tutor him in medicine in December, 1846, and he enrolled in the Medical Institute of Geneva College in the fall of 1847, where one of his fellow students was Elizabeth Blackwell, the first woman admitted to a regular (allopathic) medical college. Smith did not return to Geneva the following fall. He followed Geneva's charismatic surgery professor, Frank Hastings Hamilton to his office in Buffalo and the new (1846) Buffalo Medical College.
Smith spent the four-month winter term at Buffalo Medical College in 1848–1849, where Hamilton was Professor of Surgery and Austin Flint was Dean and Professor of Medicine. Both men were data-collectors and well-acquainted with the work of French physician Pierre Louis and his numerical method. Smith followed their examples in his surgical and civic work. During the summer cholera epidemic of 1849, Smith and Hamilton cared for patients at Buffalo's Sisters of Charity Hospital.
Smith went to Manhattan in the fall of 1849 for a third four-month academic session at The College of Physicians and Surgeons (now Columbia University Vagelos College of Physicians and Surgeons), listing Hamilton as his preceptor and receiving his diploma in 1850. Shortly afterward, he obtained a house officer position at Bellevue Hospital. During his time at Bellevue, Smith began his seventy-year literary career by publishing a review of seventy-eight cases of urinary bladder rupture.
Surgical and academic career Smith became a successful New York City surgeon and medical educator. He finished his Bellevue house officer duties in 1852 and was appointed attending surgeon at Bellevue Hospital in 1854, a position he held until 1891. The Boston Medical and Surgical Journal (now The New England Journal of Medicine) pronounced him one of New York's up and coming young physicians in 1858.
Smith did not enlist during the Civil War, but in 1862 he published his 279-page, pocket-sized Hand-book of Surgical Operations, which became the Union Army's surgical field manual and likely contributed to the now recognized improvements in Civil War medical outcomes. That same year, he traveled to the Virginia swamps during the Peninsula Campaign of 1862, where he was appalled by the military's dismal sanitation and the reckless surgery of many Northern volunteer surgeons. Smith also volunteered at the Union Army's Central Park Hospital, where he developed a lower extremity amputation procedure that became the surgical standard in the United States and England for the next fifty years.
Smith helped start Bellevue Medical College (now NYU Grossman School of Medicine), in 1861, receiving his first academic appointment as the school's professor of the principles of surgery. He served as the Medical College's professor of anatomy from 1863 to 1872 and developed a respected teaching approach that discouraged memorization and encouraged students to visualize the body as a machine they should construct from scratch.
According to Smith, but also Walsh, Smith was the first to use antisepsis and asepsis at Bellevue Hospital in 1875–1876. Harris argues that Smith was the one who taught Joseph Lister's antiseptic techniques to a young William Halsted, later one of the pioneers of modern American surgery.
Smith maintained a busy medical life into his eighties despite his civic obligations. He was professor of orthopedic surgery at the Medical Department of the University of the City of New York (also now NYU Grossman School of Medicine) from 1874 to 1882 and clinical professor of surgery there from 1874 to 1894. He was a consulting surgeon to St. Vincent's, Bellevue, and Columbus Hospitals until 1911. Medical historian and U.S. Army physician Fielding Garrison named Smith the “Nestor of American Surgeons” in 1917. Smith said in 1918, reflecting on his many other achievements, "My steadfast aim and purpose has been to succeed as a practiser [sic] and teacher of the science and art of surgery."
Support for women physicians Smith was a lifelong advocate for women physicians, often helping behind the scenes. Being raised by a woman may have made him more tolerant than other physicians, but Smith came of age in a time and place that was home to the American Woman's Rights movement, which was closely tied to the abolitionist movement he favored. When Elizabeth Blackwell arrived at his medical college in 1847, he quickly accepted her, and Blackwell added his reminiscences to her 1895 autobiography.
Blackwell's medical school success settled the question of women in medicine for Smith. He editorialized in February 1861 that, "public opinion, of course, sets strongly in favor of the medical education of females", and that Blackwell's example should force the American Medical Association to amend its code of ethics to, "recognize properly educated female physicians as practitioners in good and lawful standing."
Smith supported Blackwell's efforts to open a woman's medical college in Manhattan in 1868 by serving as one of its examiners. After Elizabeth left for England in 1869, he continued to serve as an examiner for her sister Emily for almost twenty years. He argued strongly for women physicians in his first Lunacy Commissioner report in 1882 and proudly announced that New York's Willard Asylum had added a female physician to its staff in 1885.
Support for women nurses Smith was also a supporter of women nurses, who, like women physicians, were often opposed by male doctors. He editorialized several times on behalf of women nurses during the Civil War, citing the women-led Sisters of Charity Hospital in Buffalo as one that, "has no equal in this country." He helped Louisa Lee Schuyler start the country's first nursing school at Bellevue Hospital in 1872 and was an examiner for the Bellevue School of Nursing. Smith assured Bellevue's nursing graduates in 1903 that the introduction of trained nurses was the greatest advance he had witnessed in medicine.
Hospital design Smith was a respected voice in mid-century hospital design. He encouraged sanitary principles and plain buildings based on the pavilion system during the Civil War, citing Florence Nightingale's hospital experience in Crimea. The United States Sanitary Commission asked Smith to inspect Union Army hospitals in the District of Columbia in 1862. The trustees of Roosevelt Hospital (now Mount Sinai West) sought his counsel on their hospital's construction in 1865. The Roosevelt trustees placed a copy of his recommendations in the new hospital's cornerstone in 1869.
The trustees of the Johns Hopkins Hospital asked Smith and four others to offer suggestions for their proposed hospital in 1875. The Boston Medical and Surgical Journal reviewed the final reports and found that Smith brought, "a ripeness of experience and a breadth of research which make his paper exceedingly instructive to the sanitary student." The Hopkins trustees ultimately chose John Shaw Billings to advise them, but Billings was not satisfied with his own work and incorporated ideas from Smith and the others in his final design.
Public health Smith became one of the seminal leaders of nineteenth-century American public health while still pursuing his medical career. He was a frequent critic of New York City's corrupt and inefficient sanitation efforts before the Civil War, but reformers brought him into the daily business of public health in 1864. Smith managed a landmark block-by-block sanitary survey of Manhattan for the Citizens’ Association, the results of which encouraged the New York legislature to remove health department responsibilities from New York City and create a four-county Metropolitan Board of Health in 1866.
Governor Reuben Fenton appointed Smith to the Metropolitan Board of Health in 1868, Smith's first public appointment. The legislature returned local health department control to New York City in 1870, and Mayor Oakey Hall appointed Smith a City Health Board sanitary commissioner. Smith remained a New York City health commissioner until 1875.